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. This is a collaborative decision between Dr. Arné and the patient.
All Oral and Maxillofacial Surgeons are trained to administer outpatient Anesthesia. To administer anesthesia in the office, an oral surgeon must have completed at least three months of hospital-based anesthesia training. After this training, Oral Surgery residents continue to provide additional anesthetics within their residency programs. This consists of providing up to hundreds of anesthetics being delivered in outpatient clinical settings. Oral and Maxillofacial Surgeons vastly exceed the training requirements of other medical specialties who perform outpatient anesthetics in their offices (GI, Cardiology, etc..). In fact, adverse anesthetic outcomes in Oral and Maxillofacial Surgery offices are quite rare when compared to other medical and dental practitioners who provide outpatient anesthesia. This is because the Oral Surgeon is closely involved and is always hands-on with a patient’s airway and can physically see and correct problems before they arise.
After graduating with a DDS degree in ’97, Dr. Arné was accepted into the UNC-CH Department of Anesthesiology as a resident. He interviewed alongside many newly graduated MD’s for this very competitive position. In short, Dr. Arne’ had the privilege of receiving additional training in Anesthesiology prior to being accepted into his Oral and Maxillofacial training program. Dr. Arné adheres to the standards given by the American Society of Anesthesiology for dental offices as well as the standards provided by the American Association of Oral and Maxillofacial Surgeons.
In the state of NC qualified applicants for a general anesthesia permit will undergo an in-office evaluation by a state dental board-appointed examiner. (Dr. Arné has served as an examiner for the State of NC since 2002). The goal of this examination is to ensure public safety for patients undergoing outpatient surgical procedures in a dental office. The examination consists of the examiner observing a live surgical procedure during which a general anesthetic is administered to the patient. The examiner is also tasked with inspecting patient monitors, emergency equipment and ensuring emergency medicines are readily available. The examiner will also review past anesthetic records, question the doctor and ancillary staff about emergency procedures, and test the doctor and the surgical staff on anesthesia related emergencies. General Anesthesia licensure is a privilege and is a very serious matter and is addressed as such. If the examinee is successful in passing the evaluation, the state dental board will issue the doctor a license to perform general anesthesia. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has a separate licensure process so that its members can administer general anesthetics. Dr. Arné has passed all licensure requirements for both the State of NC as well as AAOMS. For NC, the license is renewable every two years if the doctor maintains the required amount of continuing education units related to anesthesia.
Anesthesia Options Provided by Dr. Arné
- Local Anesthetic or “Dental Shots” (No sedation)
- Local Anesthetic with Nitrous Oxide (Used for minor procedures)
- IV or “Twilight” Sedation (A light anesthetic to provide a comforting feeling and anxiety control)
- IV General Anesthetic (Used for anxiety and pain control while also preventing surgical recall). The patient is breathing on their own during the entire procedure. This type of anesthetic is used for wisdom teeth removal and most dental implant placement procedures.
Local Anesthetic or "Dental Shots"
With this method the patient remains totally conscious throughout the procedure. A local anesthetic (e.g., Lidocaine or Marcaine) is administered in the area where the surgery is to be performed. Local anesthetics are always used in conjunction with the other anesthesia methods regardless of the oral surgery procedure.
Indications: Simple oral surgery procedures such as minor soft tissue procedures and simple tooth extractions.
Nitrous Oxide Sedation with Local Anesthetic
No Intravenous line (IV) is needed. A mixture of nitrous oxide (laughing gas) and oxygen is administered through a nasal breathing apparatus. Nitrous oxide has a sedative effect while also reducing minor anxiety and providing some pain relief. The patient’s oxygen saturation levels and other vital signs are closely monitored throughout this type of anesthetic. There will be surgical recall with Nitrous Oxide but you as the patient may just not care what is going on.
Indication: Simple oral surgery procedures to more involved procedures such as removal of wisdom teeth and placement of dental implants.
Intravenous Sedation ("IV Sedation") AKA "Twilight Sedation"
On a scale of being totally awake and having “dental shots” to having a nitrous oxide anesthetic to having a general anesthetic and being completely asleep; a “twilight sedation” or “IV sedation” is a step above a nitrous oxide anesthetic and a step below a general anesthetic. The goal of a twilight sedation is to ensure that the patient’s anxiety, pain, and comfort are well addressed. This type of anesthetic is primarily used to help alleviate the anxiety associated with your treatment. It is also used to assist in pain control that can be associated with a particular procedure. You may not be completely asleep, but you will be comfortable. You may or may not have some recall of your procedure, but you will be comfortable. You will be able to respond to commands such as “turn your head” or “take a deep breath.” Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are very closely monitored like what one would experience in an operating room.
Indication: More involved procedures, wisdom teeth removal, dental implants, surgical extraction of teeth other than wisdom teeth.
Office Based General Anesthesia with Local Anesthetic
Medications are administered through an intravenous line (I.V.). The patient falls asleep and is completely unaware of the procedure being performed. The medications most 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 very closely monitored like what one would experience in an operating room.
Indication: General anesthesia is available for all types of oral surgery. A patient may choose general anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or having a dental implant placed will choose general anesthesia. General anesthesia may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.
It is our goal to provide comfort and care while upholding the highest safety standards. We do this for our patients from the time they come into our office until our services are no longer needed (days, weeks, months, or even years later). If you have any questions and more importantly concerns regarding the type of anesthesia that will be administered during your oral surgery procedure, please do not hesitate to discuss this with Dr. Arne’.
How is the IV sedation administered?
A thin, hollow, plastic catheter with a needle inside will be inserted into a vein in your arm or hand. Once inserted, the plastic catheter is advanced, and the needle is removed. There will be no more “needle sticks” moving forward. The catheter is then attached to plastic tubing coming from a bag of IV fluid and secured with tape. The IV fluid only serves to carry the medicines into your bloodstream. It has no anesthetic properties to it. The amount and type of medicine administered for your anesthetic depends on the depth of anesthesia needed to perform the surgery. Of course, Dr. Arné will administer the least amount of medicine needed to achieve the desired outcome. Finding the right anesthetic plane for each patient is as different as there are people. There is no “cookbook” or recipe to follow. Every patient is different, and this is where Dr. Arné’s anesthesia training and experience come into play.
Is IV sedation safe?
IV sedation and IV general anesthesia are very safe. At any time during a procedure a reversal agent can be administered to reverse the effects of the medications previously given.
The reason anesthesia exists is for patient safety via pain and anxiety control. Since anxiety and pain from a procedure can cause issues with a patient’s vital signs there are times when being sedated is much safer for the patient than staying awake. It goes without saying that pain and anxiety can cause an increase or decrease in one’s breathing, blood pressure and heart rate. Therefore, if one can control a patient’s pain and anxiety through sedation then one can control a patient’s blood pressure, heart rate, and breathing. In the very rare case that a sedated patient’s heart rate, breathing, or blood pressure becomes too high or too low, the level of sedation and/ or adjunct medicines can be delivered through the IV to assist in returning the patient’s vital signs to a more normal range. If this same patient is now awake for a procedure, no IV line was be placed and what would have been a non-issue (i.e. A patient fainting after injection) is now an issue. Why react to a potential problem when planning ahead is much safer?