didn't respond to sedation

[shelly0624]

I went to an oral surgeon.
I needed to have 13, 14 and 17 extracted. I was told (20 years ago) that on a scale of 1-6, the #17 molar was a 6 in difficulty to extract. It is sideways and anchored FIRMLY into my jaw. There was a small opening in my gum at the top which allowed for decay.

The oral surgeon could not acheive "twilight". All I know is that after a lot of nervous and wordy conversation on unrelated topics...I started to feel coinsiderable pain as she worked on the #17 tooth. Initially, I wasn't overly concerned, but it was at that point that I asked...Aren't I supposed to be OUT?
(She is an MD, oral surgeon and oral anesthesiologist). She kept saying she only had a couple more things to do. I couldn't take it any more and asked for more sedative. She said she couldn't legally give me any more. She asked me if I abuse drugs or drink. No to both. She said, then it is your medication. (I take an average dose of Lamotrigin..300 milligrams. I am mildly bi-polar ..type 2. My illness is mostly characterized by big church projects to accommodate a creative outlet and too much energy..with exhaustion afterwards).

Then, frustrated, she said she couldn't do anything more and would have to stitch me up. She said I would need to be put totally under in an OR and may risk infection before then.
I was almost unrecognizable with swelling and bruising, since all the teeth were on one side.
When I went back a week later for an exam, she said that she hadn't told me anything about imminent infection or regarding the impending need for the procedure in an OR. I was afraid I was going to have to have the surgery soon again or it would become dangerously infected.
(The whole time during the procedure I was crystal-clear, not even drowsy). She said my memory was inaccurate and fuzzy. I remembered her conversation and quoted much of it to her. She said she gave me enough sedative for three men. I am about 25-30 pounds overweight. She really struck me as a fast-talker.

She really scolded me for going to the doctor for concern of infection. I had a red streak going down my jaw to my throat. (The doctor said it was the gravitational effect of the bruising..causing the discoloration to move downward). She said to come to her next time.

I had a colonoscopy and upper GI done only 8 months before, which required twilight sedation. There was no problem.
She told me that the drilling, hammering, etc made the difference, creating too much stimulation for the sedation to take affect. She had to leave the roots in either #13 or #14 (not concerned about those)..but the #17th wouldn't budge after much effort, so the roots were left in. How much of the tooth, I don't know. Since the tooth was live, I'm assuming most of it minus the decay. Because of the discomfort, it creates almost a painful TMJ effect, with pain and tightening in the jaw. For two weeks I have been on prescription strength (800 milligrams) Ibuprofen. I have been on anti-biotic and think there is no infection.

She told me me that the teeth with roots were inert, that if after 5 years or whatever, if the jaw started to reject the molar, it would have to be done in an OR in a university. She would do the procedure and I'm not sure who would be putting me under unconscious sedation.

I have Care Credit and GEHA is my insurance (A high option dental coverage). The estimate included the complete removal of the #17 molar. She wants to claim it as a complete removal and told me that if I had problems, she would take care of it for free. I am thinking that if she does this, my insurance would never allow another extraction by another surgeon. It feels dishonest, like insurance fraud. Just the sedative was about $1100. A complete removal of the #17 was $630. I'm not sure if an incomplete removal would be less. Maybe money has nothing to do with it. I'm certain she used more sedative than we were charged for.

Is it possible that a person cannot be brought to a point of twilight sedation?
I'm scared. I mean, REALLY scared. Is she were to put me under, I'm afraid I would never wake up. I found patient reviews regarding her practice. Out of 13 reviews, one said she was heavy-handed and had considerable bruising and pain. But one said she botched the anesthesia and finished the procedure while the patient was in pain. Everyone else thought it was an OK experience.
I am not one to fight for myself. I will protect others vehemently. (Childhood roots). I am confused and afraid to be an inconvenience. I'm not sure what to do. I'm not the suing type (it's against my religion, actually..barring really extreme cases)...so I'm not coming from that angle. I guess I'm knowing she's going to cause me stress if I insist on an accurate claim on my insurance.
So many things..Really, I want to know how common it is to botch conscious sedation...
Thank you, anything would be helpful.

 

[Gordon]

It sounds like one of two things.
1) The cannula wasn't properly into the vein and you weren't getting the drug IV at all
2) You weren't given enough drugs. There is no such thing as a legal limit nor an "average" dose, some people need more, some less. It's dealt with by a technique called "titration".

I think that your professional relationship with this practitioner has become unworkable and you should ask your dentist to refer you to a different surgeon.

 

[scared0902]

Was this IV or oral sedation?

I had oral sedation once, and it didn't work for me at all. I was also told that I was maxed out to the limit. I felt totally normal, even anxious. Then, when I left, I fell asleep for twenty hours

My dentist told me my liver had become used to anti-anxiety meds, and that oral sedation wouldn't work for me. I'm guessing IV sedation would still work since it's more predictable and...stronger?

 

[shelly0624]

It was an IV, not oral. I read somewhere that anxiety can cause sedation to become ineffective, but I wasn't anxious because I thought I would be "out".
I do have difficult spider-web veins. So she put the IV in my hand, if I remember right. I have large veins in my hands. Thank you both for responding. I've had nightmares for the last several nights.

 

[scared0902]

I'm so sorry you had that experience!

I'm going in for IV in a couple of months and am really counting on it to work! Could you go in for another opinion somewhere? I don't know if you are in the US, but most places do second opinions for free.

Let me know what happens!

 

[shelly0624]

I'm sure my experience is very rare and that your procedure will be fine. I have a strong feeling this was not an isolated event with this person. My problem is that I shut down and don't want to deal when I feel that my experience (no matter how upsetting to me) will somehow make somebody look bad or feel bad. (Childhood roots as I mentioned). That will not be my goal..but simply to assign my care to another person. Yet I couldn't get over the issue of facing the fact that I will be inconvenient and my descison scorned by the surgeon. This has caused a lot of anxiety. I will let my "knight-in-shining-armor" husband of 34 years do the talking It will definitely be more expensive. I'm not even sure how our insurance or the surgeon will settle it. If indeed, the the teeth are inert, that will be an answer to prayer and a closed chapter. If not, I'll have to get through the concern about the sedative and will cross that bridge when I get there, I guess.
I think I will probably, in fact, have to be put completely under. I don't know why she continued a difficult surgery when she realized the sedative wasn't working. You have that power and control when you have your procedure done. You will undoubtedly know if your sedative isn't working. My problem is that I didn't realize I should have gone out immediately, at the beginning of the surgery.

 

[shelly0624]

Another thing my husband mentioned. He said he saw a TV report that in some dental, hospital and surgery settings..that sedatives and medications were being pilfered, either sold or used and replaced with something ineffective. Hard to say..