Several methods of anesthesia are available. The method of anesthesia that is chosen by a patient during the consultation appointment with Dr. Özcan, depends upon the nature of the surgical procedure and the patient’s level of apprehension.
The following table indicates the choices of anesthesia available, a description of the anesthetic techniques, and the usual indications for each anesthesia modality.
MethodTypes of AnesthesiaDescription of TechniqueUsual Indications
Method Local AnestheticDescription of Technique The patient remains fully conscious throughout the procedure. A local anesthetic (e.g. lidocaine) is administered in the area where the surgery is to be performed. Local anesthetic is used prior to all oral surgery procedures, and may be used in conjunction with other methods of anesthesia.Usual IndicationsLocal anesthetic is administered prior to all oral surgery procedures, from minor soft tissue procedures and simple tooth extractions, to removal of multiple teeth and other more complex procedures.
Method Office Based Intravenous Sedation Anesthesia with Local Anesthetic*Description of Technique Medications are administered through an intravenous line (IV). The patient falls asleep and is generally unaware of the procedure being performed. Medications most commonly used are Propofol® (a sedation agent), Remifentanyl (an opiate), Versed® (a benzodiazepine), and Ketamine. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.A patient may choose to have their oral surgery procedure completed under intravenous sedation anesthesia. Depending upon one’s level of anxiety, intravenous sedation may be very helpful for a patient, even when undergoing relatively simple procedures. Most patients having their wisdom teeth removed or implants placed choose to do so under intravenous sedation. In the presence of infection, intravenous sedation anesthesia is an adjunct to local anesthesia, the effectiveness of which is compromised in these circumstances.
Method Hospital or Surgery Center Based General AnesthesiaDescription of Technique A patient is admitted to the hospital where Dr. Özcan performs the oral and maxillofacial surgical procedure(s), working together with the Anesthesiologist who administers the anesthesia.Usual IndicationsGeneral anesthesia is indicated for patients undergoing extensive procedures such as face and jaw reconstruction. General anesthesia administered in a hospital setting is also indicated for patients with significant medical conditions such as heart disease or lung disease.
To administer deep intravenous sedation in the office, an Oral Surgeon must have completed an extensive four year Residency in Oral and Maxillofacial Surgery, of which six months is dedicated solely to anesthesia training within a hospital based program. In the province of British Columbia, offices are inspected annually to ensure that the competency of the practitioners and their respective facilities meet the provincial standards as established by the College of Dental Surgeons of British Columbia. Dr. Özcan and the surgical team are extensively trained in Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS) and Basic Life Support (BLS).
With regards to a patient’s surgical experience, our greatest priorities are patient safety and well-being, in addition to patient comfort. While the majority of patients will experience a constant deep sedation state, there are circumstances whereby this is not always the case. This may translate to a surgical experience which involves varying degrees of sedation, dependent upon a patient’s response during the sedation process. It may not always be possible to sustain a patient in a continual state of sedation throughout the entirety of the surgical procedure, as circumstances may not permit the surgical team to maintain a deeper level of sedation. A lightening of sedation may be indicated during the procedure, whereby patients will be aware of their surroundings but continue to have a pleasant experience, while still attaining the goal of an optimum result. Please remember that our utmost priority is patient safety, and an accompanying positive surgical outcome. If you have any questions or concerns regarding the type of anesthesia that will be administered during your oral surgery procedure, please do not hesitate to discuss this with Dr. Özcan at the time of your consultation.
Light Intravenous Sedation (“Twilight Sedation”)
There are circumstances under which deep sedation is not appropriate for some patients, perhaps related to one’s health status and/or medical history. This would be assessed during one’s initial consultation with Dr. Özcan. In such cases, our office offers the option of surgery being performed under a lighter form of intravenous sedation, which may be referred to as “Twilight Sedation”. This type of sedation helps one remain calm and comfortable while undergoing dental procedures. Intravenous sedation (“IV sedation” or “twilight sedation”) permits one to undergo surgical treatment while feeling very relaxed. Such sedation enables one to nicely tolerate the procedure, while not recalling those procedures that may otherwise be somewhat uncomfortable. IV sedation will essentially help alleviate the anxiety associated with your treatment. Although you may not always be asleep during the procedure, you will be comfortable, calm and relaxed, drifting in and out of sleep – a “twilight sleep”.
How is the IV sedation administered?
Administration of IV sedation involves a small needle being introduced into a vein in your arm or hand. The needle will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. (If you are apprehensive having needles, an EMLA® patch may be purchased at the pharmacy prior to your appointment, and applied to the inside of the elbow (usually one’s left elbow) and/or the back of one’s hand (generally one’s left hand). The EMLA® patch(es) should be placed 1 hour prior to your surgical appointment.