Several methods of anesthesia are available. The method of anesthesia that is chosen for or by a patient depends upon the nature of the surgical procedure and the patient’s level of apprehension.
The following table illustrates the choices of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.
MethodTypes of AnesthesiaDescription of TechniqueUsual Indications
Method Local AnestheticDescription of Technique The patient remains totally conscious throughout the procedure. A local anesthetic (e.g. lidocaine) is administered in the area where the surgery is to be performed. Local anesthetic is used in conjunction with all of the other methods of anesthesia in all oral surgery procedures as well.Usual Indications Simple oral surgery procedures such as minor soft tissue procedures and simple tooth extractions.
Method Nitrous Oxide Sedation with Local AnestheticDescription of Technique A mixture of nitrous oxide (laughing gas) and oxygen is administered through a nasal breathing apparatus. The patient remains conscious in a relaxed condition. Nitrous oxide has a mild sedative and analgesic (pain- controlling) effect.Usual Indications Simple oral surgery procedures to more involved procedures such as removal of wisdom teeth and placement of dental implants.
Method Office Based General Anesthesia with Local Anesthetic*Description of Technique Medications are administered through an intravenous line (I.V.). The patient falls asleep and is completely unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Diprivan. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely and continuously monitored. Longer or more complex procedures in addition to patients that cannot tolerate an I.V. may require the use of a medical anesthesiologist (which we offer as an option in our office) to provide an inhalational general anesthetic.Usual Indications General anesthesia is available for all types of oral surgery. A patient may choose general anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or having a dental implant placed will choose I.V. general anesthesia. General anesthesia may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.
Method Hospital or Surgery Center Based General AnesthesiaDescription of Technique A patient is admitted to a hospital or surgery center where anesthesia is administered by an anesthesiologist.Usual Indications Indicated for patients undergoing extensive procedures such as face and jaw reconstruction and TMJ surgery. Also indicated for patients with medical conditions such as heart disease or lung disease who require general anesthesia.
To administer general anesthesia in the office, an oral surgeon must have completed six months of hospital based anesthesia training. Qualified applicants will then undergo an in office evaluation by a state dental board appointed examiners. The examiners observes an actual surgical procedure during which general anesthesia is administered to the patient. The examiners also inspects all monitoring devices and emergency equipment and tests the doctor and the surgical staff on anesthesia related emergencies. If the examiners reports successful completion of the evaluation process, the state dental board will issue the doctor a license to perform general anesthesia and this on-site examination is repeated every 5 years. The license is renewable every two years if the doctor maintains the required amount of continuing education units related to anesthesia including maintaining Advanced Cardiac Life Support certification.
Again, when it comes to anesthesia, our first priority is the patient’s comfort and safety. If you have any concerns regarding the type of anesthesia that will be administered during your oral surgery procedure, please do not hesitate to discuss your concerns with Drs. Yamada and Zeidan at the time of your consultation.
Intravenous Sedation/general anesthesia (“Twilight anesthesia”)
Our office offers our patients the option of Intravenous (I.V.) Sedation or Intravenous (I.V.) General Anesthesia. Both I.V. Sedation and I.V. General Anesthesia help you to be comfortable and calm when undergoing a surgical procedure and are designed to better enable you to experience your oral surgical procedure in a state that makes you either very relaxed or asleep; it will enable you to tolerate as well as not remember (general anesthesia) those procedures that may be very uncomfortable for you and help alleviate the anxiety associated with your treatment.
If you choose the option of I.V. sedation or I.V. general anesthesia, it will be administered and monitored by Drs. Yamada and Zeidan and the surgical team therefore eliminating the costly expense of having your treatment carried out in an operating room or same day surgical facility.
Should you choose to have one of our board certified medical anesthesiologists perform your general anesthesia, you have the option to fall asleep without needing an I.V. (which is called a mask induction) and it will require the use of a breathing tube to administer the anesthetic gas (intubation). Using an anesthesiologist requires more coordination in scheduling, so more advanced notice will be necessary for this option.
How is the IV sedation/general anesthesia administered?
A thin needle or catheter will be introduced into a vein in your arm or hand. The needle or catheter will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable or go to sleep. Some patients with medical conditions and/or on specific drug regimens may only be lightly or moderately sedated.
The goal of either IV anesthesia is to use as little medication as possible to get the treatment completed. It is very safe, much safer than oral sedation. At any time a reversal agent can be administered to counteract the effects of the medications if necessary. For patient safety, every patient is continuously monitored with the same level of monitoring that is used in the hospital operating room. With IV sedation there are also other different “levels” of sedation available to you in our office.
Nitrous Oxide (Laughing Gas)
Nitrous Oxide is a sweet smelling, non irritating, colorless gas which you can breathe. Nitrous Oxide has been the primary means of sedation in general dentistry for many years. Nitrous oxide is safe; the patient typically receives 50-70% oxygen with no less than 30% nitrous oxide. Patients are able to breathe on their own and remain in control of all bodily functions. Patients do not fall asleep with nitrous oxide..