What is a general anesthetic? How is is different from sedation?
During a general anesthetic the patient is completely asleep and totally unaware of the surgical procedure. Sedation is a state of relaxation. The sedative medication can be administered either by mouth, inhalation or intravenously. Sedation depth can vary from "mild" where there is relief from anxiety, to "deep" where the patient is extremely relaxed and has little recall of the procedure.
Most of the time, you will receive a general anesthetic for your dental procedure. You may be offered sedation if this is an appropriate and more suitable option. This will be discussed with you before the procedure.
I know someone who was supposed to be asleep for their dental work, but woke up in the middle. Will this happen?
The most common cause of ‘waking up’ during dental surgery is because the patient is receiving moderate or deep sedation rather than a general anesthetic, and therefore some recall of events is expected. (see above)
Waking up during a true general anesthetic is known as "awareness" and is extremely rare. It is more likely during some types of surgery and some types of anesthetic, for example when muscle relaxant drugs are used. Under some circumstances, the amount of muscle relaxant is not correctly matched with enough anesthetic medication, and awareness can occur. I do not use muscle relaxants as part of the anesthetic for dental procedures, so awareness is virtually unheard of.
How do you know I will be properly asleep?
Your blood pressure, electrocardiogram, pulse and blood oxygen levels are monitored continuously during the procedure. These provide valuable information about how deeply asleep your are. In addition, the amounts of oxygen and anesthetic gases you are breathing are monitored breath by breath. Everyone is different in how much anesthesia medication they require, and the amount you receive is individually adjusted to an appropriate level for you.
My next door neighbour's sister-in-law's cleaner says it is not safe to have an anesthetic outside a real hospital. Is this true?
If your neighbour's sister-in-law's cleaner was administering the anesthetic in her kitchen, I would agree. However, all non-hospital surgery facilities are inspected and certified by either the BC College of Physicians and Surgeons or the College of Dental Surgeons of BC to ensure that equipment, procedures, and staffing meet provincial standards. The same standards apply regardless of whether the location is a government hospital or an independent facility.
Not all patients are suitable for treatment in a free standing facility. Our screening procedures will identify patients for whom a general anesthetic in the non-hospital setting might not be appropriate. If there is any doubt, we will arrange for you to meet with the anesthetist to review any medical issues before proceeding. If anesthesia or surgery is deemed unsuitable for an independent facility, alternative arrangements will be made.
What is the difference between an anesthesiologist and an anesthetist?
In Canada the terms are interchangeable, general anesthetics are administered by medically qualified doctors with specific training in anesthesia..
In the US, an anesthesiologist is a physician, while the term anesthetist usually refers to a nurse with special training in providing anesthesia.
Is general anesthesia safe?
Modern day anesthetic medications, monitoring procedures and techniques make an anesthetic extremely safe. Having said that, there is always a risk, just as there is in driving a car or taking a plane flight. In fact, statistics suggest that the risk of death from a general anesthetic is comparable to that of a commercial flight.
What happens if my child is scared of dentists and needles, and is unlikely to cooperate with having an IV injection?
This is not uncommon. Most of the time, with the combination of the anesthetic cream on the hand and a little distraction, we are able to start an IV with minimal discomfort. If this is not possible, the anesthetic can be administered by having your child breathe through a mask. However, this technique has the disadvantages that it takes longer and the smell of the anesthetic gas can be unpleasant.
What happens if I have an allergic reaction to the anesthetic?
Present day anesthetic drugs are highly unlikely to generate an allergic resopnse. In the rare event that the patient does react to the medication, we have all the same medications, equipment and expertise required to treat the reaction as is available in any hospital.
After how long will I or my child be able to go home following the dental procedure?
This varies depending on the individual, and the length of the surgical procedure. Most patients are ready to leave about 30 minutes after the end of the procedure, some take a little longer. You will not be discharged until we are happy that you are safe to go home.
Can I meet my anesthetist before the procedure?
Yes. If you have any concerns and wish to schedule an appointment, please contact your Dentist's or Oral Surgeon's office. If you wish to contact me directly, please email me.
How will I feel when I wake up?
Most patients wake up feeling good. During the procedure, any areas that might be uncomfortable afterwards will have local freezing put in while the patient is asleep, so pain on waking up is not common. A small number of patients may experience nausea or vomiting. If you have had these symptoms after anesthesia before, or are particularly prone to motion sickness, let me know and I will give you extra medication to help prevent post-operative nausea.
When will I feel normal?
The effects of the general anesthetic will have disappeared within a few hours of the procedure, but you should not drive, operate heavy machinery or make important decisions for 24 hours. When you feel completely back to normal will depend on the dental procedure, and whether you are taking any other pain medication afterwards. The nurse will go over those details with you before you are discharged.
Who will be giving me my anesthetic?
At Dr. Brad Forster's office and the Delbrook Surgical Centre I administer virtually all the general anesthetics for dental procedures. Occasionally, if I am not available, a certified anesthesiologist (usually from Lions Gate or the Royal Columbian Hospital) will stand in.
What should I do to prepare for the anesthetic?
Your dental or oral surgeon’s office will give you instructions on how to prepare for your anesthetic. It is extremely important to comply with these instructions. Failure to do so may increase the risk of the anesthetic and can result in cancellation of the procedure.