Anesthesia

What are the anesthesia options?
What is IV sedation?
What is the difference between IV sedation and general anesthesia?
Who administers the IV sedation anesthesia
What Medications are used for IV sedation?
What other medications are given during anesthesia?
Is IV sedation Safe?
Is it possible to wake up during anesthesia or surgery?
What are possible side effects or complications?
Recovery from anesthesia
How soon can I return to work, school, or normal activities after procedure and anesthesia?
What is nitrous oxide or laughing gas?
Is Laughing gas safe?
What is Local Anesthesia?
Is local anesthesia safe?
Medical Precautions
Insurance, fees, and payment options

What are the anesthesia options?
We offer three anesthesia options: IV sedation (asleep), nitrous oxide (laughing gas), and local anesthesia. The best option and what is chosen by significant majority of  patients is IV sedation anesthesia, which provides  optimum comfort and a complete painless experience.  With IV sedation, you’ll take a short nap during the procedure and wake up immediately when finished. The nitrous oxide or laughing gas is a conscious sedation that helps you feel more relaxed, but not fully asleep, during the procedure. Local anesthesia is simply the numbing technique similar to what you may have had at a dentists office. You’ll be fully awake but completely numb during the procedure.

What is IV sedation?
IV sedation involves administration of several medication intravenously. Initially, nitrous oxide gas is given to relax you, and then a very small IV needle or catheter is placed with minimal discomfort.  Patients are monitors as the medications are slowly given to achieve the right level of sleepiness. This takes no more than two to three minutes. Once you are sleep, the surgeon will start the procedure. You’ll wake up immediately when procedure is completed and recover for about 30 minutes before ready to go home. IV sedation is recommended highly for wisdom teeth extractions, extraction of teeth, bone grafting, dental implants, biopsies, and management of infections. They can be safely administered in both adults and children.

What is the difference between IV sedation and general anesthesia?
IV sedation results in deep sleep while patient breaths normally on their own and does not require intubation. This is contrary to general anesthesia which is usually provided in hospital setting by an anesthesiologist. With general anesthesia patient is intubated and the airway and breathing is completely controlled by the breathing tube and the a ventilator. Some refer to IV sedation as ‘office general anesthesia, but it is not true general anesthesia.

Who administers the IV sedation anesthesia?
IV sedation will be administered by Dr. Kazemi who is trained and licensed for this procedure. He has received extended anesthesia training in the hospital during his residency and is well familiar with anesthesia protocol, its medications, emergency and airway management, and post anesthesia recovery.

What Medications are used for IV sedation?
Medications typically include Valium or Versed (Benzodiazapines), Fentanyl (a narcotic), and Brevital (a short acting barbiturates) or Propofol. Medications are given as a cocktail, which means they are combined but each is given in small doses to avoid risks and complications while achieving the desired anesthesia level.

What other medications given during anesthesia?

  • Steroids: minimizes swelling; given as single IV dose.

  • Antibiotics: If there is existing infection.

  • Anti-nausea mediation (e.g. Zofran)



Is IV sedation Safe?
IV sedation is a very safe and predictable when administered by an experienced clinician with proper training and accepted protocol. Dr. Kazemi is a board-certified oral and maxillofacial surgeon with extensive anesthesia training. He is licensed in administration of both IV and consious sedation. Patients are continually monitored during anesthesia and emergency equipment is on hand, if necessary. The medications used have a long history of safety and are short-acting.  Anesthesia is also safe In patients with respiratory problems or cardiovascular disease, providing that precautions are taken. To avoid possible airway compromise, patients with severe upper respiratory compromise, such as severe cold with stuffy nose and productive cough are best to postpone the surgery until they feel better.

We provide full monitoring during anesthesia including EKG, blood pressure, pulse rate, pulse oximeter (measures oxygenation), pre-cordial stethescope, and CO2 monitoring. The facility is equipped with emergency equipment and medications and the entire team is trained to manage any possible complications quickly and properly. The surgeon is CPR and ACLS certified and can manage any complications that arise effectively and quickly. Suburban hospital is in close proximity in the event additional assistance is required.

Is it possible to wake up during anesthesia or surgery?
The anesthesia is given to keep you in a steady state of sleepiness and avoid waking up during surgery. This is accomplished by administering small increments of the medications in regular intervals during surgery. Very rarely, a patient might briefly wake up during procedure. If that happens, additional medications are given and patient will fall asleep again within a few seconds. This short and brief awake period is rarely recalled by the patient. Some patients have very high tolerance to anesthesia medications and remain some what alert, even after receiving considerable amount of medication. In these patients, surgery will be done under a lighter state of anesthesia, but patients remain quite comfortable.

What are possible side effects or complications?
Anesthesia is remarkably safe when administered with proper protocol, monitoring, medications, and expertise. Rare potential complications include nausea, vomiting, respiratory depression, clinically significant changes in blood pressure, and cardiovascular problems. Complications are prevented by taking a good patient medical history and examination, taking proper precautions in those with certain illnesses, continuous monitoring, supplemental oxygen, judicious use of medications, availability of emergency medications and equipment, and a well trained surgeon and team.

Nausea following surgery is the most common side effect with IV sedation. A prophylactic dose of an anti-nausea medication (such as Zofran) can be given during procedure to help decrease nausea in susceptible patients. It often resolves spontaneously by the evening or the next day. If mild, carbonated soda can help resolve it. If it is more severe, anti-nausea medication may be prescribed in either pill or suppository forms. Also, you might consider not taking strong narcotic pain medications until nausea has subsided. Ibuprofen or Tylenol can be substituted during this time.
Allergies to anesthesia medications are extremely rare.

Recovery from anesthesia
As soon as the procedure is completed, you will immediately wake up, often in response to  a simple tap on the shoulder. You can walk a few minutes later with help of assistants to the recovery room where you will relax for 30 to 45 minutes before going home.  You can not drive after surgery and must have someone must take you home. You might feel sleepy for the rest of the day. It’s best to take a nap at home and just relax. By the next day, most people have recovered from effects of anesthesia and can return to some normal activities. The overall time for recovery can vary based on patient’s tolerance and physiology, anesthesia time, and amount of medications administered.

How soon can I return to work, school, or normal activities after procedure and anesthesia?
Most patients return to work, school, or some normal activities one to two days after surgery. Most schedule their surgery on a Friday and can be ready to go back by that Monday. There is no problem with traveling or flying the following day, although it’s best to rest for a day or two. Of course there is always individual variations in overall recovery.

What is nitrous oxide or laughing gas?
This is laughing gas. While it  provides some relaxation, the patient is still awake and aware of the procedure. This approach may be adequate for simple procedures or those who are less anxious. It may also be used in children having simple extractions of primary teeth.

It is administered via a nasal mask. After two to three minutes, patient will experience relaxation and light headedness. It also acts as an analgesic decreasing discomfort from the procedure. Following the procedure, nitrous oxide gas is stopped and patient is given 100 percent oxygen. After two to three minutes, the effect of nitrous oxide is gone and patient regains normal feeling.
Patients may eat prior to nitrous oxide sedation and drive home safely. An escort is not necessary.

Is Laughing gas safe?
Laughing gas is extremely safe in both children and adults and there no long lasting side effects. It is always administered with minimum of 30 percent oxygen.

What is Local Anesthesia?
This is the ‘numbing’ only approach. The patient is fully awake. Although he or she is numbed adequately, so there is no pain, there are other sensations that may be uncomfortable, like pressure, vibrations, or sounds. Local anesthesia is also given to patients following IV sedation or nitrous oxide sedation. The numbness gradually resolves over three to four hours following the procedure.

Is local anesthesia safe?
Local anesthesia when administered in proper dose, is very safe. People often use the term “novocaine” when talking about local anesthetics… even though novocaine has not been used in dentistry for decades (both because it wears off too quickly and because allergies to novocain and other ester-based -caines are relatively common). All the -caines used for local anesthesia these days are amides rather than esters.

True allergies to the local anesthetics used nowadays are exceedingly rare – only a few cases have been reported worldwide. Some people are allergic to preservatives in local anesthetics. Patients may rarely experience heart palpitations, shaking, sweating, or feeling faint, which are not the symptoms of a true allergy.

Medical Precautions
Precautions and special considerations are necessary in patients with certain medical conditions. You may consult with your physician or speak to the oral surgeon for specific recommendations.

Heart murmur: Patients with heart valve disease may require antibiotic prophylaxis prior to surgery to prevent bacterial endocarditis. High-risk patients requiring antibiotics include those with artificial heart valves,  history of prior infective endocarditis, certain congenital heart conditions, constructed shunts, any repaired congenital defects with prosthetic valves or devices, and cardiac transplant with valve problems.  Antibiotics are no longer necessary for patients with mitral valve prolapse,  rheumatic heart disease,  bicuspid valve disease, calcified aortic stenosis, congenital heart conditions such as ventricular septal defect, atrial septal defect, and hypertrophic cardiomyopathy.  The new guidelines were updated in 2007 by American Heart Association*.

Heart disease: Patients with a history of heart attacks, chest pains, enlarged hearts, arrhythmia, and valve disease may require special precautions. First, it is important to have a proper physical exam by your doctor to make sure your condition is stable. You may continue all of your medications without change throughout your treatment. Patients with heart attack (myocardial infarction) may have elective oral surgery after six months to minimize risks. However, with a good functional status, necessary oral surgical procedures may be done between six weeks and three months without undue added risk.
Local anesthesia with epinephrine is used with caution and limited dosage in patients with cardiovascular disease. Sedation is highly recommended to minimize stress on a patient’s heart while providing continued monitoring and supplemental oxygen. Your oral surgeon may consult with your doctor for other necessary precautions.

*Reference: 2007, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Fever, Endocarditis, and Kawasaki Disease Committee, Council on Association: A Guideline From the American Heart Association Rheumatic Prevention of Infective Endocarditis: Guidelines From the American Heart

High blood pressure: Hypertension must be controlled with proper blood pressure medications prior to your surgery. Do not alter your regimen; all medications should be taken normally throughout your treatment.

Patients on blood thinners: If you are on Coumadin, it is best to stop it 72 hours before surgery, if approved by your physician. If it is not advisable to stop the Coumadin, your physician may change the dosage and perform a blood test to check the levels. Patients on aspirin or Plavix may continue the medication as routine, although bleeding might be slightly more prolonged. Patients with bleeding disorders should see their hematologist prior to any oral surgery.

Asthma: If having IV sedation, bring your inhaler with you on the day of surgery. Two puffs are usually recommended right before surgery. Patients with severe asthma that has required hospitalization may require other therapy by their physician before surgery.

Diabetes: Patients with uncontrolled diabetes have significant chances of infection and poor healing. Proper control is essential for the overall health. Well controlled diabetic patients can have oral surgery safely with no more risk for infections than non-diabetic patients. If you are insulin dependent and having IV sedation, take half of your normal dose on the morning of surgery as you can not eat or drink anything. You will be given IV fluids with dextrose to help keep you sugar level up during surgery. Non-insulin dependent patients may continue other medications as normally as possible. Antibiotics are often prescribed after the surgery as prophylaxis.

Patients on steroids: Patients with adrenal insufficiency or long term steroid therapy for various medical conditions have decreased production of natural steroids, critical in many regulatory functions of the body. Such patients are recommended to take steroid supplements by doubling their normal dose on the morning of surgery. It may also be administered intravenously during surgery.

Patients on Bisphosphonates: Patients taking bisphosphonate drugs may have increased risk of osteonecrosis of the jaw bone. Patients using the oral form (Fosamax, Actonel, and Boniva) for more than three years should discontinue medication for 3 months before surgery. Those on IV form (Zometa, Aredia, Boniva-IV form) are best to avoid surgery and seek non-surgical options. Risks and benefits should be discussed thoroughly by your surgeon.

Pregnancy: It is always best to defer any elective oral surgery until after delivery. Treatment in the first or last trimester is avoided, unless absolutely necessary. However, if oral surgery must be performed due to pain or infection, local anesthesia is the only method of choice. Medications considered safest are Acetaminophen, Penicillin, Codeine, Erythromycin, and Cephalosporin. Aspirin and Ibuprofen are not used because of possible bleeding.

Breast feeding: Medications known to enter milk and potentially affect infants should be avoided. Acceptable drugs can be delivered according to age and size of the baby. The older the child, the less chance of a problem with the drug. Drugs that can be used sparingly include Acetaminophen, antihistamines, Codeine, Erythromycin, Fluoride, Lidocaine, and Clindamycin. Drugs that are potentially harmful to the infant include Ampicillin, Aspirin, Barbiturates, Diazepam, Penicillin, and Tetracyclines.

Gag reflex: Patients with gag reflex may have difficulty tolerating upper wisdom teeth surgery. IV sedation is highly recommended to prevent gag reflex and make the patient comfortable during surgery.

Insurance, Fees and Payment Options
The cost of depends on type of anesthesia and length of procedure. There is no cost for local anesthesia. Once an X-ray has been reviewed and treatment plan completed, the exact cost will be discussed. Anesthesia services are often considered under dental insurances. We have several payment options including short- and long- term plans. Those with insurance may choose to pay the fees and receive reimbursement directly from their insurance company, or pay an approximate co-pay and we will submit the necessary claims. If you need special financial assistance to prepare for your desired procedures, a separate evaluation appointment is recommended.