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 Anesthetic
The patient remains totally conscious and aware throughout the procedure. A local anesthetic (such as lidocaine) is administered (as in injection) in the area where the surgery is to be performed. This area or region becomes completely “numb” or anesthetized. This is the same as having an injection by your dentist for a filling, crown, or root canal. Local anesthetic is used in conjunction with the other methods of anesthesia in all oral surgery procedures.
Local anesthesia can be used a wide variety of oral surgery procedures, as this provides complete “numbness” or anesthesia for the site or region.
Method Nitrous Oxide Sedation with Local Anesthetic
A mixture of nitrous oxide (laughing gas) and oxygen is administered through a nasal breathing apparatus. The patient remains conscious and in a relaxed condition. Nitrous oxide has a sedative, calming, and analgesic (pain-controlling) effect. Local anesthesia (injection) is given after the nitrous oxide has become effective.
A patient may choose this for simple oral surgery procedures to more involved procedures such as removal of wisdom teeth and placement of dental implants, depending on their level of anxiety.
Method Office Based IV Anesthesia with Local Anesthetia
Medications are administered through an intravenous line (IV). 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. The patient’s vital signs as well as oxygen and carbon dioxide “levels” are closely monitored. Local anesthesia (injection) is also administered after the patient “falls asleep”. The sites receiving the oral surgery will be “numb” or anesthetized when the patient “wakes up”.Usual Indications
A patient may choose IV anesthesia for simple or complicated procedures depending on their level of anxiety and medical status. This is an option for all types of oral surgery.
Method Hospital or Surgery Center Based General Anesthesia
A patient is admitted to a hospital or surgery center for their procedure and administration of anesthesia.Usual Indications
Indicated for patients undergoing extensive procedures or for patients with complicated medical conditions such as heart disease or lung disease who require IV anesthesia.
To administer IV anesthesia in the office, an oral surgeon must have completed a well-defined and structured hospital based anesthesia training regimen during their residency program. Qualified applicants will then undergo an in office evaluation by a state dental board appointed examiner. The examiner observes an actual surgical procedure during which IV anesthesia is administered to the patient. The examiner also inspects all monitoring devices and emergency equipment and tests the doctor and the surgical staff on anesthesia related emergencies. If the examiner reports successful completion of the evaluation process, the state dental board will issue the doctor an anesthesia license. The license is renewable every two years if the doctor maintains the required amount of continuing education units related to anesthesia.
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 your doctor at the time of your consultation.
How is the IV anesthesia administered?
IV or “intravenous” anesthesia is administered using an over-the-needle catheter, also known as a peripheral catheter. The catheter consists of a needle within a plastic sleeve (cannula), and these can be separated. The catheter is introduced into the vein by the needle (similar to blood drawing). Then the needle is subsequently removed while the small plastic cannula remains in place within the vein. The cannula has a hub attached which is used to connect to the IV fluid line. The medications for the IV anesthesia will be administered and controlled through this line. The cannula is then fixed to the patient’s skin by using an adhesive dressing.
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 dentistry for many years. Nitrous oxide is safe; the patient 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. The patient may experience mild amnesia and may fall asleep not remembering all of what happened during their appointment.
There are many advantages to using Nitrous Oxide
- The depth of sedation can be altered at any time to increase or decrease sedation.
- There is no after effect such as a “hangover”.
- Inhalation sedation is safe with no side effects on your heart and lungs, etc.
- Inhalation sedation is very effective in minimizing gagging.
- It works rapidly as it reaches the brain within 20 seconds. In as few as 2-3 minutes its relaxation and pain killing properties develop.
Reasons to Not use Nitrous Oxide
Though there are no major contraindications to using nitrous oxide, you may not want to use it if you have emphysema, exotic chest problems, M.S., a cold or other difficulties with breathing, or have had certain types of inner ear surgery.