Ambulatory Anesthesia

Anesthesia

Ambulatory Anesthesia Oral and maxillofacial surgeons as well as dentists in general have always prided themselves on making patients comfortable during procedures. This is often accomplished by the administration of local anesthesia (novocain). Sometimes, however, a patient will want to be asleep for certain procedures. Ambulatory anesthesia is the administration of medications in the office that induce either general anesthesia in which the patient is totally asleep or sedation in which the patient is in a semi-conscious state. It just so happens that the oral and maxillofacial surgeon is a unique clinical practitioner who has extensive anesthesia training which enables him to provide this service for his patients. As a result, we are often able to perform procedures in the office that otherwise might have required treatment in the hospital operating room.

How Should I Prepare Myself to Receive an Ambulatory Anesthetic?

Prior to the beginning of your anesthetic, several non-invasive (painless) devices will be attached to you that will be used to monitor your health and physiologic progress through the anesthetic. These devices are typically a blood pressure cuff, an ECG (electrocardiogram) and a pulse oximeter (a device that measures the amount of oxygen in your blood). Therefore, it is suggested that you wear loose clothing to facilitate the application of these important devices.

Secondly, if a patient is to receive an ambulatory or general anesthetic, it is imperative that they have an empty stomach for 6 full hours prior to any intravenous anesthesia (this includes liquids and water). Although most of the more modern anesthetic medications are kind to the stomach and do not produce nausea, occasionally just the anxiety that one has about having surgery can generate a queasy feeling in one’s stomach. The simple precaution of not eating or drinking before anesthesia can prevent what might otherwise be an uncomfortable bout of nausea.

More importantly, during a general anesthetic some of our protective reflexes (coughing, swallowing, etc.) are temporarily suppressed and a patient who became sick with a full stomach could present a potentially dangerous scenario of choking. There are no dietary restrictions for procedures performed with local anesthesia (Novocain) alone. Finally, if you are receiving an ambulatory anesthetic, you will require an escort and/or someone to drive you home. Most doctors would suggest that a minimum of six hours pass without further medication before you attempt to drive a motor vehicle or operate machinery. This time varies, however, and is something that you should ask your doctor.

In summary:

Wear loose clothing
Do not eat or drink for a minimum of six hours prior to your appointment (including water)
Bring a driver and/or an escort with you (do not plan on driving or operating machinery until the next day)

What Medications Will I Receive?

Every case is different but there are certain medications that the oral and maxillofacial surgeon will typically utilize. Versed and Valium are examples of a drug called benzodiazepenes. This type of medication relieves anxiety (anxiolytic) and provides sedation as well as amnesia to the surgery.

Fentanyl and Demerol are examples of narcotics. These medications act as pain killers (analgesics) during the surgery. Propofol is a short-acting, intravenously administered hypnotic agent that is unrelated to the barbiturates that were typically used in years past (pentothal, etc.). It is a medication used to induce a state of general anesthesia (total unconsciousness) but generally allows for rapid awakening and greater mental clarity when compared to more outdated anesthetics. Nitrous oxide or laughing gas is almost universally given to aid in the anesthesia process. It has both sedative and analgesic properties. All patients will also receive oxygen which is most commonly delivered through a nasal mask (a small mask that covers the nose).

How Are the Medications Administered?

Most of the medications that you will receive are given intravenously. Your surgeon will place a small intravenous line in your arm before the surgical procedure begins after which all medications will be given through this route. This remains in place until the end of the procedure. In addition to the intravenous route described above, you will receive oxygen and possibly some laughing gas through a nasal mask. When administering anesthesia to young children, a cherry flavored oral sedative (Versed) is often used in combination with “laughing gas” to produce an amnesic and/or hypnotic level of anesthesia to avoid the need for an intravenous line (needle). All of the medications that we use are short acting and enable the patient to recover rapidly. It is not unusual for the patient to be discharged and walk out of the office within 15 to 30 minutes of completion of the procedure. The patient will, however, need and escort and someone to drive them home.

How Long is the Recovery Period?

Everyone metabolizes medication at different rates. This means that some patients wake up very quickly while others more slowly. On the whole, the medications used are short acting and patients feel normalwithin a few hours after the procedure. We recommend that driving or operating heavy machinery wait until the following day. Most patients will easily return to work or school the next day following ambulatory surgery and anesthesia unless they necessitate the use of mind and reflex altering medications to control pain.

Ambulatory anesthesia has allowed the oral and maxillofacial surgeon to perform many procedures in the office without the need for a hospitalization. This modality has also allowed the patient to be extremely comfortable during their surgical procedures. Moreover, this format of delivering anesthesia has, statistically, one of the longest track records of safety and effectiveness.

Most states have very strict guidelines regarding the administration of anesthesia in the office which insures the safety to the patient. As do most oral and maxillofacial surgeons, we follow the guidelines set forth by our state regulatory body. By doing so, our office is inspected regularly, we maintain a state license which is renewed every year, and all office staff are certified in CPR. All of our surgeons have been certified in Advanced Cardiac Life Support.

The oral and maxillofacial surgeon has advanced training in all aspects of anesthesia and emergency care. Through the use of ambulatory anesthesia, we pride ourselves on our ability to make your surgical experience a painless and comfortable one.

Office Policies on the Delivery of Ambulatory Anesthesia

For the sake of the patient’s safety, family members will be asked to sit in the waiting room while anesthesia is being administered and the patient is undergoing surgery.

All patients will be required to have an adult escort with them who will be responsible for transporting the patient home after the delivery of any ambulatory anesthetic.

The information listed above is the opinion of the doctors of Connecticut Maxillofacial Surgeons, L.L.C. and does not necessarily reflect the opinion of the specialty as a whole.