Pre-Surgical Considerations

Anesthesia options
Managing anxious patients
Pre-surgical instructions
Antibiotic prophylaxis
Patient taking medications

Anesthesia options
There are three anesthesia options: IV sedation, nitrous oxide, and local anesthesia. IV sedation is the most recommended and best option chosen by most patients. It can be safely administered to patients of all ages — from five to 85. Most patients recover by the following day. Very simple extractions and biopsies maybe performed with nitrous oxide or local anesthesia as long as the patient is not very anxious. For children with simple extractions, IV sedation or nitrous oxide are appropriate options. Some children appear cooperative and calm, but can quickly change at time of the surgery. It is best to always inform parents of the potential IV sedation needs and prepare them accordingly.

Managing anxious patients
Anxiety is not uncommon for patients having oral surgery. Recommend IV sedation anesthesia and let them know about our personable and calming staff and atmosphere. You can further elaborate on our unique techniques (minimally invasive approaches) that speeds up recovery and minimize pain and swelling in most patients.

Pre-surgical instructions

  • Take all routine medications as normal (except anticoagulants and bisphosphonates)
  • Do not smoke
  • Avoid food or liquids for 8 hours prior to surgery
  • Have an escort (older than 18)
  • Patients on coumadin: best to stop 72 hours before surgery if approved by physician
  • Patients on oral bisphosphonates: best to stop three months before surgery if approved by physician and procedure is not emergent or urgent. If it is an emergency, it may be performed with informed consent.
  • Antibiotic prophylaxis is recommended for certain heart valve conditions and prosthetic joints (see below)

  • Antibiotic prophylaxis

Pre-operative antibiotics are indicated only for patients with one of the following conditions (there may be history of heart murmur or not):

  1. Artificial heart valves
  2. History of infective endocarditis
  3. Some congenital heart defects, such as a completely repaired heart defect with prosthetic material or device
  4. Any repaired congenital heart defect, or cardiac transplant which develops a problem in a heart valve

Antibiotics are NO LONGER NEEDED for the following types of patients (who say they have heart murmur):

  1. Mitral valve prolapse
  2. Rheumatic heart disease
  3. Bicuspid valve disease
  4. Calcified aortic stenosis
  5. Congenital heart conditions such as ventricular septal defect, atrial septal defect, and hypertrophic cardiomyopathy

** If a patient is not sure of their condition, get their physician’s telephone number and call to find out!

Antibiotic regimen for prevention of infective endocarditis:

  • Not penicillin allergic:  Amoxicillin 2 g, 60 minutes before surgery
  • Penicillin allergic:  Cephalexin 2 g, Clindamycin 600 mg, Azithromycin 500 mg, or Clarithromycin 500 mg  30-60 minutes before surgery

Antibiotic regimen for prosthetic joints:

  • Not penicillin allergic:  Amoxicillin 2 g, Cephalexin 2 g, or Cephradine 2 g, 60 minutes before surgery
  • Penicillin allergic:  Clindamycin 600 mg 60 minutes before surgery

Patient taking medications:

  • Insulin: If having IV sedation, patient should take half of the normal insulin dosage in the morning. AM appointments are recommended.
  • Coumadin: If approved by their physician, stop the coumadin 72 hours before surgery. Patient may get back on it the following day after surgery.
  • Plavix: No changes are necessary, although some physicians may recommend stopping it for five days before surgery.
  • Aspirin: It may be beneficial to stop it 72 hours before surgery, but bleeding is usually not a significant concern, although it may take longer to stop.
  • Steroids: Patient should take double the normal dosage on the morning of the surgery.
  • Blood pressure medications: Continue on medications as routine. If having IV sedation, patient may take them on the day of surgery with a small sip of water.