Several methods of anesthesia are available. The method of anesthesia that is chosen for or by a patient depends upon the nature of the surgical procedure and the patient’s level of apprehension.
The following table illustrates the choices of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.
MethodTypes of AnesthesiaDescription of TechniqueUsual Indications
Method Local AnestheticDescription of Technique The patient remains totally conscious throughout the procedure. A local anesthetic (e.g. lidocaine) is administered in the area where the surgery is to be performed. Local anesthetic is used in conjunction with the other methods of anesthesia in all oral surgery procedures.Usual Indications Simple oral surgery procedures such as minor soft tissue procedures and simple tooth extractions.
Method Nitrous Oxide Sedation with Local AnestheticDescription of Technique A mixture of nitrous oxide (laughing gas) and oxygen is administered through a nasal breathing apparatus. The patient remains conscious in a relaxed condition. Nitrous oxide has a sedative and analgesic (pain- controlling) effect.Usual Indications Simple oral surgery procedures to more involved procedures such as removal of wisdom teeth and placement of dental implants.
Method Office Based General Anesthesia with Local Anesthetic*Description of Technique Medications are administered through an intravenous line (I.V.). The patient falls asleep and is completely unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Diprivan. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored.Usual Indications General anesthesia is available for all types of oral surgery. A patient may choose general anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or having a dental implant placed will choose general anesthesia. General anesthesia may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.
Our Nurse Anesthetist, Greg Aprilliano
Greg Aprilliano, CRNA has over 30 years of experience in healthcare. He has practiced as a nurse anesthetist for last 20 years. His anesthesia experience is wide-ranging and has included the care of patients during procedures such as open heart, organ transplantation, trauma resuscitation, general surgery as well as the care of adult and pediatric patients in the office setting.
Greg received his undergraduate Bachelor of Science in Nursing degree from the University of Vermont in 1994. Over the ensuing years he practiced in Baltimore, MD. He then practiced at the R. Adams Cowley Shock Trauma Center in critical care including multi-trauma, neurotrauma-intensive care and trauma resuscitation units. He went on to work with the Transplant Resource Center. There he specialized in organ procurement and placement of donated organs. Here he was one of five organ procurement coordinators in the state of MD. This entailed working with organ donor families and patients throughout the state and nation. He then attended the nations top ranked anesthesia program at Virginia Commonwealth University. He graduated with honors earning a Master’s Degree in Nurse Anesthesia in 2002. Upon graduation he was awarded the Agatha Hodgins CRNA Memorial award for academic and clinical excellence. Once a board certified nurse anesthetist, He practiced in Richmond Va. where he covered a busy hospital operating room caring for patients undergoing operations ranging from open heart, neurosurgery, vascular to pediatric oral surgery. In 2009 he moved his family to Plymouth, NH where he was one of two anesthesia providers covering the local hospital their included the emergency department, obstetrics and surgical services.
He remains passionate about his work and dedicated to the safety and well being of patients while under his care regardless of the setting. He remains committed to continually advancing his skill set to ensure his patients remain pain free, safe and happy with their care. He has been a board certified nurse anesthetist through the NBCRNA (National Board of Certification and Recertification for Nurse Anesthetists) since 2002. He is also a member of the following organizations committed to clinical excellence and patient safety.
- AANA (American Association of Nurse Anesthetists)
- NHANA (New Hampshire Association of Nurse Anesthetists
- ASRA (American Society of Regional Anesthesia)
- AAPM (American Academy of Pain Management)
- ACLS (Advanced Cardiac Life Support)
- PALS (Pediatric Advanced Life Support
Again, when it comes to anesthesia, our first priority is the patient’s comfort and safety. If you have any concerns regarding the type of anesthesia that will be administered during your oral surgery procedure, please do not hesitate to discuss your concerns with your doctor at the time of your consultation.
Intravenous Sedation (“Twilight Sedation”)
Our office offers our patients the option of Intravenous Sedation or Dental Intravenous Anesthesia or to some it is referred to as “Twilight Sedation” for their dental treatment. Intravenous Sedation or “twilight sleep” helps you to be comfortable and calm when undergoing dental procedures. Your treatment can be completed under intravenous sedation. Intravenous sedation or “IV sedation” (twilight sedation) is designed to better enable you to undergo your dental procedures while you are very relaxed; it will enable you to tolerate as well as not remember those procedures that may be very uncomfortable for you. IV sedation will essentially help alleviate the anxiety associated with your treatment. You may not always be asleep but you will be comfortable, calm and relaxed, drifting in and out of sleep – a “twilight sleep”.
If you choose the option of intravenous sedation your IV sedation/anesthesia is administered and monitored by the doctor therefore eliminating the costly expense of having your treatment carried out in an operating room or same day surgical facility.
How is the IV sedation administered?
A thin needle will be introduced into a vein in your arm or hand. The needle will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. At times a patient’s vein may not be maintainable, in these situations the medications will be administered and the needle retrieved – both scenarios will achieve the same desired level of conscious sedation. Once again some patients may be asleep while others will slip in and out of sleep. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated and may not sleep at all.
The goal of IV sedation is to use as little medication as possible to get the treatment completed. It is very safe, much safer than oral sedation. With IV sedation a constant “drip” is maintained via the intravenous tube. At any time an antidote can be administered to reverse the effects of the medications if necessary. Along with IV sedation there are also other different “levels” of sedation available to you in our office. There is nitrous oxide analgesia.
Nitrous Oxide (Laughing Gas)
Nitrous Oxide is a sweet smelling, non irritating, colorless gas which you can breathe. Nitrous Oxide has been the primary means of sedation in dentistry for many years. Nitrous oxide is safe; the patient receives 50-70% oxygen with no less than 30% nitrous oxide. Patients are able to breathe on their own and remain in control of all bodily functions. The patient may experience mild amnesia and may fall asleep not remembering all of what happened during their appointment.
There are many advantages to using Nitrous Oxide
- The depth of sedation can be altered at any time to increase or decrease sedation.
- There is no after effect such as a “hangover”.
- Inhalation sedation is safe with no side effects on your heart and lungs, etc.
- Inhalation sedation is very effective in minimizing gagging.
- It works rapidly as it reaches the brain within 20 seconds. In as few as 2-3 minutes its relaxation and pain killing properties develop.
Reasons to Not use Nitrous Oxide
Though there are no major contraindications to using nitrous oxide, you may not want to use it if you have emphysema, exotic chest problems, M.S., a cold or other difficulties with breathing. You may want to ask your dentist for a “5 minute trial” to see how you feel with this type of sedation method before proceeding.