Anxiety is normal when facing surgery. If a person is apprehensive, a past traumatic experience can increase the anxiety. The primary goal of our team is to ensure your procedure is smooth, safe, and comfortable. After your doctor examines you, he will make recommendations for the type of anesthesia options best suited to your procedure and your overall health. These will be recommendations only, as you will ultimately decide the type of anesthesia.
This is the conventional type of anesthesia used at your dentist’s office. The surgical area will be numbed with an injection and the procedure will then be performed. Depending on the type of procedure, there will be varying degrees of noise and pressure, but you should not experience any discomfort. If you have a high level of anxiety, however, any pressure might be perceived as discomfort. Therefore, if you are mildly or moderately apprehensive, you may prefer one of the following options:
Oral Sedation with Local Anesthesia
You will be given an oral premedication (Valium or similar) to take in our office prior to surgery that will decrease your level of anxiety. The procedure itself will be performed identical to the option above. The premedication gives additional relaxation and comfort. The first dose should be taken one hour prior to the appointment. If this first dose is insufficient after thirty minutes , please take the second dose. However, if the first dose has a profound effect (drowsiness, loss of coordination, loss of balance), do NOT take the second dose. You will still be aware of the procedure, but will be much more relaxed. With this method of anesthesia, you will be cognitively impaired. Therefore, you cannot come to the appointment alone. An adult who will drive you to and from our office must accompany you.
Intravenous (IV) Anesthesia
If you have a high degree of anxiety, or do not wish to remember the experience of the surgery, IV sedation affords you the luxury of taking a short nap and waking up at the end of the procedure.
Before the procedure, medication is given through a small IV and you will begin to fall asleep. The numbing injection (local anesthetic) will be given, but you will likely not remember it. Therefore, after you wake up, you will not experience any discomfort since the area will be numb. You will not be aware of the surgery and should remember nothing about the experience. For most conventional hospital surgeries, intubation (breathing tube) and paralysis are routinely administered. We do not use these techniques with our anesthesia and you will be breathing on your own throughout the procedure. This is far safer than conventional hospital anesthesia, and much less expensive.
Since you will have been sedated, you will need a ride to and from the surgery appointment. Although you will be able to communicate and function on your own, you will likely not remember going home, as these medicines have a powerful amnestic effect. Therefore, an unescorted bus ride or an unescorted cab ride home will not be permitted. A responsible adult must accompany you.
Additionally, you must have an empty stomach at the time of surgery, except for a small amount of water taken with your premedication. Your stomach lining produces strong acids in response to even minimal amounts of food entering the stomach. When you are under anesthesia, your normal reflexes are depressed or absent. Therefore, if you vomit, you will not be able to control any stomach contents from entering your lungs. If these acids enter your lungs, the result could be severe, life-threatening damage. As a result, the following pre-surgical oral intake instructions have been developed for your safety and must be followed: (If these are not clear to you, ask the surgeon or the surgical assistant who met with you during your consultation for clarification.
Medications with sips of water may be taken until 30 minutes before the procedure for those age 12 years and older if taken/administered in our office under our supervision.
For those between ages 6 months and 12 years, clear liquid sedative medications may be administered by your child’s surgeon in the office up to 30 minutes prior to surgery to help calm your child.
If your medications change before the day of surgery, notify your surgeon by calling 508‐676‐3041 as soon as possible before surgery.
Clear Liquids such as water, or clear juices such as apple juice, white grape juice, flat soda, tea, black coffee (no milk), and clear Jell‐O maybe offered until two (2) hours prior to the scheduled procedure. You may take your regular daily medications up to this time if you have discussed them with your surgeon.
Breast milk may be given to infants up to four (4) hours before surgery.
No Solid food or non‐clear liquids (such as non‐human milk, orange juice, infant formula, protein drinks) six (6) hours prior to the scheduled procedure unless approved by your surgeon.
You may eat a light meal of toast and clear liquids 6 hours prior to your surgery. You must time this meal to finish the last mouthful six (6) hours prior to your scheduled surgery.
When administering sedation by any route (oral, inhaled, or IV), we will monitor all vital functions for your safety in compliance with applicable state regulations and good anesthesia care standards. Compliance with these safety measures imposes additional costs for the necessary staff, equipment, and medications. Therefore, a nominal fee will be assessed for the anesthesia procedure separate from the actual surgical procedure. The actual amount of this fee will depend on the duration of the surgery. Our administrative team will present the fees for the anesthesia, along with your estimated insurance coverage.
Frequently Asked Questions About Anesthesia
Can I be asleep for my surgery?
Yes, as long as there is no medical condition that would make it unsafe. If you are anxious or apprehensive about the surgery, we have the capability to make sure you are asleep, comfortable and don’t recall any part of the surgery. You will likely not remember the local anesthesia shots, sounds of the instruments or pressure from the procedure. If you have had a previous bad experience or would prefer to not remember any of the surgery, you will find this option very appealing. The entire ACOMS surgical team takes great pride in making sure our patients are very comfortable.
Is it safe to be asleep? Am I going to wake up?
Our anesthesia technique does not include any intubation or paralysis, which is routine for hospital surgeries. Therefore the risk of major complications (death, stroke, heart attack) is very low (~1 in 100,000) and our surgeon’s track record of major complications from anesthesia is flawless. Furthermore, local anesthesia medicine is given after you are asleep. That means that we can reduce the dosage of IV medication, and the chance of overdosing is dramatically reduced. Our surgeon administers IV anesthesia up to 10 times per day, three days per week. Our equipment is up-to-date and we are prepared for any and all emergencies. Our surgeon has the mandatory training to handle any emergency situation, should one arise.
Will I remember any part of the surgery?
If you are young, healthy and have no history of medical problems, there is a greater than 95% chance that you will remember nothing from the surgery. Many people do not remember going home.
However, there are a small percentage of people who have a very high tolerance to medication, either due to genetic predisposition or previous history of substance abuse, or who have difficult airway management issues (for example, severe sleep apnea). If you are in this group of patients, there is a small chance that you will remember some talking or conversation towards the end of surgery. This will not be a traumatic or painful memory, since you will be numb and will not be feeling any discomfort.
Although our priority is your comfort, our ultimate goal is your safety.
Will I need an IV (intravenous) line to be asleep?
The IV line is the method we use to give the medication to help you fall asleep. If you have anxiety about the IV, tell your surgeon at your consultation, and you will be given an oral premedication such as Valium prior to the surgery to help get relaxed. To minimize any discomfort, we use the smallest IV line consistent with safety. Usually, it is a small, child-size catheter; so it is much less traumatic than a conventional emergency room IV. For most of our patients, the IV is not stressful.
What are the side effects of the anesthesia?
With our method of anesthesia, the chance of undesirable side effects is greatly reduced. There is always a risk of nausea and vomiting from any anesthesia. Since the total amount of medication is less than for a conventional hospital anesthesia, the probability of this side effect is significantly lessened.
Also, there are a small percentage of people who become emotional or combative when waking up from the anesthesia. They are not crying because they are hurting; rather, it is a side effect of the medication. Most of the time these patients do not remember their reactions, but it can be difficult for loved ones to witness. It is only temporary for a few hours after the surgery and there are no long-term effects.
Are there any contraindications to the I.V. Sedation in the office?
Our lower age limit is approximately 6 years of age. Our upper age limit depends on the patient’s overall medical condition.
Patients younger than 6 years old and anyone with significant medical problems will be evaluated on a case-by-case basis since some of these cases are best done in an out patient surgical facility/hospital setting.
Is there an anesthesiologist present at the surgery?
Our surgeon is a diplomate of the National Dental Board of Anesthesiology and a Fellow of the American Dental Society of Anesthesiologists. He is also certified in Advanced Cardiac Life Support and Pediatric Advanced Life Support. To reach his level of competency, he completed a 5-year residency that included being part of the medical anesthesiology department at the State University of New York at Buffalo-Buffalo General Hospital with extensive training in inpatient and outpatient general anesthesia. While serving as one of the two chief oral and maxillofacial surgery residents in Buffalo, NY, our doctor also moonlighted as the anesthesia department’s first responder for cardiac arrest emergencies in the Buffalo General Hospital, a 400+-bed tertiary-care hospital. Needless to say, we think our surgeon is an extremely well qualified expert in the field of anesthesia who has safely performed thousands of anesthesia cases.