Anaesthesia (GA) / Unconcious Sedation
anaesthesia in Adults / Children (being put to sleep) is a treatment
available for all.. For most adults / children, general sedation
works acceptably well. If sedation fails then GA can be provided.
General Anaesthesia is used to perform root canal therapy procedures
or even to have a complete cosmetic makover done. Talk to our
dentist to find out more.
are General Anaesthesia and Deep Sedation?
(GA) is when you are totally unconscious. In this state, you
can't feel any pain. You can't reliably breathe on your own,
so for more complex procedures (such as fillings - these are
actually more complex than extractions under GA!) and procedures
of longer duration you need to having a "breathing tube"
Deep sedation is a state of
depressed consciousness, where you may lose the ability to breathe
independently and you can't respond to verbal commands. However,
you can still feel noxious stimuli like pain, so local anesthesia
is General Anaesthetic Adminstered ?
All Day All
Night Dentist arranges to have GA administered by a registered
Aust Qualified Anaesthetist, in a theater environment (following
the guidelines of the Australian Anaesthetists Society).
The dental surgeon requires
special additional training which is provided the faculty of
dentistry (Sydney University) to be able to provide this dental
treatment under GA.
"In assessing the needs
of an individual patient, due regard should be given to all
aspects of behavioural management and anxiety control before
deciding to treat or refer for treatment under general anaesthesia.
General anaesthesia for dental treatment should only be administered
in a hospital setting with critical care facilities. All dentists
involved in arranging or providing treatment under general anaesthesia
should discuss with the patient advice and treatment options
to avoid or reduce future episodes of general anaesthesia.
GA is usually started off with
an injection in the hand or arm. It can be supplemented by a
face mask but if a face mask is used you probably won't remember
If post-op pain is expected,
the normal practice is to inject a long acting local anaesthetic
during the GA, so that when you wake up everything is nice and
numb for a good few hours (say 6 hours?) afterwards, which should
give you time to take some painkillers and allow them to kick
in. It's much better to premptively stop pain than it is to
try to deal with it once it has started.
Apart from the risk of death
(which, while very small, is still significantly higher than
for conscious IV sedation), general anesthesia has a few major
(1) Complications are more likely
with GA compared with conscious sedation both during and after
the procedure. GA depresses the cardiovascular and respiratory
systems. For some groups of medically compromised patients,
it is contraindicated for elective procedures.
(2) Laboratory tests, chest
x-rays and ECG are often required before having GA, because
of the greater risks involved.
(3) Very advanced training and
an anesthesia team are required, and special equipment and facilities
(4) You can't drink or eat for
6 hours before the procedure (otherwise, vomiting is possible
and this would be extremely dangerous during GA).
(5) There are additional costs
regarding theatre fees and Anaesthetists fee ( however medicare
provides up to 70% rebate on the anaesthetists fee)
Are there any circumstances
under which general anesthesia should be used?
Exceptional circumstances include treatment for certain groups
of special needs patients, procedures which would be very unpleasant
if you were conscious (such as very complex extractions of bony
impacted wisdom teeth), certain other types of oral surgery,
and people with an extreme anxiety of dental procedures for
whom conscious IV sedation isn't enough (although IV sedation
works fine for about 97% of people with a high anxiety of dental
If it's extractions
that really terrify you, it may be possible to be put to sleep
for the extractions and then have fillings etc. done under conscious
sedation with local anaesthetic. However, general anaesthesia
is not widely on offer, and must be carried out in a hospital,
in the UK at least.
Fear of the
dental experience has been demonstrated to be one of the most
significant barriers to the delivery of quality dental care.
When the stress of the dental treatment situation is combined
with dental fears, some patients find themselves unable to successfully
have dental treatment done. In our practice, the most common
type of anesthesia used is local anesthesia. In most cases,
this is the only drug agent necessary. Most patients tolerate
the local anesthesia well, and they recognize this feeling of
having their lip numb for a dental procedure.
As noted above,
there are many people who require a different approach for various
reasons. For the patient who fears the required treatment, I.V.
sedation offers a way to have required dental treatment done
in a non-threatening manner. Other patients who benefit are
those who need surgical procedures or a very large amount of
work to be done at one time.
For these situations,
we use intravenous sedation because it is a very conservative
and appropriate method of controlled patient management during
dental procedures. Sedation is the calming of a nervous, apprehensive
individual through the use of drugs, without inducing the loss
of consciousness. This highly effective technique requires the
introduction of drugs directly into a vein, and it has the advantage
of giving maximum control to the treating doctor as well as
giving comfort to the patient.
is not placed under general anesthesia, for the patient’s protective
reflexes are still in place, including the ability for the patient
to maintain his own airway. Appropriate monitoring equipment
is used during the I.V. sedation appointment. A pulse oximeter,
an EKG monitor, and supplemental oxygen will be used during
the appointment. The use of intravenous sedation has been a
very effective tool in our practice for outpatient dental care
in many different situations.
It is our hope
that this discussion has helped with your understanding of the
procedures that have been proposed for you. Please feel free
to ask further questions if you have any concern.
Some people have such
dread of going to a dentist that they will avoid treatment even
when severe problems arise. For these patients, our team of
professionals recommends IV Sedation as a safe and painless
solution to both their fears and their dental care requirements.
IV Sedation allows patients to interact with the dentist in
a sleep-like state where they feel no pain and lose subsequent
conscious memory of the procedure. IV Sedation uses a variety
of FDA-tested drugs that are administered by the dentist to
achieve this unique state of consciousness that frees patients
from both fear and pain.
During IV Sedation,
the dentist uses a combination of anti-anxiety drugs to place
the patient in a deeply relaxed state of consciousness that
allows the patient extremely limited interaction with the dentist
but inhibits sensation. The dentist delivers the IV Sedation
dosage through a very small and thin needle wrapped in a soft
plastic tube that goes into a vein in either the arm or the
back of the hand. After insertion, the dentist removes the needle,
leaving only the plastic tube, or “Venflon” in the skin.
The drugs go
into the bloodstream through the Venflon, which remains in place
throughout the IV Sedation procedure. While administering the
dosage, the dentist talks with the patient to determine the
appropriate sedation level. Remember, IV Sedation differs from
the completely anesthetized condition of surgery patients. Patients
often report being in a fog-like state where they feel nothing
and forget details of the procedure, although they do remember
the needle insertion (normally only a scratch) and the dentist’s
Most drugs used
by dentists for IV Sedation fall into the anti-anxiety category-
the most common being Benzodiazepine (“benzo”), Midazolam, and
Diazepam. The majority of dental professionals prefer Midazolam
for IV Sedation because it purges itself from the system more
rapidly than other drugs. Some dentists also use Valium, but
it remains in the system longer and can produce a burning sensation
when first entering the veins.
patients, some dentists will mix a local anesthetic with a Diazepam
IV emulsion that the drug manufacturer claims makes IV Sedation
easier on vein tissue. Diazepam enters the bloodstream at 1mg
per minute, while Midazolam enters the bloodstream at 1mg every
two minutes due to its additional strength. Each patient is
different, so the dentist carefully considers which drug is
the best choice in each individual case of IV Sedation. Additionally,
the dentist will monitor both patient response to the drug and
vital life signs.
Once the patient
reaches the correct level of sedation, the drug is turned off,
but the Venflon remains in place so that if necessary the dentist
can administer additional amounts. In the unlikely event of
a rare emergency, the dentist can also use the Venflon to treat
the patient with an appropriate counteragent.
1. A responsible adult
must accompany the patient home. Sensory imbalance should be
expected following the dental office sedation, and the patient
must be supported while ambulatory.
2. Following dental office
dismissal, mild sleepiness may persist for several hours, and
the patient should be encouraged to go to bed and sleep.
3. The patient should
be cautioned against sitting up or standing erect suddenly after
a rest period at home, as this may lead to transient dizzy spells.
4. The patient is not
to engage in any activity that requires sensory or motor coordination
for 24 hours following the dental appointment. Driving a car,
operating power tools, or making important decisions are not
to be done during this period.
5. The patient should
not indulge in any alcoholic beverages for 24 hours following
the dental appointment.
6. If needle puncture
site remains painful, apply moist heat to the site.
7. Nausea may develop
if patient is ambulatory too soon or frequently. Make patient
lie quietly in bed.
8. Take postoperative
medication only as ordered by your dentist.
9. Any unusual event
such as pain or swelling at needle puncture site, any rash,
prolonged sleeping, fainting episodes, marked vomiting, or bizarre
dreaming should be reported.