Properly Sedating Your Patients is Not One Size Fits All
A routine procedure commonly performed by trained Oral & Maxillofacial Surgeons is the administration of anesthesia to our patients. While a local anesthetic (i.e. “Novocaine”) is what ultimately allows us to work on our patients without hurting them, fear and apprehension of the anticipated oral surgery is not addressed by local anesthesia, but by our administered anesthetics.
While the procedure is “routine,” anesthesia is not a “one size fits all” process.
As anesthesia providers, we need to assess the expectations of our patients pre-operatively in terms of what level of consciousness or unconsciousness they anticipate having during their procedure. Our surgeons feel comfortable providing deep sedation to our patients if their medical histories allow. This is different from general anesthesia, in a hospital setting, where the goal is to render patients completely unconscious.
The goal of deep sedation is to adequately depress patients’ level of consciousness to the point where their anxiety is eliminated, their memory of the procedure is limited and their awareness of what is going on is minimized, while at the same time ensuring that they are still breathing effectively.
A variety of factors come into play when assessing a patient’s past medical history to determine how best to proceed with each individual’s anesthetic.
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Older and younger patients both can require decreased dosing of anesthetic medications to obtain the proper anesthetic effect.
Obese patients with a high BMI (Body Mass Index) are at increased risk for anesthetic complications from many different standpoints and may require treatment in the controlled environment of a hospital Operating Room in order to safely take care of them. Small, thin patients may also require decreased dosing.
History of cardiovascular or pulmonary disease
Anything that would compromise a patient’s ability to adequately pump blood to perfuse organs (previous heart attack, abnormal heart rhythm, valvular heart problem, etc.) or to adequately breathe (obstructive sleep apnea, asthma, COPD, smoking) may necessitate that we change or alter the patient’s anesthetic plan to ensure we are “taking care of the whole patient, and not just their tooth.”
History of alcohol or recreational drug use/abuse
This can significantly alter the way the patient’s liver metabolizes the anesthetic drugs and put them at risk for acute withdrawal.
Ultimately, our job as oral surgeons is to safely and efficiently perform the procedures each patient came for in a comfortable, non-stressful and most importantly, safe environment. A properly administered anesthetic will provide this, but may be very different for any two given patients.
The vast majority of patients we see will be able to proceed safely with the anesthetic they need or desire. Of course there are always going to be patients who, for safety reasons, have to go to a hospital operating room, surgery center or even have to change their anesthetic plan to something like an oral premed (Valium or Ativan) coupled with Nitrous/Oxide.
Making sure the patient is safe and comfortable is critical. And, while properly administering anesthesia may seem routine, it is anything but!