Anesthesia: Experience Matters

In an effort to provide the most comfortable and effective treatment, Board Certified Oral and Maxillofacial surgeons, Dr. Monteleone and Dr. Kessler are both trained and licensed to offer the highest expertise in anxiety control and anesthesia using the most modern and safest medications at South Tampa Oral and Dental Implant Surgery.

From nitrous oxide and IV conscious sedation to deep sedation and general anesthesia, combined, Dr. Monteleone and Dr. Kessler have safely completed thousands of anesthetics. Both doctors are also certified in Advanced Cardiac Life Support (ACLS).

Types of Anesthesia

There are a few types of anesthesia available for most surgical procedures. Although, the patient’s medical history and the complexity (and duration) of the surgery may dictate only one option in some circumstances, most often our patients have the option of choosing between one of the following anesthesia options. Please, note that each option includes local anesthesia. Local anesthesia refers to the numbing medication that you may have received at your dentist’s office in the past. The difference between the options below has to do with the level of the patient’s awareness/consciousness.

Nitrous Oxide for Oral Surgery

Nitrous oxide, or laughing gas, is available for office procedures. This serves to make the patient feel more relaxed and also provides significant analgesia (pain control). Laughing gas is suitable for minor procedures with fairly relaxed patients. Nitrous oxide is very safe, and patients can generally function normally, including driving after a short recovery period.

IV (intravenous) Sedation

This includes: minimal sedation, moderate sedation and deep sedation. IV sedation utilizes an arm vein for access for the medications. This anesthetic makes the patient much more relaxed and the depth of sedation is “titrated” to the desired effect for the procedure being performed.

General Anesthesia

By far the most utilized mode of anesthesia in an oral surgery office is general anesthesia. This allows the patient to sleep throughout the procedure unaware of the surgery being performed. A small IV is placed into an arm vein, and total intravenous anesthesia (TIVA) is administered. These medications are fast acting and metabolized quickly, which allows for continuous infusion of safe, but effective doses. When the procedure is finished, the infused doses are discontinued, and the patient wakes relatively quickly. Patients generally find this anesthetic very comfortable and enjoyable. Nausea is uncommon and can usually be avoided in susceptible patients.

Frequently Asked Questions

How safe is IV anesthesia?

IV anesthesia is considered to be very safe especially in healthy patients. Several studies have been done to look at the level of safety of anesthesia performed by an oral surgeon, and all have demonstrated safety at or above the safety level of any other setting.

Is an Oral and Maxillofacial Surgeon qualified to perform anesthesia?

Absolutely. After graduating from dental school, oral and maxillofacial surgeons are required to receive at least four years of hospital based, formal post graduate training in Surgical Critical Care, Cardiology, Pulmonology, General Surgery, Emergency Medicine, ENT, Pediatrics, Plastic Surgery as well as extensive training in Anesthesia and Facial Trauma. Both Dr. Kessler & Dr. Monteleone received intensive training at Level One Trauma Centers. They cared for the most critically injured patients.

An oral surgeon’s training includes operating room anesthesia; however, the large majority of the training and experience is in office anesthesia. This is a relatively narrow scope that allows the surgeon to concentrate his abilities on a small range of anesthetics and techniques. This makes oral surgeons very proficient at the type of anesthesia that they do, thus accounting for the extremely high safety rating.

Is the anesthesia performed by an oral surgeon different than that performed by a dentist?

Yes. There are four levels of licensure for dental practitioners.

Level One: This gives the dentist the certification to give local anesthesia (numbing shots) without which no civilized dentist could practice.

Level Two: This certifies the dentist to give nitrous oxide (laughing gas). All dentists have Level One and Level Two certification.

Level Three: With a few additional hours of training, dentists may obtain Level Three certification. This allows them to perform IV conscious sedation. By definition, conscious sedation requires that the patient be awake and able to converse throughout the procedure. You are not asleep with level III anesthesia.

Level Four: Generally, only certified oral surgeons obtain the training necessary to receive Level IV certification. This allows them to perform deep sedation or general anesthesia in which the patient is asleep throughout the procedure. This requires specialized training and specialized monitoring, and provides a much more comfortable level of anesthesia for most procedures. An oral surgeon can perform any of the four levels of anesthesia, and can therefore provide the greatest flexibility in anesthesia options.

Are there other benefits to IV anesthesia?

Yes. The IV access gives the ability to give other medications that are very beneficial to patients. We give long lasting pain medication, medication to decrease swelling, and medication to prevent nausea along with the anesthetics. These help tremendously in the overall comfort of our patients.