Conscious Sedation for Wisdom Tooth Extraction

BaldEagle

Forum Ride Along
3
0
0
I just had three taken out yesterday. I had nitrous, then the sedation and the Novocain as extra precaution. I dont remember anything from the surgery but afterward i insisted i can walk then walked into the door. I was basically out of it for the rest of the day. Today i am not really in pain its just uncomfortable and saddening not being able to eat what looks good :sad:
 

silver

Forum Asst. Chief
762
1
18
Ive had 9 teeth pulled at one time (baby and adult) with only novocaine. Never again...
 

Cup of Joe

Forum Captain
273
1
0
I had a few orbicularis otis muscles removed with only novocaine. Need to get all my wisdom teeth removed soon.
 

medicdan

Forum Deputy Chief
Premium Member
2,488
13
38
rwik, rather than share personal experiences (I've had several, including tonsil removal under general this past summer), let me try to refocus you on questions to ask...

-- Who, how many, and what qualifications are the personnel in attendence? Who will be in the room with you, who is in the office/building? Is your DDS performing the procedure with a hygenist present? Is there an RN? You mentioned the dentist is also an MD-- what specialty, what post-med school training (other than dental residency)? Does your dentist have BCLS? ACLS? Hygenist?

-- What meds, specifically is the provider planning on using? IV to be established? Who's starting the line/qualifications? What sedatives? Propofol? Ketamine? Versed? What analgesia during the procedure? Fentanyl? Nitrous?

-- What equipment/procedures does he use to monitor you during the procedure? BP? Pulse? How often? Cardiac Monitor? O2 Sat? What are his capabilities policies if anything deviates from normal?

-- What emergency equipment and procedures exist, and how readily? Does the office have an AED? Manual defib? Advanced airway equipment? Policies for when to call EMS? Average response time (you may know this best)?

-- What is you're provider's rate of complications? How often does he perform this particular procedure/how long have they been doing it? Changed procedure recently? Active in local professional community? Journals? Dental equivalent of M&M Rounds? How transparent are they about their success/complications? Infection risks? KevinMD.com had an interesting blog post a few days ago about how we all feel our surgeon is "the best" but perhaps we need to look deeper into their track records.
http://www.kevinmd.com/blog/2011/12/informed-judgment-abilities-surgeon.html
-- What is the local precedent for propofol use in outpatient clinics? Does your DPH require particular standards to be met, and does the office have this credential? Is propofol commonly used for surgeries like your's, or is another drug used more commonly? Why one or the other? Do non-dental providers commonly use propofol in outpatient clinics? What monitoring is required in hospital when it's used?

-- What does the consent form look like?

After asking these questions, you need to think for yourself how you feel about these risks and contingencies. There's a fine line between being an empowered patient and being a pain in the ***, but you're a medical professional yourself and understand the risks better than many other patients.

I'll leave my questions for you here... Good luck, let us know how it works out!
 
Last edited by a moderator:

rwik123

Forum Asst. Chief
718
6
18
rwik, rather than share personal experiences (I've had several, including tonsil removal under general this past summer), let me try to refocus you on questions to ask...

-- Who, how many, and what qualifications are the personnel in attendence? Who will be in the room with you, who is in the office/building? Is your DDS performing the procedure with a hygenist present? Is there an RN? You mentioned the dentist is also an MD-- what specialty, what post-med school training (other than dental residency)? Does your dentist have BCLS? ACLS? Hygenist?

-- What meds, specifically is the provider planning on using? IV to be established? Who's starting the line/qualifications? What sedatives? Propofol? Ketamine? Versed? What analgesia during the procedure? Fentanyl? Nitrous?

-- What equipment/procedures does he use to monitor you during the procedure? BP? Pulse? How often? Cardiac Monitor? O2 Sat? What are his capabilities policies if anything deviates from normal?

-- What emergency equipment and procedures exist, and how readily? Does the office have an AED? Manual defib? Advanced airway equipment? Policies for when to call EMS? Average response time (you may know this best)?

-- What is you're provider's rate of complications? How often does he perform this particular procedure/how long have they been doing it? Changed procedure recently? Active in local professional community? Journals? Dental equivalent of M&M Rounds? How transparent are they about their success/complications? Infection risks? KevinMD.com had an interesting blog post a few days ago about how we all feel our surgeon is "the best" but perhaps we need to look deeper into their track records.

-- What is the local precedent for propofol use in outpatient clinics? Does your DPH require particular standards to be met, and does the office have this credential? Is propofol commonly used for surgeries like your's, or is another drug used more commonly? Why one or the other? Do non-dental providers commonly use propofol in outpatient clinics? What monitoring is required in hospital when it's used?

-- What does the consent form look like?

After asking these questions, you need to think for yourself how you feel about these risks and contingencies. There's a fine line between being an empowered patient and being a pain in the ***, but you're a medical professional yourself and understand the risks better than many other patients.

I'll leave my questions for you here... Good luck, let us know how it works out!
This morning was the day of my procedure! It went much better than i though it would.

-All the anesthesia was done my a CRNA

-Maybe someone can help me out with this part. I was under the impression that this procedure was going to be conscious sedation. When i go back for the follow up next week i'll have to ask about the details. When I asked what drugs they were using she said propofol with other gases to keep me asleep. I was actually ASLEEP. Not the twighlight sleep or conscious sedation with versed, fet, and propofol. The last thing I remember was her pushing the propofol and her placing a mask over my face (which was hooked up to the normal OR suite anesthesia machine). Later when I woke up, my left nostril was numb. Was a nasally intubated? How could they manage me sleep with gases when they were working on my mouth? Do they often utilize nasal intubation for dentistry? The doctor was a DMD, MD..MD in Oral and Maxillofacial surgery, and DMD in dental medicine. I assume both her and the CRNA had ACLS.

-Meds were propofol with the gases she mentioned (don't remember which ones specifically..administered i assume through the machine). She mentioned 2 other drugs which I can't recall along with a dose of zofran. Was hooked up to an EKG, NIBP, pulse ox and i imagine gases were monitored through the drager machine.

Thanks again for the all the wisdom and advice everyone. I wouldn't question going through this experience again and recommend it to anyone going through any oral surgery procedure.

oh and oxycodone does wonderful work :yay:
 
Last edited by a moderator:

BaldEagle

Forum Ride Along
3
0
0
just a quick tip that i would do if i could do it again...keep up wit the meds! yesterday was day 2 for me and i was barely swollen and in little pain so i didnt take my meds so i could respond to calls. well last night the swelling and pain flared and i was taking over the counter stuff so i had to wait several hours for them to wear off to take my vicodin. i wanted to sleep but the pain prevented me. so when they say the third day is the worst, they arent kidding. :cool:
 

VinBin

Forum Captain
274
5
18
Anytime you go "under" or are put in a "less conscious" state, there are inherent risks, why take them if you don't have to?

I've had all four wisdom teeth taken with just local (all were impacted, if that makes any difference). I'll be honest, it was relatively painless after the initial injections. I think the key is to have a skilled dentist who ensures that the entire region is fully numb more than anything else.

Now, the week that followed extraction was hell, but the procedure is very doable with just local anesthetic...
 

johnrsemt

Forum Deputy Chief
1,292
146
63
Man I don't even do fillings or root canals without Nitrous and major amounts of Xylocaine (Novacaine on steroids; and it usually doesn't make me sick afterward, except last week). Xylocaine also lasts longer, which makes drinking from a straw fun.

When I had my Wisdom teeth out the Dentist knocked me all the way out. He did it on his own dime, too; he said he wasn't going to touch me if I was awake; and my parents insurance wouldn't pay for knocking me out. So the dentist paid for it.

I will admit freely: I am a dental WIMP
 

johnrsemt

Forum Deputy Chief
1,292
146
63
I don't let the dentist touch me for things like that if I am awake. I had an oral surgeon in Indiana call my Dentist in Utah about my history, before he did a cyst removal, and my dentist told him that he (dentist) would pay half the general, because the oral surgeon wouldn't be able to touch my mouth if I was awake, but the insurance wasn't going to pay for it. The Oral Surgeon and my dentist (from 3 years earlier) split the cost of general. I don't remember the day at all.

I do heavy Xylocaine and heavy Nitrous, and I don't sleep for 24-36 hours before for a root canal, and I still hate it
 

Remi

Forum Deputy Chief
Premium Member
3,776
2,406
113
I do heavy Xylocaine and heavy Nitrous, and I don't sleep for 24-36 hours before for a root canal, and I still hate it
What is heavy xylocaine?
 

CANMAN

Forum Asst. Chief
689
326
63
Yeah..its being done in an oral surgery office..doctor is a MD/DDS. From what everyone else has been saying it seems to be very safe. The only thing that bothered me was the out of hospital part..being that when administering any type of anestesia you want to be able to provide life support and step beyond the level you are performing. IE, intubation/respiratory measures even when you are performing conscious.
Common practice, oral surgeon's offices do this stuff day in and day out. My old program used to rotate in and out of an oral surgeon's office to do intubations on the regular. You will be fine....
 

johnrsemt

Forum Deputy Chief
1,292
146
63
Lots and lots of Xyolocaine; My wife has to do Valium the night before and morning of Dental work but I drive her in for it, but I can't do that because I usually do it on days that I go in by myself. It is a 50 minute drive 1 way.
 

Remi

Forum Deputy Chief
Premium Member
3,776
2,406
113
Lots and lots of Xyolocaine; My wife has to do Valium the night before and morning of Dental work but I drive her in for it, but I can't do that because I usually do it on days that I go in by myself. It is a 50 minute drive 1 way.
The reason I asked is because when referring to local anesthetics, "heavy" means that solutes (usually dextrose) have been added to the anesthetic in order to make the solution hyperbaric as compared to CSF. It usually refers to 0.5% or 0.75% bupivacaine being used for a spinal anesthetic. I had never heard of hyperbaric ("heavy") lidocaine and couldn't imagine why it would be used for dental infiltration or nerve block.

For whatever it's worth, "Xylocaine" is just a brand of normal lidocaine. It and bupivacaine are the most commonly used local anesthetics, and lidocaine is only a little more potent than procaine (Novocaine), which I don't think is really used anywhere anymore.
 
Top