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 best suited to your procedure. These will be recommendations only, as the type of anesthesia will ultimately be decided by you.
This is the conventional type of anesthesia used at your dentist’s office. None of the drugs given for this type of anesthesia affect your mental acuity; therefore, you will be able to drive yourself home. The surgical area will be numbed with an injection and the procedure will then be performed. For your additional comfort, laughing gas can also be given through a nasal mask. 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.
You will be given an oral premedication (Valium) to take prior to your arrival 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 two hours prior to the appointment. If this first dose is insufficient after one hour, 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. You must be accompanied by an adult who will drive you to and from our office.
If you have a high degree of anxiety, or do not wish to remember the experience of the surgery, general anesthesia affords you the luxury of taking a short nap and waking up at the end of the procedure. An oral premedication, as explained in the previous section, is given prior to your arrival. Before the procedure, medication is given through a small IV and you will begin to fall asleep. The numbing injection (Novocaine) 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 will 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 heavily 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, a bus or cab ride home will not be permitted. You must be accompanied by a responsible adult.
Additionally, you must have an empty stomach on the morning 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. Even a sip of liquid or a bite of food is not allowed.
When administering IV general anesthesia, we will monitor all vital functions. There will be additional costs for the necessary equipment and medications. Therefore, a nominal fee will be assessed for the procedure, depending on the duration of the surgery. Our administrative team will present the fees for the anesthesia, along with your estimated insurance coverage. You can decide later whether to be asleep, but we will need a minimum of 48 hours notice prior to your surgery date to allow us additional time for setup and recovery.
There are rare cases in which the surgery will be performed by our doctors in the hospital setting with the assistance of medical anesthesiologists. We are currently affiliated with Providence Regional Medical Center of Everett, the University of Washington and Harborview Medical Center. Due to time and cost involved, hospital surgeries are only performed once every few months. Applicable cases include:
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 “Novocaine” shot, 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.
Our anesthesia technique does not include any intubation or paralysis, which is routine for hospital surgeries. Therefore, our risk of major complications is very low (~1 in 70,000) and our practice’s track record of major complications from anesthesia is flawless. Furthermore, the numbing medicine is given after you are asleep. That means that we control the dosage of IV medication and the chance of overdosing is dramatically reduced. The general anesthesia is administered by our fully trained doctors up to 10 times per day, five days per week. Our equipment is new and up-to-date and we are completely prepared for any and all emergencies. Our doctors and our entire surgical team have been extensively trained to handle any emergency situation, should it arise. Since our inception in 2003, our office has never had a major complication associated with the anesthesia.
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 is 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.
Yes. The IV is the method we use to give the medication to help you fall asleep. By the time you arrive, you will be very relaxed from the premedication. To minimize any discomfort, we apply a freezing topical anesthetic along with the laughing gas. The IV 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.
Falling asleep by way of inhaling anesthetic gases is permitted in the operating room setting when IV access is difficult (for example, with small children or with people who have extremely small and difficult veins). The risk of complications is higher for this type of anesthesia and should be reserved for the hospital operating room setting.
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 is 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.
Our age limit is approximately 6 years of age. Patients younger than 5 will be treated with the help of the anesthesia team at the hospital or a mobile anesthesiologist at our office.
All of our doctors have had a MINIMUM of 9-12 months of direct patient care with the medical anesthesiology department at their respective institutions. They are extremely well qualified, experts in the field, for the type of anesthesia we administer. Many of our doctors have had additional extensive training in the field of anesthesiology. Therefore, for the type of anesthetic we use, a separate anesthesiologist is not needed.
For a printed version of frequently asked questions about anesthesia, click here