When is GA normally called for (as opposed to other forms of sedation)

[jjh6ytrh]

Perhaps this is a better question for the resident dentists here, but I was just curious as to when all the different types of anesthesia are indicated? I know when LA is called for, that is fairly simply and straightforward. However, when is RA (gas), IV Sedation, and GA called for? Is it just a matter of preference in most cases and the ability and willingness to pay?

Thanks!

Mike

 

[letsconnect]

Hi Mike,

GA these days is a last resort, since IV sedation is so much safer and has the same effect as GA in about 98% of people with a dental phobia (that estimate comes from Stanley Malamed's book on sedation in dentistry).

IV sedation is useful if someone really doesn't want to know what is going on, and if they're really afraid of certain dental procedures. It is also useful for stuff which almost anyone would find unpleasant (like a lot of teeth being removed in one go, or difficult-to-remove teeth like impacted wisdom teeth), and for people who have difficulties with an extreme gag reflex, especially if it's physiologically caused rather than a psychological reaction.

RA (nitrous oxide) is a more participatory technique and perhaps better suited to people who like to be in control, but who want something that takes the edge of their anxiety.

Then of course there are many psychological techniques which can be used - many of them originated from children's dentistry like tell-show-do, structured time, giving lots of control to the patient, using non-threatening language, etc. These can work really well for lots of people with dental fears, and unfortunately they're a bit underused in some regions due to the relatively wide availability of sedation options these days.

GA is rarely called for these days - basically only if IV sedation doesn't work for whatever reason in a particularly phobic person. For example, if the person has a very high tolerance to the drugs used for IV sedation (benzodiazepines) due to long-term use - in that case, IV sedation doesn't always have the desired effect.

 

[2scaredforwords]

After I started crying in the office and we got the treatment plan together, my dentist looked at me and said IV sedation, right and I said yep. He said he kind of figured by my reaction when I came in.
I also think that the time of the procedure is a factor as well as desire to get all of the work done in one setting.

 

[Knightsaber]

They used GA on me because my bottom teeth were apparently going to be terribly difficult to get out. Judging by the pain after it was all over with...they were. So I would say extensive procedures can call for it too.

 

[brit]

They used GA on me because my bottom teeth were apparently going to be terribly difficult to get out. Judging by the pain after it was all over with...they were. So I would say extensive procedures can call for it too.

I agree - involved surgery of jaws for instance...sometimes being 'out cold' is best.

 

[RP]

They used GA on me because my bottom teeth were apparently going to be terribly difficult to get out. Judging by the pain after it was all over with...they were. So I would say extensive procedures can call for it too.

But if I remember correctly Knight, they tried IV for you on the uppers and based on your med history it wasn't as effective as all would have hoped for. They couldn't get you knocked out.... So clinically it was because of the drugs ineffectiveness, moreso knowing you wouldn't be able to tolerate the procedure where you were able to power through the uppers.

I think most oral surgery can be done under IV - Remember I had a 3 hours of extensive upper jaw surgery when removed the big cyst and rebuilt the floor of my nose - never knew a thing. On the other side- Orthognathic surgery, procedures done to correct jaw alignment are usually done under general, here would be a greater risk in having voluntary muscles moving during such a procedure or the potential for pain control during surgery to be impossible under IV/local alone.