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.
Local anesthesia (Novocaine) with or without Nitrous Oxide (Laughing gas)
This is the conventional type of anesthesia used at your dentists 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.
Oral Sedation with Local Anesthesia and Nitrous Oxide
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.
Intravenous (IV) General Anesthesia (asleep)
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:
- Major reconstruction cases requiring bone grafts from distant sites (hip, tibia, etc)
- Corrective jaw surgery that requires deep anesthesia.
- Children under the age of 6 who are unable to tolerate local anesthesia
- Patients with extremely high drug tolerance and/or behavioral issues