Oral and Maxillofacial surgeons are unique in that they have recieved formal training in anesthesia. This training is part of their residency and it is within the department of anesthesiology of the hospital system in which they are trained. The training includes everything from starting an IV to advanced cardiac life support (ACLS). Certification of ACLS is required to maintain a standard of care in the office setting.
Your initial consultation is very important to your overall treatment plan. Our doctor will discuss the specifics of your exam and surgical procedure that may need to be preformed. He will also review your medical history and evaluate your anesthetic needs and risks. The anesthetic may vary from local anesthesia to what is considered general anesthesia in the office. After the course of anesthesia is decided you will be given specific instructions either by the doctor or the trained office staff.
The choice of anesthesia is between the patient and the doctor. It is best made after an informative consultation. Following the consultation you will be given preoperative instructions which usually include: fasting six hours before surgery, wearing loose and comfortable-fitting clothing, no facial make-up, instructions on taking any medications prescribed by the doctor or your physician, and having someone responsible with you to take you home and watch over you for the rest of the day.
Undergoing intravenous anesthesia and surgery at our office is similar to having surgery and anesthesia at the hospital surgery facility. However, there are differences in the anesthesia techniques: you will not be intubated and the recovery time is shorter. You will be monitored with similar equipment as in day surgery. Once you are taken to the surgical suite, one of our trained surgical assistants will place a number of monitors; these include an automatic blood pressure monitor, an electrocardiogram, and a pulse oximeter. This is why loose comfortable clothing is required.
Dr. Dobbin or a trained phlebotomist starts the intravenous line. This is for the administration of fluids and medications. You will receive oxygen via a nasal cannula that fits comfortably underneath your nose. Most patients receive a combination of medications which may include versed (a tranquilizer), fentanyl (a narcotic), among other medications. Also, medications may be used to decrease swelling, prevent swelling, and/or to help dry salivary flow. Once you are “sleepy” a local anesthetic will be administered. Usually, we use a combination that will include a long acting agent that may keep your mouth numb for 4-8 hours.
After surgery you will be allowed to recover (wake-up) for a period of time. While you are recovering your vital signs will be monitored. Once you are stable and awake you will be discharged to the care of your ride home. You should not attempt to perform any dangerous or strenuous activities, such as driving or operating machinery for at least 24 hours after surgery.
Local Anesthesia involves injections in the oral cavity to provide numbness to the surgical site. Utilizing a local anesthetic alone, you will remain alert and aware of your surroundings.
A tranquilizer, such as Lorazepam may be given approximately one hour prior to your surgical procedure to help relax you and reduce your anxiety levels associated with the planned surgery. If you choose this method, your consent form must be signed prior to taking this medication and you should avoid a heavy meal prior to this visit. Also, you should have someone drive you to our office and drive you home because of the effects of the medication.
This technique involves placing an IV and administrating medications through the IV to help reduce consciousness, help relaxation, and decrease stress. Sometimes amnesia and increased pain tolerance may occur. Furthermore, with this technique you may not have anything to eat or drink for six hours prior to surgery and an adult must escort you home and watch over you following surgery. Sometimes intravenous sedation may require medical consultation with your physician.
Intravenous General Anesthesia
This anesthetic technique allows for the patient to become unconscious during their surgical procedure. Most patients will be completely unaware of their surgical procedure and will have little or no recollection of what has transpired during the affects of the medication. This is different from a general anesthetic in the hospital in that you will not be intubated (tube placed in lungs to breathe) and you will not be paralyzed as in a day surgery setting. With this technique no food or water is allowed for 6 hours prior to the procedure and again someone must accompany you home and watch you for the remainder of the day. Also, this technique may require some medical consultation with your family physcian or medical specialist if you are on other medications or have other health issues.
Please note that patients taking regular medications for conditions such as heart aliments, high blood pressure, diabetes, seizure disorders, thyroid disorders, gastic reflux, and asthma should take their medication with a small amount of water even if it is within the six hour time frame prior to surgery unless instructed otherwise by our surgical staff. It would be helpful at your initial consultation to have a complete list of medications and your physician’s names and phone numbers which will facilitate the consultation progress. Please remember that we are following the highest standard of care of set forth by the American Association of Oral and Maxillofacial Surgeons.
If you should have any questions regarding the above, please remember your initial consulation will include a review of all items mentioned above as well as our doctor’s opinion on the surgical and anesthetic techniques that should be utilized to make it a safe and comfortable procedure.