The following is a brief explanation of various techniques used by our office to ensure a comfortable oral surgical procedure.

1. Local Anesthesia: Most commonly referred to as “injecting novocaine”, the administration of local anesthesia allows a portion of the oral cavity to become “numb” and allow minor oral surgical procedures. Typically, the local anaesthetic will be Lidocaine (also known as xylocaine) or Carbocaine (Mepivicaine) foe minor procedures. This technique is usually sufficient for minor procedures on non-anxious patients.
   
   
2. Nitrous Oxide Sedation: Commonly known as “laughing gas”, nitrous oxide combined with oxygen is a weak inhalation anesthetic that can be used in conjunction with local anesthesia. Administered most commonly via a nasal mask, patients can breathe the nitrous oxide-oxygen mixture and experience some relief of anxiety and pain with this agent. This inhalation agent also requires the administration of a local anaesthetic that is administered after the patient has breathed the anaesthetic for several minutes and has become relaxed. Once the oral surgical procedure is completed, the patient will breathe 100% oxygen for 3-5 minutes to ensure that the anaesthetic has been cleared from the body. Although the patient can typically resume normal activities after this anaesthetic, we recommend that the patient have someone drive them home after that appointment. In our office, nitrous oxide sedation is most commonly used in conjunction with other anaesthetic techniques (such as IV sedation) as patients who elect to have this type of sedation often believe they will be “asleep” during the procedure when, in fact, patients breathing nitrous oxide-oxygen sedation are possibly relaxed but very much awake.
   
   
3. Oral Sedation: In a few cases, patients may do well with administration of an oral sedative prior to an oral surgical procedure. The medications may be an anti-anxiety (tranquilizer) agent such as Valium or Xanax or an analgesic agent (narcotic pain reliever) such as Hydrocodone or Demerol. A local anaesthetic is also required for the surgical procedure, but the oral agent may provide the anxiety alleviation and/or analgesia to complete the surgical procedure comfortably. Please do not take tranquilizers or pain relievers prior to oral surgery without discussing this with our office.
   
   
4. Intravenous Anesthesia: The majority of our patients are sedated using an intravenous (IV) route. The anaesthetic itself can vary widely, but is typically classified into one of the following categories.

• IV Analgesia- As the name implies, this IV technique involves primarily pain control without putting the patient asleep. These patients are relaxed, comfortable, but awake and responsive. As the surgery procedure progresses the patients comfort level can be adjusted and enhanced by giving additional medication as needed.
  
• IV Sedation or Conscious Sedation- An intravenous technique similar to IV Analgesia. This technique typically not only involves the administration of analgesic (pain reliever) agents but also anxiolytic (anti-anxiety) agents such as Valium or Versed. These patients may appear to be awake and will respond to us during the procedure. The patient is often amnesic for the procedure, remembering little if any of the procedure. If the patient does have any memory of the procedure, it is often a memory of someone talking to them without remembering what was actually said. Patients will often remember the end of a procedure or being discharged to home. Conscious sedation is an excellent technique for patients to have a comfortable, pain free oral surgical experience.
  
• General Anesthesia- An intravenous technique also known as unconscious sedation. Patients who undergo this anaesthetic will appear to be asleep. These patients will typically respond to our requests, but will sleep comfortably if left alone. These patients typically have no memory of the procedure, breathe on their own throughout the procedure and wake typically within 15-30 minutes after completion of the oral surgery. This is the most common technique used in teenagers and healthy adults for procedures such as wisdom tooth removal.
  

All intravenous techniques are tailored to the patient’s specific needs and medical history. Patients must not eat or drink anything 6-8 hours prior to the procedure and are fully monitored during the procedure with an EKG, pulse oximeter (oxygen saturation monitor) and automatic blood pressure cuff that takes your blood pressure every 3-5 minutes. Patients will breathe 100% oxygen via a nasal mask or nasal cannula throughout the anaesthetic and be administered a local anaesthetic before the surgical procedure, but after the administration of appropriate IV anaesthetic medications. This ensures that the patient does not feel the “Novocain” injections but has adequate local anesthesia (and thus no pain) as they recover from the IV anesthetic. These patients are then recovered appropriately and discharged home with a responsible adult for post-operative rest and recovery.

Common Anesthetic Scenario:

A healthy 18-year-old male is scheduled for removal of impacted wisdom teeth under deep IV anesthesia (unconscious sedation). Before arriving to our office for surgery he should:

1. Refrain from eating or drinking anything for 8 hours prior to surgery (nothing to eat or drink after midnight).
   
2. Brush his teeth and rinse his mouth thoroughly prior to the surgery.
   
3. If he was given specific instructions to take a medication prior to surgery (for example, Valium to alleviate anxiety or antibiotics for a heart murmur), these should be taken as instructed and with as little water as possible.
   

Upon arriving at our office, he will:

1. Sign all necessary paperwork (signed by parents if patient is a minor).
   
2. Be asked to go to the restroom prior to surgery.
   
   

At the appropriate time, the patient and his caretaker(s) will be escorted to the surgery room. The patient will then be placed into the dental chair and placed into a reclined position. The cardiac monitors and blood pressure cuff are then placed appropriately on the patient. The patient will then have a nasal mask placed over his nose and will breathe “laughing gas” (nitrous oxide-oxygen sedation). Once the patient becomes relaxed, he may experience a sensation of numbness in his extremities. It is at that time that an intravenous infusion will begin using a small intravenous catheter. The patient will feel a very small pinch in their arm or hand. Once the IV is started, the patient will be given medications to relax him and then medications that allow him to drift into sleep. It is during this time that family members and caretakers are asked to return to the waiting room.

With the patient comfortable and asleep, the local anesthesia (typically Lidocaine) is administered and allowed to begin working. Once local anaesthetic is achieved, the surgery is begun and subsequently completed. Some patients are then given injections of another local anaesthetic (Marcaine) to provide prolonged local anesthesia and pain control.

As the patient is recovering, family members or caretakers will return to the room for instructions as to the care of the patient. Please note that patients may become irritable or emotional during the recovery phase. This is especially common in teenage females, but can occur in any patient with significant anxiety about a procedure. Do not be alarmed if they are crying or seem “out of sorts”, as this will subside as the effects of the anesthesia diminish. Once we determine it is safe to discharge the patient, the patient will be placed in the vehicle of the caretaker and should be taken home. Patients will often sleep the rest of the day after surgery and should not be left alone.

Things to remember:

1. Always fill out your medical history form accurately as even small details about you may be very important in our assessment as to which anaesthetic is best for you.
   
   
2. Always inform our office of ALL medications you may be taking (even illicit drugs that you may use) as these can often react with our anesthetic drugs and cause serious, life-threatening side effects.
   
   
3. Always follow the guidelines for not eating or drinking prior to anesthesia. Failure to follow these instructions can lead to aspiration of stomach contents into your lungs. Aspiration of these contents into your lungs can cause severe pneumonia and even death.
   
   
4. Remember that we ask that you not eat or drink anything for at least six hours prior to procedure. On some occasions, patients may have an afternoon surgery appointment. We feel it is prudent for the patient to get up early that morning and have something to eat prior to beginning the 6-8 hour period during which they cannot eat before surgery. This helps the patients to feel better prior to surgery but still ensures adequate time for gastric (stomach) emptying prior to the anaesthetic.
   
   
5. Patients that normally take medications for acid reflux such as Prevacid, Prilosec, Zantac (Ranitidime), or Tagamet (Cimetidine) may take these medications prior to surgery and anesthesia with sips of water to prevent the excess accumulation of gastric acid and reflux on that day.

Our goal is to provide a safe and comfortable anesthetic tailored to your specific needs. Please assist us with the necessary information to achieve this goal.