| Edward L. Kasper, D.D.S. | Wilson P. Heaton, D.D.S. | Bradley C. Wright, D.D.S. |
| Carlo G. Pagni, M.B,. B.Ch., B.A.O., B.D.S., F.D.S.R.C.S. (Eng.) | ||
| Anesthesia | |
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The management of fear and anxiety has been an integral part of the practice of dentistry for many years. The first demonstrations of anesthesia was in 1844 by Dr. Horace Wells, a dentist who underwent a dental extraction performed by an associate, using nitrous oxide for pain control. Soon afterward, Dr. William T.G. Morton, a dentist, used ether vapor when performing a surgical extraction on a patient. Today a vast array of equipment and medications are available to the practitioner to help deal with patient apprehension of dental treatment. Oral and maxillofacial surgeons have the knowledge and advanced training to manage these fearful patients using various methods of sedation or general anesthesia. ROUTES OF ADMINISTRATION There are various routes of administration for sedative drugs. Medications can be given orally, which is convenient, but the results are unreliable because the onset and peak effect are difficult to predict accurately. Nitrous oxide, an agent that is administered through the lungs via inhalation, has the advantages of rapid onset and short recovery. The concentration of the gas can be titrated to achieve the desired effect. Unfortunately, nitrious oxide is a relatively weak sedative agent. Parenteral routes (intravenous, intramuscular, subcutaneous) are the most reliable and controllable. For sedative drugs, the intravenous route is the most common and is well accepted by patients. SEDATIVE DRUGS The types of medications used for sedation in our office consists of antianxiety agents, narcotics, and sedative-hypnotics. The most widely used antianxiety medications are diazepam (Valium) and midazolam (Versed). Both reduce anxiety, produce relaxation, and cause amnesia. Studies have shown that Versed has greater amnesic properties than Valium, while Valium produces greater muscle relaxation. Narcotic drugs are used to produce mood changes, provide analgesia,and eleviate the pain threshold. Some medications in this category that are commonly used as intravenous agents are meperidine (Demerol) and fentanyl (Sublimaze) which is used in our office. The majority of sedative-hypnotics are classified as barbiturates. Two well-known barbiturates, thiopental (Pentothal) and methohexital (Brevital) which is used in our office are mainly considered general anesthetic agents; however, the response is dose-related and these drugs can be used as sedative agents in lower doses. Other drugs may be used in conjunction with the above medications such as anticholinergic agents i.e. atropine which decreases salivary activity. PATIENT MONITORING Proper patient monitoring is essential to ensure the appropriate level of sedation is being administered and for patient safety. Vital signs will reflect changes in depth of anesthesia or physical status. For conscious sedation, multiple blood pressure readings are standard. In addition, a pulse oximeter is used to monitor both pulse rate and the level of oxygen in the blood. This monitor has greatly advanced the practitioner's ability to detect a decrease in patient respiratory exchange. An electrocardiogram (EKG) is also employed to monitor heart rhythm. Although advanced technology has given dentistry many fine tools with which to monitor patients, the quickest and most reliable method is often physical evaluation and assessment by the practitioner. Looking at mucosal color, the color of blood in the surgical field, respiratory chest movement, or patient response to stimuli will provide much information to the alert practitioner. CONCLUSION The control of pain, fear, and anxiety by anesthetic techniques is a tool used by oral and maxillofacial surgeons. Although specific methods may vary from practitioner to practitioner, the delivery of anesthesia in the dental office adheres to an excellent standard based in science, research, and education. |
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