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Anesthesia options for Louisiana Oral & Implant Surgery patients:
As your oral surgeon, I understand that you may be nervous about having a surgical procedure (no matter how big or small). There is nothing wrong with being nervous, and I want you to know that I will do everything possible to build your trust and decrease any potential anxiety. I believe a clear understanding of your anesthetic options is an important way for to help you feel better as a patient.
There are 3 different anesthetic options for your procedure at Louisiana OIS. A thorough discussion will be held during your consultation appointment regarding the best choice for you. Each option involves the administration of local anesthesia. Below is a brief description of each option.
Option 1: Local anesthesia only:
Local anesthesia is what you may typically think of when going to the dentist. Local anesthesia involves giving a local anesthetic (usually lidocaine) to the area through an injection in the gums. The discomfort of an injection is commonly decreased by using a topical anesthetic first. Given properly, a local anesthetic injection causes minimal pain and is appropriate for many oral surgical procedures. Local anesthesia given properly will eliminate 100% of a patient’s pain during a procedure (i.e. will make a procedure painless). Unfortunately, it will not eliminate the feeling of pressure or vibration during the procedure.
Option 2: Local anesthesia + Nitrous oxide:
Nitrous oxide (commonly known as “laughing gas”) is a very effective supplement to local anesthesia for decreasing patient discomfort. Nitrous oxide is a gas that is given through your nose with a mask. While it will not put you to sleep, it will help you to relax and decrease any pain you may experience during injections. We begin administration of nitrous oxide before local anesthetic injections to decrease injection discomfort.
Option 3: Local anesthesia + IV sedation:
Intravenous sedation is a very effective and safe method which allows many patients to sleep through their entire procedure. This process involves starting an IV with a tiny needle in a small arm vein just under the skin. Next, medications are given through the IV to put the patient to sleep. Only after the medications have taken effect are injections given, and the patient is usually completely unaware of the injections or the procedure that follows. The patient is usually awake enough to walk within 5-10 minutes after the procedure. The advantages of IV sedation are many and include the ability to easily and safely adjust the level of sedation to suit each patient. It also allows us to give additional pain and anti-inflammatory medications to decrease postoperative soreness and swelling. In most cases of IV sedation, the patient remembers little to nothing of his or her surgery.
Deep/conscious sedation FAQs:
What are the important pre-procedure instructions if I am being sedated for my procedure?
The most important thing to remember if you are being sedated is to not eat or drink any food or drink (including water) whatsoever for at least 8 hours before being sedated for your procedure. For your safety, you may not have anything by mouth (including water) prior to your procedure.
Note: In most instances, it’s OK to take your regular medications the day of your procedure with 1 or 2 small sips of water only. This will be discussed at your consultation visit.
Other important things to remember:
You must have a driver with you at your appointment and they must wait in our waiting room throughout your procedure (i.e. they may not leave the premises)
Wear loose-fitting short-sleeved clothing
Remove nail polish from both index fingers prior to surgery
Notify our office if you catch a cold (upper respiratory infection) within 2 weeks of your procedure. This may require rescheduling since it is not safe to be sedated with a current or recent respiratory infection.
Is every patient a candidate for deep/conscious sedation?
Almost all patients are candidates for the administration of IV sedatives during their procedure. There is variation in the level of sedation achievable ranging from conscious sedation (sedated but awake) to deep sedation (essentially totally asleep). Many patients are candidates for deep sedation.
I want patients to know that my first priority at Louisiana OIS is patient safety. My #1 goal for your procedure is for you to undergo your procedure safely, comfortably and without complications. The level of sedation appropriate for you will be discussed extensively at your consultation visit and is dependent on numerous factors such as age and overall health status. Most patients are candidates for deep sedation, but it is important to understand that some patients are not ideal candidates for safety reasons. The safety of the patient always comes first in my practice philosophy.
Will I be totally asleep?
The answer to this question is closely related to the above question. Most patients will sleep throughout their procedure but as discussed above, your safety comes first and will never be compromised. The ultimate goals of IV sedation are patient comfort and patient safety.
What if I wake up during my procedure?
I would like to put your mind at ease about the possibility of waking up during the procedure. It is okay if you wake up during the procedure. In most instances, more medications can be given in to deepen the sedation. I want to emphasize that the goal of IV sedation is to maximize your comfort during your procedure. Many patients will remain asleep throughout their procedure, but this is generally not a requirement for the patient to feel completely comfortable throughout the procedure.
Will I remember my procedure?
Most patients will not remember their procedure, however some will depending on the level of sedation and this is no cause for concern.
How long will I sleep after my procedure is over?
Most patients who undergo sedation are awake within 5-10 minutes after their procedure. Many are even able to walk with assistance after waking. One advantage to modern anesthetic IV medications is their ability to have a fast onset and quick recovery.
Why can’t I eat or drink anything prior to my procedure?
The short answer is that it is extremely dangerous for a patient to be sedated with any food or drink in their stomach. It can take the stomach up to 8 hours to empty after a meal, so it is imperative to refrain from eating and drinking for at least 8 hours prior to the procedure. Having an empty stomach is an important safety measure used to prevent possible vomiting while you are asleep which could result in severe lung damage.
Should I take my regular daily medications prior to my procedure?
In most instances it is preferable and even safer for you you to remain on all of your normal medications even on the morning of surgery. Exceptions will be discussed at your consultation visit. However, it is generally OK to to take your medications the morning of surgery with 1-2 small sips of water.
Do you use monitoring equipment during sedation?
Yes. The most advanced and up-to-date monitoring equipment is used throughout your sedation to ensure your safety. This is the same type of equipment used to monitor patients in hospital operating rooms. Parameters measured include: electrocardiogram, oxygen saturation, end-tidal CO2, respiratory rate, heart rate, blood pressure.
What type of anesthesia training do you have as an oral and maxillofacial surgeon?
Anesthesiology training is critical to the field of oral and maxillofacial surgery. Throughout training I spent significant time with the University of Florida department of anesthesiology as an acting anesthesiology resident providing adult and pediatric general anesthesia for the hospital operating rooms at the same standard of care as an anesthesiologist. This training was continued in the department of oral and maxillofacial surgery where an additional several hundred deep sedation/general anesthesia cases were performed prior to graduation. Upon completing training, oral and maxillofacial surgeons are certified general anesthesia providers and are held to the same standard of care as an anesthesiologist.
How safe is the anesthesia and are there risks?
Well-administered and well-planned anesthesia is incredibly safe. However, just as with anything in life there are risks (although extremely small). These risks will be reviewed at your consultation appointment. In brief, one of the more common complications (though still rare) is postoperative nausea or vomiting. Some of the medications used for sedation may occasionally cause nausea or vomiting; however, we also use medications to help prevent this and it is usually short-lived should it occur. The risk of a life-threatening problem during sedation is extremely small. The chances of such an adverse event during an IV sedation are even much lower than the risk we all take every day by simply getting into a car and driving.
What if there is an emergency during sedation?
Serious emergencies are extremely rare when anesthesia is administered correctly and according to each individual patient. Despite their rarity, extensive equipment and training has been invested in treating these emergencies should they occur. As a general anesthesia provider, I am trained, equipped, and have experience in treating anesthetic emergencies. All emergency medications and equipment is on-site at Louisiana OIS.
Are you trained in advanced life support?
Yes. I am certified in advanced cardiac life support (ACLS) and pediatric advanced life support (PALS). Re-certification is every 2 years.
How long after my sedation should I be accompanied by another person and when can I drive?
You should not stay by yourself until at least 24 hours after your sedation. Similarly, you should not drive or operate machinery for at least 24 hours after your sedation.
What can I expect after my sedation?
Many of today’s modern anesthetic medications have the advantage of wearing off quickly which provides patients the advantage of being awake shortly after their procedure is finished. Most patients will be awake enough to walk to their vehicles with assistance after sedation. Despite this, some of the effects of the medications can linger. Though this varies from patient to patient, you can expect to be tired, sleepy and possibly forgetful on the day of surgery. It is normal not to remember the time immediately following your procedure. Rarely, patients may get light-headed or nauseated after waking up (especially when walking).
Do people commonly react in ways similar to popular online videos after their sedation?
Usually not. The vast majority of people will not have this type of reaction. This uncommon reaction is known as emergence delirium and may manifest as confusion or certain emotional states. In my experience, this occurs in fewer than 5% of patients after sedation. When it does occur it usually wears off within an hour or so.