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Thursday, July 31, 2014
Conscious sedation for multiple extractions
Hello, My 28 year old son recently was examined by a dentist. He needs a great deal of dental work. His upper teeth are beyond repair (lots of antibiotics before the age of 2). The dentist has recommended upper full extraction as well as removal of impacted wisdom teeth x4; He has recommended utilization of Demerol, Valium, and NO2; I am an RN; This seems to be a good deal of dental work for this level of conscious sedation... I am particularly concerned regarding the wisdom teeth and anesthesia safety. Your thoughts would be appreciated.
Thank you for your question. This case is usually done under moderate (conscious) sedation, if sedation is needed at all. The issue is only partially the procedure and more the patient. If your son is not terribly anxious about this treatment, this is a great option, particularly if the sedation is well-maintained during the procedure (i.e. additional medication is given as needed during the procedure).
The other option that oral surgeons, who are also licensed to do deep sedation, might consider is just that - deep sedation. This is a hybrid state where the patient is sometimes in a light general anesthetic and sometimes in a moderate sedation state. Most would probably choose moderate sedation since there can be a fair amount of residual bleeding as the procedure continues and the risk of airway complications is more likely with deep vs. moderate sedation.
True general anesthesia with an independent anesthesia provider, like a dentist anesthesiologist, is another option, and now you would have the most qualified dentist providing the anesthesia and independently watching over your son while the dentist does the procedure. If your son is very anxious about this surgery, this may be the best option.
I think the plan of moderate sedation is a good one. If an oral surgeon is comfortable with deep sedation for this case, that is another option. A much smaller number of oral surgeons are comfortable with true general anesthesia for this type of case, and they will be administering the anesthesia and doing the surgery at the same time. Or you can find a dentist anesthesiologist in your area by going to http://www.asdahq.org/.
Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University