What You Need to Know About Office Based Anesthesia for an Oral Surgery Procedure
Whether the procedure is removal of wisdom teeth, bone grafting, or placement of dental implants, one thing many people say is that they don’t want to be awake for the procedure. We hear this from patients daily, and we understand! The next most common concern that patients express to us is their fear of “being sedated”, and we understand that as well!
Much of the fear and anxiety associated with being sedated is a result of unanswered questions and unknowns. We make a point of spending as much time with our patients as needed during our consultation appointments to attempt to answer all those questions. We understand that consultation appointments often provide patients with an overwhelming amount of information. So we hope that this will provide some insight into being sedated for an oral surgery procedure, and in doing so, help to alleviate some anxiety.
Other than “not being aware of the procedure”, what benefit exists from sedation/anesthesia?
The benefits of office-based anesthesia are numerous for both oral surgeons and patients alike.
As mentioned above, the elimination of patient anxiety with oral surgery procedures is the most significant benefit. But there are other, less obvious benefits.
Keeps you motionless during surgery
In many instances surgical procedures require delicate instrumentation and manipulation of bone and tissue and sudden movement (usually unintentional) can negatively impact the outcome. Adequate sedation/anesthesia will allow a patient to remain very still during surgery.
Makes procedure seem like it lasts for 2 seconds
Some surgical procedures can be lengthy, and it is difficult for anyone to remain calm and still for a prolonged period. This is not an issue when a patient is under sedation/anesthesia.
Even when you are numb, you still feel pressure
Local anesthesia (numbing medicine) does not eliminate noises, feelings of pressure, or vibration during a procedure, and this is not an issue with sedation/anesthesia.
Plan ahead for post-surgery
Someone must bring you, stay in the office, take you home, and stay with you a while afterwards
Oral surgery procedures may be “outpatient” in nature, but that doesn’t mean you can go about your day like normal afterwards. Once the initial sedation has worn off, you’re still going to be impaired for some time as you recover. The amount of time varies with each individual, but generally people are impaired for 4 – 8 hours after getting home. The person that brings you to the appointment needs to plan on caring for you at home for at least 4-6 hours. You’ll likely be aware of your surroundings, but still somewhat disoriented from the anesthesia – having a caregiver for the day is generally a smart idea!|
Anesthesia affects everyone differently
Just because your cousin threw up after anesthesia, doesn’t mean that you will too
Anesthesia has wide ranging effects on different people.
Most patients emerge from sedation and feel a little groggy for several hours.
On occasion, patients may emerge from sedation feeling disoriented, possibly nauseous, fatigued or confused. It is usually impossible to know how you will feel when emerging. Fortunately, the side effects of anesthesia are well known and precautions are taken to prevent the most common ones.
Just because it took your sister 6 hours to be able to dance, doesn’t mean it will take you that long
Recovery periods differ for each patient, and how you feel in the 24 hours after your surgery will depend on how your body metabolizes the anesthetic drugs.
Medications, medical conditions, age, sex, etc. can affect the length of recovery from anesthesia.
The best predictor of how you will respond is a previous experience with anesthesia; if this is your first time with office-based anesthesia, then you should understand that your recovery length may be unpredictable.
You’re constantly and thoroughly monitored while sedated
Many people have a conscious anxiety or fear of anesthesia: usually associated with the “loss of control”. Know that while you are sedated, your heart electrical activity (EKG), heart rate, blood oxygen saturation (pulse oximetry), blood pressure, respiratory rate, and end-expiratory carbon dioxide level are being constantly monitored by our team.
For the science nerds like us: the carbon dioxide levels measured at the end of an exhaled breath (called ETCO2 or End Tidal CO2) provides critical information that can tell us if your breaths are too deep or shallow (tidal volume) or too rapid or slow (tachypnea or bradypnea).
We use state of the art monitoring equipment and are very strict about performing frequent monitor checks and calibrations.
Our assistants of are DAANCE (Dental Anesthesia Assistant National Certifying Exam) certified.
Dr Stewart and Dr Michael are BLS, ACLS, and PALS certified. In fact, Dr Michael is a BLS instructor!
What happens if there’s a complication with the sedation?
The key is keeping calm
The great thing about office-based sedation/anesthesia is that complications are very rare when appropriate training is in place and precautions are taken (as is the case in our office).
Nevertheless, some things are beyond our control and the best policy is to make sure that we are prepared to handle any possible situation that may arise.
We maintain state of the art emergency equipment and emergency medications on hand.
We-as a team-undergo frequent training drills where we practice our roles in various emergency scenarios. While we always hope that urgency or emergency scenarios do not arise, we are proud of the fact that we place so much emphasis on being well-prepared in case such a situation occurs.
What kind of training is involved to be able to perform office-based general anesthesia?
Oral and Maxillofacial Surgeons are unique
If you’re receiving office-based sedation/general anesthesia for an oral surgery procedure by an Oral and Maxillofacial Surgeon, know that it’s being delivered by a highly qualified individual.
In the U.S., Oral and Maxillofacial Surgeons are required to undergo intensive general anesthesia training in a hospital-based residency training program working alongside Anesthesiology residents and being trained by Anesthesiologists. Oral surgeons can provide IV general anesthesia (this is different than a simple IV sedation or conscious sedation) that can assure your adequate level of anxiolysis and comfort. A simple IV sedation (which requires significantly less training and expertise) is usually not optimal for patients undergoing most oral surgical procedures.
In order to be allowed to perform IV general anesthesia, Oral and Maxillofacial Surgeons in Texas must undergo a rigorous anesthesia evaluation of their office (including office layout, equipment, medications, and surgeon knowledge) by a peer from the Texas Society of Oral and Maxillofacial Surgeons.
Make sure your Oral Surgeon is Board Certified
Board Certification (American Board of Oral and Maxillofacial Surgery) is important to consider when evaluating the training of the individual administering your anesthesia. Oral and Maxillofacial Surgeons undergo a very rigorous written and oral exam to become Board Certified, and anesthesiology is a large part of that exam. You can be assured that a Board Certified Oral and Maxillofacial Surgeon has proven adequate training and knowledge in anesthesiology.
Don’t be afraid to ask questions!
The more you know….
If you’ve scheduled an oral surgery procedure and are feeling uneasy about it, never be afraid to speak with the oral surgeon or staff. Asking questions about the procedure, including the anesthesia, is all part of the process and could provide you the comfort and peace of mind you need. Coordinating with a friend or family member to care for you, having trust in your oral surgeon, and understanding the nature of office-based anesthesia are all important.
If you have any questions about anesthesia, we encourage you to contact our experienced oral surgery team at the Texas Oral Surgery Group.