Several methods of anesthesia are available. The method of anesthesia that is chosen for or by a patient depends upon the nature of the surgical procedure and the patient’s level of apprehension.
The following table illustrates the choices of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.
MethodTypes of AnesthesiaDescription of TechniqueUsual Indications
Method Local AnestheticThe patient remains totally conscious throughout the procedure. A local anesthetic (e.g. lidocaine) is administered in the area where the surgery is to be performed. Local anesthetic is used in conjunction with the other methods of anesthesia in all oral surgery procedures.
Simple oral surgery procedures such as minor soft tissue procedures and simple tooth extractions.
Method Moderate Sedation
Medications are administered through an intravenous line (I.V.). The patient is lightly sedated, in an altered state of consciousness but remains calm and relaxed.
Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.Some patients with medical conditions and/or on specific drug regimens may choose moderate sedation to relieve anxiety and stress during oral surgery procedures.
Method Deep Sedation
Medications are administered through an intravenous line (I.V.). The patient falls asleep and is completely unaware of the procedure being performed.
Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Diprivan.
Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.Available for all types of oral surgery. A patient may choose sedation for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or having a dental implant placed will choose sedation. Sedation may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.
When it comes to anesthesia, our first priority is the patient’s comfort and safety. If you have any concerns regarding the type of anesthesia that will be administered during your oral surgery procedure, please do not hesitate to discuss your concerns with Dr. Girn at the time of your consultation.
Intravenous Sedation Conscious Sedation
IV (intravenous) conscious sedation is a safe form of anesthesia for patients who are nervous and/or want to be asleep for the surgery. During your consultation appointment, Dr. Girn will evaluate your medical history to determine if you are a candidate for IV sedation in the office.
A patient who undergoes IV sedation first has an IV started in a vein in the arm. The medication is then administered through the IV line, and within one to two minutes, the patient will fall asleep (sedation). Once a person is sedated, the surgical procedure will commence.
During this period of sedation, the patient is continually monitored by Dr. Girn and his staff. Specialized monitoring equipment that is used includes a heart rhythm monitor, blood pressure cuff, and pulse oximetry.
After the surgery is complete, it usually takes about 20-30 minutes for a patient to wake up and be ready to go home. A responsible adult is required to escort the patient back home either by car or taxi. The patient will also have some numbness in the mouth for a few hours since local anesthetic (freezing) is administered while asleep.
How is IV Conscious Sedation Different From Other Forms of Sedation?
IV conscious sedation is different from oral sedation and general anesthesia. In oral conscious sedation, a person takes an oral pill and must commonly wait about 30 – 60 minutes for a feeling of relaxation to take affect. Although a patient can be given larger doses to become unaware of what is going on (sedation), it is difficult to dose to this level and there is a risk of over-sedation. In general anesthesia, the patient has a deep anesthetic which requires supervision by an anesthetist, and the patient has a breathing tube inserted to maintain proper breathing.
Training and Safety
Dr. Girn is certified to provide deep sedation in the office and has certification in ACLS (Advanced Cardiac Life Support). During his residency in oral and maxillofacial surgery, Dr. Girn received extensive hands-on training in the Department of Anesthesiology. This training included provision of IV sedation and general anesthesia, airway management and intubation techniques. His staff are trained in CPR, and the assistants possess DAANCE (Dental Anesthesia Assistant National Certification) in Canada. In addition, Centrepoint Oral and Facial Surgery meets or exceeds the requirements governed by the College of Dental Surgeons of BC as we are a Certified Inspected Deep Sedation Facility.
How is the IV sedation administered?
A thin needle will be introduced into a vein in your arm or hand. The needle will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. At times a patient’s vein may not be maintainable, in these situations the medications will be administered and the needle retrieved – both scenarios will achieve the same desired level of conscious sedation. Once again some patients may be asleep while others will slip in and out of sleep. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated and may not sleep at all.
The goal of IV sedation is to use as little medication as possible to get the treatment completed. It is very safe, much safer than oral sedation. With IV sedation a constant “drip” is maintained via the intravenous tube. At any time an antidote can be administered to reverse the effects of the medications if necessary.