general anesthesia for dental surgery questions

[sharon]

I just had an implant on #10 and the oral sugeon insisted on in-office general anesthesia (versed & fentanyl). I questioned him on this - doesn't this mean I need a breathing tube, and he said no, while at the same time confirming that I'm not having conscious sedation but having ga. He does not do this procedure on an upper tooth under anything except ga, no exceptions. So I had the surgery and lived through it though my face is very bruised (and not even in the location of the surgery). The surgeon is a "board certified dental anesthiologist" so I assume he is most likely well qualified to do this. I have two more implants to go through and am seriously considering someone else to do the work.

Questions - Is it generally considered "safe" to have ga in an in-office setting without an additional anesthesiologist? Can the doctor easily handle both the surgery and the anesth. parts of this? Is this considered the norm?

Physical exam- I understand before ga one must have a physical to ensure they are in good shape for this. I'm not obese and have no major problems such as diabetes, but still, there was no MD clearance or any kind of phyiscal. Is this the norm?

Recovery time - They had me out of the dental chair and into a wheelchair, pushing me to the waiting vehicle within 6-8 minutes of waking up, maybe not even that long. So there was virtually no recovery time at all. I was totally unable to walk on my own and had to have assistance to get into the chair and into the car. I weakly begged for 5 more minutes but no way would they let me. Based on all other out-patient procedures and surgeries I've had this is not the norm. There is always at least a half hour wait and for me usually more because I always have a difficult time coming out of it. So I have to ask again, is this the norm? To me it seems almost "illegal" in a medical way.

Thank you for helping with this!
Sharon

 

[drhirst]

Hi sharon,
Here in the UK this would not be considered a safe procedure. However, when it comes to sedation and general anaesthetics the regulations are very much more conservative in the UK.
My concern is that GA is much more risky than sedation. If you were happy to have the procedure without GA and reduce the risks why should you not be allowed to do so?
Just my opinion
Lincoln

 

[sharon]

Thank you Dr. Hirst, I wish I could come to the UK to have my next two implants put in.

My dentist highly recommended this surgeon to me and I have no doubt he is a good surgeon, but . . . .. I'll have to let him finish this implant, he better not plan on doing GA again for that final appointment. Is this something that can be done under local w/oral valium - the appoinment where they put the final metal thingy on? Sorry, I don't what that thingy is called. If not, well I might have to pay someones else, I guess. I have since talked to my general dentist and he said he has no problem referring me to another surgeon for the next 2 implants if I'm not comfortable with this guy.

I'm torn, I have to admit it was nice to be totally unaware of the entire procedure and would like that for the next two implants (both of which I plan to have done at the same time later this summer), but on the other hand I am very uncomfortable with their anesthesia policies (especially wheeling me to the car with no recovery period) and the fact that they won't do implants under any other way. I really think with 10-15 mgs of valium I would be able to handle this or possibly with coscious sedation but they aren't willing to budge.

 

[comfortdentist]

I practice in the states. I use versed fentanyl intravenously for patients who need it. It seems to me that some doctors "push" the anesthesia and always insist on using it. Most implant surgery isn't that invasive.
As to recovery it is normal to stay longer than 5-10 minutes. I've been practicing for thirty+ years now and very much want to finish with my sparkling clean record

 

[sharon]

I practice in the states. I use versed fentanyl intravenously for patients who need it. It seems to me that some doctors "push" the anesthesia and always insist on using it. Most implant surgery isn't that invasive.
As to recovery it is normal to stay longer than 5-10 minutes. I've been practicing for thirty+ years now and very much want to finish with my sparkling clean record

You are a great and helpful denstist. No doubt that your sparkling clean record will follow you wherever you go

 

[Suzannah99]

As a child I had 8 teeth extracted under GA in hospital in the UK and was rushed out just as quick (according to my Mum). I remember waking up, remember not being able to breathe properly and remember desperately trying to alert the staff as I couldn't speak. I also could not walk without help and remember Mum and Dad pretty much carrying me to the car.
Once we set off I was trying to get their attention over my breathing problem and I ended up realising the only way to get their attention was to open the car door - I did this and promptly fell out of the car. They stopped and mum ran over to me. I pointed to my throat and Mum saw my lips going blue so she went in my mouth and pulled out a blood clot which was like a thick piece of tent string about 12 inches long. Once that was out I could breathe again. This all happened just 10-15 minutes after waking up.

If ever I was going for GA again I would write on my hand the words pen and paper so that I could point to it and let them know there was an issue by writing it down.
I think the staff and my parents thought I was just dazed still form the GA - which I was - but I was unable to communicate the problem effectively.
If you have no option but GA then I would suggest doing that but it sounds like you were lucky and had no issues upon waking.
I was also pretty bashed about under GA and had bruises in places you wouldn't expect.

 

[sharon]

Suzannah - that sounds horrible!! Shame on the office for letting you out so soon, hope they learned a lesson and I hope they got a good lashing from your parents (and lawyer!) That must have been so frightening for you.