Procedures of Interest - Anesthesia

After your complete evaluation, Dr. West will make a treatment recommendation which may include a surgical procedure. We offer our patients a wide range of anesthetic choices for the surgical procedure. You will have the option of choosing one or more of the following methods to control your pain and anxiety:

Local anesthesia that numbs the surgical area
Nitrous oxide oxygen (or laughing gas) to relax you
Intravenous sedation for more profound relaxation
General anesthesia for a sleep like state during the procedure
Oral pre-medication can also be administered to decrease anxiety prior to arriving in the office.

Dr. West is licensed to perform injectable anesthesia and IV sedation in the State of Virginia by virtue of his Oral and Maxillofacial Surgery and Anesthesia training. He is also Board Certified by the National Dental Board of Anesthesiology and is a Fellow of the American Association of Dental Anesthesiology. All procedures are performed with the highest standard in monitoring and anesthetic care. Dr. West and his staff will explain all options to you and assist you in making the most appropriate anesthetic decision.

About Anesthesia

Anesthesia as an outpatient in our office can vary from local anesthesia to general anesthesia.
Local anesthesia (numbing)
Intravenous sedation

General Anesthesia

Oral Maxillofacial Surgeons are unique amoung the surgical specialities with regards to anesthesia training. Every Oral and Maxillofacial Surgeon, during their residency, receives formal anesthesia training with the Department of Anesthesia in the hospital. This includes IV sedation, airway management, and intubation techniques. This also includes complete training in Advanced Cardiac Life Support. Most states have very strict guidelines regarding administration of anesthesia in the office, to ensure patient safety. Dr. West follows the guidelines and protocols set forth by our State Medical and Dental Regulatory Body and the office is regularly inspected.

Dr. West has advanced training in all aspects of anesthesia and emergency care. This commitment has provided our patients with the highest standards of care and availability of the latest techniques and drugs. It is our utmost goal to make your surgical experience as pleasant and stress free as possible, while maintaining the highest level of safety.

Local Anesthesia

Some patients can have their procedures completed using a local anesthesia to numb the area. This technique is mainly used for routine extractions or minor procedures. It may not be adequate for surgical extractions or the removal of impacted wisdom teeth. For those people wishing to be sedated so that they are unaware of the surgery, IV sedation and general anesthesia is offered.

What is local anesthesia? This involves administration of a “novocain” shot which freezes or numbs a small area so surgery can be performed without altering consciousness. Using local anesthesia only, the patient is completely alert and fully aware of his/her surroundings. Local anesthesia does not decrease the patient’s level of anxiety towards the surgical procedure.

Are there times when local anesthesia doesn’t work during oral surgical procedures? YES! In order for local anesthesia to work, the tissue pH must be neutral or slightly alkaline. Fortunately local anesthesia works well in non-infected tissues because normal tissue pH is slightly alkaline. However, many patients who oral surgeons need to treat have infections which cause the tissue pH around the infected tooth to be become acidic. This acidic pH does not allow for optimal effectiveness of the local anesthetic which results in the patient experiencing pain during the extraction. IV office general anesthesia allows removal of infected teeth without causing distress and pain to the patient because tissue pH is not a factor in its effectiveness. Local anesthesia does not treat the anxiety many patients have associated with dental surgical procedures. IV anesthetics effectively treat dental anxiety and allow for a safer and more comfortable environment for the patient to undergo surgery.

Conscious Sedation (IV)

During the initial consultation, Dr. West will discuss the type of procedure involved, your medical history and your level of anxiety. Some procedures, due to their nature, require the use of IV sedation, whereas others are best accomplished under local anesthesia. The choice of anesthesia is always a personal decision and should be made only after an informative consultation with Dr. West. In addition, during the initial consultation, you will be given instructions to prepare for surgery such as wearing loose warm and comfortable clothing, not have anything to eat for six (6) hours prior to surgery, taking all of your regular medications as directed, bringing an escort with you and making arrangements for your recovery at home.

Although most of the more modern anesthetic medications are kind to the stomach and do not produce nausea, occasionally just the anxiety that one has about having surgery can generate a queezy feeling in one’s stomach. The patient who becomes sick with a full stomach could present a potentially dangerous scenario of choking. Therefore, it is important to follow all pre-operative instructions. The medications used for sedation do persist in the blood stream for up to 24 hours. Therefore, it is understood that you WILL NOT operate a vehicle or operate machinery for 24 hours after being sedated. Dr. West will be available to answer any specific questions you may have in regards to the anesthetic. The benefits of intravenous sedation include a decrease in anxiety and awareness during the surgery. This translates into near or total amnesia of the procedure, lack of noise perception and no pain. During the procedure it is important to note that patients are still given local anesthesia to numb the area, as partially sedated patients may feel occasional pressure.

Coming to our office on the day of surgery is no different that having surgery in the hospital and it is often much more user friendly. The equipment, suites and recovery room are the same as those used in the hospitals. When you arrive in the surgical suite, the nurse or surgical assistant will connect you to a number of monitors. Safe anesthesia demands the use of several non-invasive monitors that will be attached to you. These devices are typically a blood pressure cuff, an EKG and a pulse oximeter (a device which measures the amount of oxygen in your blood). Therefore, it is suggested that you wear loose clothing to facilitate the application of these important devices. Routinely drugs will be injected into the IV to cause you to relax or sleep. Once you are able to sit up, the IV will be removed and you are almost ready to leave. At this time, the surgical assistants will review with you and your escort all the post operative instructions and answer any questions either of you may have in regards to the care of your mouth.

General Anesthesia

What is general anesthesia? Most of us are familiar with “hospital” general anesthesia for the removal of an appendix or gal bladder. Most certainly all of us associate hospital general anesthesia with a complex variety of tubes and ventilators as seen on TV Soap Operas. The complete relaxation of the musculature and blocking of conscious pain by rendering the patients unconscious, allows surgeons to perform very invasive abdominal surgery.

What is office intravenous general anesthesia and how does it differ from hospital general anesthesia? Office intravenous general anesthesia is far simpler than hospital general anesthesia in that a ventilator and complete muscle relaxation are unnecessary and undesirable for office oral surgical procedures. Yet both hospital and office general anesthesia are similar in that the patient remains unaware (asleep) during the ongoing surgical procedure. Also, both types of anesthesia allow for elimination of pain and anxiety while maintaining a similarly high level of safety.