Surgical Instructions

What You Should Know About Anesthesia

Oral and Maxillofacial Surgeons are unique among the surgical specialists with regards to anesthesia training. Every oral and maxillofacial surgeon, during their residence, receives formal anesthesia training with the department of anesthesia. They are taught the skills to safely administer anesthesia to patients. This includes IV sedation, general anesthesia, airway management and intubation techniques. This also includes complete training in Advanced Cardiac Life Support. It is our utmost goal to make your surgical experience as pleasant and stress free as possible while maintaining the highest levels of safety.

During the initial consultation you and Dr. Casciato will discuss the type of procedure involved, your medical history and your level of anxiety. For those persons that have anxiety re: intravenous start, we offer several methods to ease your anxiety both at home and in office. You can discuss your options with Dr. Casciato. Some procedures, due to their nature, require the use of general anesthesia or IV sedation; whereas, others are best accomplished under local anesthesia. The choice of anesthesia is always a personal decision and should be made only after an informative consultation with Dr. Casciato. In addition, during the initial consultation, you will also be given instructions to prepare for surgery such as: wearing loose, comfortable clothing, not having anything to eat or drink after midnight prior to surgery, taking all of your regular medications, bringing an escort with you and making arrangements for your recovery at home.

Coming to our office for the day of surgery and anesthesia is no different than having surgery in the hospital and it is often much more user friendly. The equipment in our treatment rooms and recovery rooms are similar to those used in the hospitals. When you arrive in the treatment room the nurse will connect you to a number of monitors. These devices are typically a blood pressure cuff, an EKG (electrocardiogram) and a pulse oximeter (a device that painlessly measures both your pulse rate and the amount of oxygen in your blood). Therefore, it is suggested that you wear loose clothing to facilitate the application of these important devices. Dr. Casciato is always on call and he can also answer any emergency questions you have in regards to your care following surgery.

Frequently Asked Questions

What is General Anesthesia?

Most of us are familiar with “hospital” general anesthesia for the removal of an appendix or gallbladder. Most certainly all of us associate hospital general anesthesia with a complex variety of tubes and ventilators as seen on TV. The complete relaxation of the musculature and blocking of conscious pain by rendering the patients unconscious allows surgeons to perform very invasive surgery.

What Is Office Intravenous Anesthesia And How Does It Differ From Hospital General Anesthesia?

Office intravenous anesthesia is far simpler than hospital anesthesia in that a ventilator and complete muscle relaxation are unnecessary and undesirable for office oral surgical procedures. Yet both hospital and office anesthesia are similar in that the patient remains unaware (asleep) during the ongoing surgical procedure. Also, both types of anesthesia allow for elimination of pain and anxiety.

What Is IV (Intravenous) Sedations?

IV sedated patients are not aware of their immediate surroundings. The patient is in a sleep-type state and is breathing on their own.

What Is Local Anesthesia?

This involves administration of a “Lidocaine” shot which numbs or freezes a small area so surgery can be performed without altering consciousness. Using local anesthesia only, the patient is completely alert and fully aware of his or her surroundings. Local anesthesia does not decrease the patients level of anxiety towards the surgical procedure.

Are There Times When Local Anesthesia Doesn’t Work During Oral Surgical Procedures?

Yes. In order for the local anesthetic to work, the tissue pH must be neutral or slightly alkaline. Fortunately, local anesthesia works well in noninfected tissue because normal tissue pH is slightly alkaline. However, many patients whom oral surgeons need to treat have infections which cause the tissue pH around the infected tooth to become acidic. This acidic pH does not allow for optimal effectiveness of the local anesthetic which results in the patient experiencing pain during the extraction. IV anesthesia allows the removal of infected teeth without causing distress and pain to the patient because tissue pH is not a factor in its effectiveness. Finally, local anesthesia doesn’t treat the anxiety many patients have associated with dental surgical procedures. IV anesthetics effectively treat dental anxiety and allow for a safer and more comfortable environment for the patient to undergo surgery.

Are There Any Special Requirements For Anesthesia?

Yes. Nothing by mouth, no food or liquids after midnight the evening prior to surgery.

Are There Any Exceptions To The Rule Nothing To Eat or Drink?

Yes. Regular medications for heart, blood pressure, seizure disorders, thyroid conditions, ulcers, gastric reflux, and asthma should absolutely be taken with the smallest amount of fluid which easily permits the pill to be swallowed. Patients who require antibiotic pre-medication should also take their medication with a small amount of water. Patients who are on chronic prednisone therapy may actually need to take more prednisone than they normally would take. Please bring your prednisone pills with you to the office.

Are There Patients Who Should Not Take Their Regular Medications?

Yes. Patients who have diabetes medications or are taking prednisone, anticoagulants, diet drugs, and anti-hyperactivity drugs should speak with the Dr. Casciato prior to any surgical procedure. Patients who take anti-hyperactivity drugs and diet medications should not take these medications on the day of surgery. Patients who are insulin-dependent diabetics should be appointed early in the morning and will be instructed what dose of insulin to administer.

Surgical Instructions

Pre-operative instructions for patients undergoing intravenous anesthesia – see Instructions For Intravenous Sedation