Patient safety in office-based surgery is of paramount importance to our practice. Foundations for safe, office-based anesthesia include obtaining an appropriate medical history, checking your vital signs, and performing an appropriate focused physical examination and airway assessment. Our surgeons will then make recommendations for anesthesia for you.
Our surgeons are all licensed to administer different types of anesthesia based on our oral surgical training and our office has been inspected and certified by our state society to ensure that it is properly equipped and prepared to manage emergencies and complications. Additionally, our ancillary staff are well-trained and prepared to treat patients safely in the office environment.
Local anesthesia (“Novocain”, lidocaine) is a numbing medication that is injected directly or regionally in the area to be treated. This is usually sufficient for minor procedures and simpler extractions.
Local anesthetic will be used in all oral surgery procedures and will also be used and in conjunction with all other methods of anesthesia.
With local anesthesia, you will be conscious and will not feel pain, just some minor pressure, during the procedure.
Local anesthesia is safe with few side effects. You can expect to feel numbness in your lip, cheek, tongue, gums, or palate that persists for a few hours following your procedure.
A mixture of nitrous oxide (“laughing gas”) and oxygen are administered over your nose with a nasal mask. Nitrous oxide is a colorless, odorless to sweet-smelling inorganic gas that was first used in surgical and dental anesthesia in the mid-1800s.
The nasal mask is kept on for the duration of your surgery and once surgery is completed, will be discontinued and you will be given 100% oxygen for 5 minutes to allow the nitrous oxide to “clear” your system.
Nitrous oxide both quickly enters and exits your system so there are no lingering after-effects. Due to the temporary effects, patients do not require an escort.
With nitrous oxide, you will be conscious but relaxed. Patients have some analgesic/pain relieving effects but still require use of local anesthesia.
Nitrous oxide is contraindicated if you are pregnant. Other contraindications include: COPD, small bowel obstruction, pneumothorax, recent middle ear surgery, vitamin B12 or folate deficiency, and severe coronary artery disease. Common side effects include nausea or vomiting but these may be minimized by avoiding a heavy meal or greasy snack immediately prior to the procedure.
With oral minimal sedation, you will be given a prescription for Valium, Ativan, or similar medications which are taken an hour prior to your appointment. Sometimes we may also prescribe a dose to be taken the night before your procedure to allow for a restful night’s sleep prior to your procedure. Dosages will be based on your weight.
Oral sedation produces a state of minimally depressed consciousness (mild sedation) that allows you to independently and continuously maintain your airway and respond normally to tactile stimulation and verbal commands. Although cognitive function and coordination may be modestly impaired, breathing, and cardiac functions are unaffected.
Minimal sedation may be achieved with an oral sedative alone or in combination with nitrous oxide/oxygen, along with local anesthesia.
Due to typical sleepiness from these types of medication, you must have an escort to drive you to and from the appointment.
Costs are typically low with these prescriptions and no IV is necessary.
Contraindications to oral sedation include: pregnancy, a history of substance abuse, narrow angle glaucoma, and allergies to these medications.
Moderate (“twilight sedation”) to deep anesthesia entails the administration of sedative agents directly through an IV (intravenous) catheter. The use of IV sedation in a dental office requires additional advanced training and licensure. Our doctors all have a permit to administer IV anesthesia in the outpatient setting.
The most common IV sedation technique in the oral and maxillofacial surgery office involves the use of a benzodiazepine (e.g., diazepam or midazolam) alone or in combination with other agents to produce sleep (Ketamine and Propofol). Additional medications may be given to prevent nausea, swelling or even post-operative pain. Due to the use of these medications (although in lower sedation dosages), your insurance will consider this type of anesthesia a “general” anesthesia.
Our practice is opioid-free so no intravenous opioids are given during an IV anesthetic.
Patients are placed on a monitor for the duration of the procedure for safety and an IV is typically placed in the arm or hand. A nasal breathing mask is placed over your nose for the procedure through which oxygen and occasionally nitrous oxide is administered.
No inhalational gases are given aside from oxygen or nitrous oxide. Sedation comes strictly from the IV medications that are titrated by the doctor to achieve a desired level of anesthesia.
You will be sitting up in a dental chair but very sleepy. Patients are not intubated or paralyzed. You will be breathing on your own although sedative medications may affect your breathing.
Our surgeons are assisted by two or three surgical assistants trained in BLS for Healthcare Providers.
Due to amnestic effects of the sedative medications, most patients have little to no recollection of their surgical procedure. The goal is to use as little medication as possible to complete your treatment comfortably and safely.
Patients are asked to fast after midnight for any IV sedation procedure, including water. Patients must also have an escort that will remain onsite during their surgery. Your escort will be able to review the post operative care instructions and ensure that you arrive home safely after your procedure. Ride-shares are not allowed as escorts.
Because of potential risks of cardiac and/or respiratory events during moderate to deep sedation, our doctors will need to evaluate you at a consultation to determine if you are healthy enough to be considered for in-office sedation.
Pediatric patients require special consideration. Children, especially very young children, have a higher risk for anesthetic adverse events especially related to respiratory complications. As such, our practice does not sedate children younger than age 12 in our office.
