About Office-Based Anesthesia
Oral and Maxillofacial surgeons are unique in that they have received 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 trained. The training includes everything from starting an IV to advanced cardiac life support (ACLS). Certification in 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 surgeons will discuss the specifics of your exam and the surgical procedure that may need to be performed. They will also review your medical history and evaluate your anesthetic needs and risks. The anesthetic may vary from a local anesthetic to what is considered a general anesthetic 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.
Following Proper Instructions Is Important
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 specific preoperative instructions which usually include having nothing to eat or drink eight hours before your surgery, wearing loose and comfortable-fitting clothing, no facial make-up, instructions on taking any medications prescribed by the doctor or your physician, and to have someone responsible with you to take you home and watch over you for the rest of the day following your surgery.
Pre and Post Surgery Procedure
Undergoing intravenous anesthesia and surgery at our office is similar to having surgery and anesthesia at the hospital day surgery facility. However, there are differences in the anesthesia techniques, specifically, you will not be intubated and it is usually less complicated and has a much shorter recovery time at our office than at the day surgery facility. 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 ET CO2. This is why loose comfortable clothing is required.
Our surgeons usually start the intravenous line themselves. 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 nausea, 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. Because of the medications used 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 of the surgical site. Utilizing a local anesthetic alone, you will remain alert and aware of your surroundings.
A tranquilizer, such as a valium, 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 the medication and you should avoid a heavy meal prior to your visit. Also, you must have someone drive you to our office and drive you home because of the effects the medication may have on your driving ability.
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 eight hours prior to surgery and an adult must escort you home and watch over you following surgery. Sometimes intravenous sedation may require a medical consultation with your physician.
Intravenous General Anesthesia/Deep Conscious Sedation
This anesthetic technique allows the patient to have a restful sleep while undergoing their surgical procedure. Most patients will be competently unaware of their surgical procedure and will have little or no recollection of what has transpired during the effects of the medication. This is different from a general anesthetic in the hospital in that you will not be intubated (a tube placed into the 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 eight hours prior to the procedure and again someone must accompany you home and watch over you for the remainder of the day. Also, this technique may require a medical consultation with your family physician or medical specialist if you are on other medications or have other health issues.
Please note that patients taking regular medications for things such as heart conditions, high blood pressure, diabetes, seizure disorder, thyroid disorder, gastric reflux, asthma, other medications 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 or nurse. It would be helpful at your initial consultation to have a complete list of medications and your physicians’ names and phone numbers so it will facilitate the consultation progress. Please remember we are following the highest standard of care as set forth by the American Association of Oral and Maxillofacial Surgeons so we would like to have all information available.
Reviewing Patients Post Recovery
If you should have any questions regarding the above, please remember your initial consultation will include a review of all items mentioned above as well as our doctors’ opinion on the surgical and anesthetic techniques that should be utilized to make it as safe and comfortable for you as possible.