<p>I'm getting my wisdom teeth out in 3 days and I'm getting IV general anesthesia. I looked up what that means and it looks as though there could be some pretty bad results if done wrong (hypoxia-->brain damage, death, etc.), albeit a pretty low risk. But an anesthesiologist will not be present, just the dentist. This has me worried because it seems he should be trained to perform something that is potentially dangerous. Should I be worried, or am I freaking out for no reason?</p>
<p>I figured I'd post it here because I assumed there must be some brilliant CCer studying anesthesiology at med school who can help me. I do not mean to opine about anesthesiology; I'm just very worried.</p>
<p>Thank you!</p>
<p>If you worried, do not use Anesthesia. I have 6 implants and every time I had a surgery, I insisted on no sedation. Every time my dentist practically flipped over it. But he cannot put you under without your consent. I said, I want to drive and want to drive straight to work…and he could not do absolutely anything about it. One time he had to actually knock my tooth out using hammer. He said, he warned me. I did not care. The shots are very strong, I did not feel any pain, and my mouth is exceptionally sensitive (by my dentist assessment). I want to know what is going on, I want to be able to let them know if it hurts (never did during implant surgeries). I am like you, I am more afraid of Anesthesia than a little pain. Pulling tooth is not as bad as drilling the bones for the implant.
However, do not take it from me, do whatever you wish. You will hurt after anyway.</p>
<p>well first off there are options less severe than general (novocaine only, laughing gas, valium) all of which still keep you conscious. I personally went with the gas option as novocaine doesn’t do much for me but I’d had gas before for a different oral surgery and it was great in terms of pain management and then you’re back to normal within 5 mins of stopping. My dad has always opted for the valium infusion the couple times he’s had oral surgery. My friend’s dad won’t even let them use novocaine. Diff strokes for diff folks.</p>
<p>In terms of the use of general, it’s pretty common in terms of wisdom teeth extraction, particularly if you’re getting all 4. Dentists must receive training in the use of general anesthetics in order to use them. My understanding is that the level of sedation is not as intense as what is needed in normal surgery which is why they don’t need as much training.</p>
<p>Thanks for the answers! I’ve been getting nose bleeds lately because I took some aspirin a few days in a row for headaches, and if I were to get a nosebleed the morning of (removal is at 9am), would that blood loss hedge against hypoxia by reducing the overall amount of blood to oxygenate?</p>
<p>" I personally went with the gas option as novocaine doesn’t do much for me "
- you must be kidding, novocaine works for the most severe cases of sensitivity. There are very few people out there who have had as much done in their mouth as me. I simply refuse to pull them all out and have removables, while most will go for it in my condition. I have never had sedation of any kind for the dental work, I refuse. Novocaine works just fine. If it does not initially, you have to ask for additional dosage (done it). But for any surgery they give you a horsy dosage to begin with, you will not feel anything, I guarantee, even knocking the tooth with the hammer (crooked root, I was warned about it) did not bother me a bit, not the slightest. I have very very sensitive teeth, I can teel the problem few years before any x-ray show anything at all.</p>
<p>I think the important questions should focus on the appropriate monitoring, the adequately trained personnel, and the readily available emergency equipment. Approximately 10 years ago, the anesthesia closed claims project reported a 9 fold increase in lawsuits when providers used IV sedation and IV general anesthesia, instead of general anesthesia with a secured airway. Don’t think for one second that these offices (surgery suites) are always equipped according to standards. Breaches are common. You can Google the recent dental scandal in Oklahoma or the pediatric dental deaths website that describes many tragic events nationwide. I wouldn’t choose IV general under any circumstances anyway. It is either general anesthesia with a secured airway or I am wide awake receiving local anesthetics.</p>
<p>By the way, my wife took my youngest daughter to a dentist that had no pulse ox, no crash cart, no nurse, and gave no direction for fasting. I was floored that he wanted to give my d nitrous oxide. I didn’t let it happen.</p>
<p>I would ask the doctor about taking the aspirin before surgery. That’s generally not a good idea, as it thins the blood. I would hope your nosebleeds are not so severe that a significant amount of blood is lost. If it is, you shouldn’t be having surgery! If you take aspririn and thin the blood, not only do you risk a nosebleed, but you also risk uncontrolled bleeding when they remove the teeth. Youngest D is having a palate expander removed in a couple of weeks, and they suggested she take tylenol an hour before as a hedge against pain - they were specific it should be tylenol, not aspirin or ibuprophen, because they would thin the blood, and could complicate things if any teeth come out with the palate expander.</p>
<p>As for the original question, I would opt for gas if it’s available. I had 2 impacted wisdom teeth removed when I was 19, in the hospital under general, as an outpatient. Will there be an assistant in the room specifically to monitor your vitals during the extraction? If there is a complication, how close is the nearest hospital? I wouldn’t expect complications, but would want to know they could handle them if necessary.</p>
<p>General anesthesia implies that you will be intubated (tube inserted into trachea) to help with breathing. This seems extreme for dental work. My suspicion is that you will not be getting general anesthesia- this requires an Anesthesiologist to be present, I had my wisdom teeth out and received deep sedation with Propofol. You should confirm the exact plan of sedation that you will be receiving.</p>
<p>General anesthesia doesn’t always mean intubation. As in TIVA (total iv anesthesia) can be a general anesthesia given without intubation. Or you can have an LMA which does not transit the trachea, yet it is used for general anesthesia. The American Society of Anesthesiologists describes general anesthesia as a state of unconsciousness such that reflexes to pain is suspended. In several states, CRNAs can provide general anesthesia without an anesthesiologist.</p>
<p>I do agree that you have to ask the details of what you will be receiving.</p>
<p>Frugaldoctor, what do you mean by a secured airway? Is that through the trachea as another poster was talking about?</p>
<p>I don’t think my nosebleeds have been very severe, so I’ll probably be okay, but I’ll definitely refrain from using aspirin before then.</p>
<p>I’ll be taking Valium and Amoxicillin (forgot the dosage) 2 hrs before the surgery, and then some numbing shots. Would I be able to go through the procedure on just that?</p>
<p>frugal,
“or I am wide awake receiving local anesthetics.” - This is exactly my choice every time. I am happy to hear your opinion as an MD that supports my choice. I never understood the reason to be under when you do not feel any pain, not a bit.</p>
<p>BTW, dentist gave me antibiotics (if I remember correctly) to take before surgery and continue after and definitely Advil - like 800 I believe. But again, I took it only because I know I am OK with Advil, actually this drug has helped me time and again and the only one that I trust. I would not have taken it if I had a stomach problem (common wth Advil).<br>
But shots are so strong, you will not feel any pain, the general is strictly for you psych. and nothing else.</p>
<p>miami, without divulging too much personal information (although the well informed will still piece it together), I have a genetic condition that makes me significantly less sensitive to anesthetics. You are right that eventually the novocaine works (all I really meant was that it takes a lot and it makes me anxious to deal with it), but I distinctly remember the dentist being surprised by how much I needed and if I recall it took something like 6 or 8x the normal dose to finally do enough for me. I’d rather deal with that while being a little cognitively impaired from the gas than on my own.</p>
<p>So if I get somewhat nervous about shots (just uncomfortable, and feel a bit faint afterward), would it be best to get the anesthesia?</p>
<p>Brown,
Sorry to hear about it.</p>
<p>Everybody is nervious about shots, they are painful. But they are more painful in front than on a back of your mouth. And again, pain after the teeth are pulled is much worse and it lasts much longer. Shots are very temporary discomfort.
It is your personal decision to get the general anesthesia or not, as you can see everybody is different about it.</p>
<p>OP,</p>
<p>I’ll lay it out the way my dentist did, which made me feel very confident in my choice. You should obviously talk it over with him since maybe some of these options aren’t available.</p>
<p>I had 5 choices for pain management in ascending order of intensity.</p>
<ol>
<li><p>Absolutely nothing - highly unrecommended by the dentist</p></li>
<li><p>Novocaine shots only - perfect for the person who either feels comfortable enough with the surgery that all they want is local anesthetic or for the person who feels more uncomfortable with a mind altering substance than the surgery.</p></li>
<li><p>Novocaine shots + gas. The gas will make you feel a little funny and put you in a bit of a euphoric state. I would describe it as being fully aware of what was going on but also much more easy to tune out what was going on if I desired. I basically didn’t care as much about the small amount of pain or the whirring noises etc. The gas wears off within minutes of cessation. My dentist said this was ideal for someone who had a little bit of anxiety about the process.</p></li>
<li><p>Novocaine shots + IV valium (+ gas I think - don’t remember). I didn’t opt for this but I remember it was described as being almost asleep but not quite. You’ll be barely conscious/responsive and pretty difficult to arouse. The valium won’t wear off for a couple hours after the surgery. My dentist said this was for someone who is pretty anxious about the process.</p></li>
<li><p>General. This required the surgery be performed at a hospital, not the office (that may or may not apply to your guy depending on his facilities). This would put you fully unconscious although I’m pretty sure there is no intubation because how would the dentist operate on your mouth with a tube in there? He said this was for someone who was very anxious and wanted absolutely nothing to do with the surgery. You would have no recollection of anything and it takes several hours for it to wear off.</p></li>
</ol>
<p>From your responses, it sounds like general is not needed and something like gas or valium would be more appropriate.</p>
<p>I would also talk to him about headphones/music and such. My dentist provided me with a very nice set of headphones to plug into my phone so I could listen to music during the surgery. Yours might not provide them but I’d be surprised if he wouldn’t let you wear your own although I think part of why he provided his own is so that he could guarantee they would be over ear headphones instead of buds so that he could easily lift it away to say stuff to you and then put it back.</p>
<p>Great reply! My appointment is in about 10 hours, so I’ll talk to the dentist beforehand about the various options, and I’ll let you guys know how it goes. May be a while though if I do end up doing general, as I’ll probably be sleeping intermittently well into the afternoon (My brother got his teeth out using this method 2 days ago; I’m a bit more concerned about brain-related procedures than he is, but his experience gives me some confidence).</p>
<p>For oral surgeries, the patient receiving general anesthesia may be intubated nasally and that gives the dentist complete access to the mouth.</p>
<p>^didn’t think about that. That makes sense - I don’t remember whether my dentist mentioned intubation for general or not. Between that conversation being a little over 3 years old and the fact that I knew I wouldn’t do general anyway it’s hard to remember.</p>