Anesthesia

A child wonders what the first day of school will be like.
Someone is about to start a new job.
A young couple is about to be married.

Each of these situations is a classic anxiety producer. What they have in common is that each involves the unknown. And that's what anxiety is: the fear of a specific upcoming event that, in all likelihood, you've never before experienced.

The Less You Worry, the Easier it Will Be

If you are like most people, an upcoming visit to Midland Oral Surgery and Implant Centers is another potential anxiety producer. In this case, the patient is typically most concerned about possible pain — whether the procedure is going to hurt.

The good news is that whether your procedure requires local or intravenous anesthesia, today's technology makes it possible to perform complex surgery in the oral and maxillofacial surgery office with little or no discomfort for the patient. Patients are more often than not pleasantly surprised with how easy everything was for them.  Knowing this should start to reduce your level of anxiety. 

 

Experts in Pain Management and Anesthesia

The ability to provide patients with safe, effective outpatient anesthesia has distinguished the specialty of oral and maxillofacial surgery since its earliest days. As the surgical specialists of the dental profession, Oral and Maxillofacial Surgeons are trained in all aspects of anesthesia administration. Following dental school, Oral and Maxillofacial Surgeons complete at least four years of training in a hospital-based surgical residency program alongside medical residents in general surgery, anesthesia and other specialties. During this time, OMS residents must complete a rotation on the medical anesthesiology service, during which they become competent in evaluating patients for anesthesia, delivering the full general anesthetics in the operating room and monitoring post-anesthetic patients. 

As a result of this extensive training, Oral and Maxillofacial Surgeons are well-prepared to identify, diagnose and assess the source of pain and anxiety within the scope of their discipline, and to appropriately administer local anesthesia, all forms of sedation and general anesthesia. Further, they are experienced in airway management, endotracheal intubation, establishing and maintaining intravenous lines, and managing complications and emergencies that may arise during the administration of anesthesia.

Putting Your Mind at Ease

The best way to reduce anxiety is to make certain you know what to expect during and after surgery. As with most anxiety-producing situations, the more you know, the less you have to be anxious about. Prior to surgery, we will review with you the type of anesthetic to be used, as well as the way you're likely to feel during and after the operation.This is the time to discuss any concerns you may have about anything .  During surgery, one or more of the following may be used to control your pain and anxiety: local anesthesia, nitrous oxide-oxygen, intravenous sedation and general anesthesia. Commonly, patients describe their feelings during surgery as comfortable and surprisingly pleasant.

After surgery, you may be prescribed a medication to make you as comfortable as possible when you get home.

The management of fear and anxiety has been an integral part of the practice of dentistry for many years. The first demonstrations of anesthesia was in 1844 by Dr. Horace Wells, a dentist who underwent a dental extraction performed by an associate, using nitrous oxide for pain control. Soon afterward, Dr. William T.G. Morton, a dentist, used ether vapor when performing a surgical extraction on a patient. Today a vast array of equipment and medications are available to the practitioner to help deal with patient apprehension of dental treatment. Oral and maxillofacial surgeons have the knowledge and advanced training to manage these fearful patients using various methods of sedation or general anesthesia.
 

Routes of Administration and Sedative Drugs

There are various routes of administration for sedative drugs. Medications can be given orally, which is convenient, but the results are unreliable because the onset and peak effect are difficult to predict accurately. Nitrous oxide, an agent that is administered through the lungs via inhalation, has the advantages of rapid onset and short recovery. The concentration of the gas can be titrated to achieve the desired effect. Unfortunately, nitrious oxide is a relatively weak sedative agent. Parenteral routes (intravenous, intramuscular, subcutaneous) are the most reliable and controllable. For sedative drugs, the intravenous route is the most common and is well accepted by patients.
The types of medications used for sedation in our office consists of antianxiety agents, narcotics, and general anesthesics. The most widely used antianxiety medication midazolam (Versed), reduces anxiety, produce relaxation, and cause amnesia. Studies have shown that Versed has greater amnesic properties than Valium, while Valium produces greater muscle relaxation. Narcotic drugs are used to produce mood changes, provide analgesia,and eleviate the pain threshold. Fentanyl (Sublimaze) is the narcotic primarily used in our office. The general anesthetics which are used in our office are ketamine and propofol; these are given in a titrated manner to desired effect.  The response is dose-related and these drugs can be given in lower doses for patient safety. Other drugs may be used in conjunction with the above medications such as anticholinergic agents i.e. atropine which decreases salivary activity.

 

Patient Monitoring

Proper patient monitoring is essential to ensure the appropriate level of sedation is being administered and for patient safety. Vital signs will reflect changes in depth of anesthesia or physical status. For conscious sedation, multiple blood pressure readings are standard. In addition, a pulse oximeter is used to monitor both pulse rate and the level of oxygen in the blood. This monitor has greatly advanced the practitioner's ability to detect a decrease in patient respiratory exchange. An electrocardiogram (EKG) is also employed to monitor heart rhythm. Although advanced technology has given dentistry many fine tools with which to monitor patients, however the quickest and most reliable method is often physical evaluation and assessment by the practitioner.
 

Conclusions


The control of pain, fear, and anxiety by anesthetic techniques is a tool used by oral and maxillofacial surgeons. Although specific methods may vary from practitioner to practitioner, the delivery of anesthesia in the dental office adheres to an excellent standard based in science, research, and education.

Adapted from AAOMS.org