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Anxiety is normal when facing surgery. If a person is apprehensive, a past traumatic experience can increase the anxiety. The primary goal of our team is to ensure your procedure is smooth, safe, and comfortable. After your doctor examines you, he will make recommendations for the type of anesthesia best suited to your procedure. These will be recommendations only, as the type of anesthesia will ultimately be decided by you.


Local anesthesia ("Novocaine")


This is the conventional type of anesthesia used at your dentist's office. The surgical area will be numbed with an injection and the procedure will then be performed. Depending on the type of procedure, there will be varying degrees of noise and pressure, but you should not experience any discomfort. If you have a high level of anxiety, however, any pressure might be perceived as discomfort. Therefore, if you are mildly or moderately apprehensive, you may prefer one of the following options.


Oral Sedation with Local Anesthesia


You will be given an oral premedication (Valium) to take prior to your arrival that will decrease your level of anxiety. The procedure itself will be performed identical to the option above. The premedication gives additional relaxation and comfort. The first dose should be taken two hours prior to the appointment. If this first dose is insufficient after one hour, please take the second dose. However, if the first dose has a profound effect (drowsiness, loss of coordination, loss of balance), do NOT take the second dose. You will still be aware of the procedure, but will be much more relaxed. With this method of anesthesia, you will be cognitively impaired. Therefore, you cannot come to the appointment alone. You must be accompanied by an adult who will drive you to and from our office.


Intravenous (IV) Sedation ("asleep")


If you have a high degree of anxiety, or do not wish to remember the experience of the surgery, IV sedation affords you the luxury of taking a short nap and waking up at the end of the procedure. Before the procedure, medication is given through a small IV and you will begin to fall asleep. The numbing injection (Novocaine) will be given, but you will likely not remember it. Therefore, after you wake up, you will not experience any discomfort since the area will be numb. You will not be aware of the surgery and should remember nothing about the experience. For most conventional hospital surgeries, intubation (breathing tube) and paralysis are routinely administered. We do not use these techniques with our anesthesia and you will be breathing on your own throughout the procedure. This is far safer than conventional hospital anesthesia, and much less expensive.


Since you will have been heavily sedated, you will need a ride to and from the surgery appointment. Although you will be able to communicate and function on your own, you will likely not remember going home, as these medicines have a powerful amnestic effect. Therefore, a bus or cab ride home will not be permitted. You must be accompanied by a responsible adult.


Additionally, you must have an empty stomach on the morning of surgery, except for a small amount of water taken with your premedication. Your stomach lining produces strong acids in response to even minimal amounts of food entering the stomach. When you are under anesthesia, your normal reflexes are depressed or absent. Therefore, if you vomit, you will not be able to control any stomach contents from entering your lungs. If these acids enter your lungs, the result could be severe, life-threatening damage. Even a glass of liquid or a bite of food is not allowed.


When administering IV sedation, we will monitor all vital functions. There will be additional costs for the necessary equipment and medications. Therefore, a nominal fee will be assessed for the procedure, depending on the duration of the surgery. Our administrative team will present the fees for the anesthesia, along with your estimated insurance coverage.


Frequently Asked Questions About Anesthesia


Can I be asleep for my surgery?


Yes, as long as there is no medical condition that would make it unsafe. If you are anxious or apprehensive about the surgery, we have the capability to make sure you are asleep, comfortable and don't recall any part of the surgery. You will likely not remember the "Novocaine" shot, sounds of the instruments or pressure from the procedure. If you have had a previous bad experience or would prefer to not remember any of the surgery, you will find this option very appealing. Dr. Gill takes great pride in making sure his patients are very comfortable.


Is it safe to be asleep? Am I going to wake up?


Our anesthesia technique does not include any intubation or paralysis, which is routine for hospital surgeries. Therefore the risk of major complications is very low (~1 in 70,000) and Dr. Gill's track record of major complications from anesthesia is flawless. Furthermore, the numbing medicine is given after you are asleep. That means that we control the dosage of IV medication and the chance of overdosing is dramatically reduced. The IV Sedation is administered by Dr. Gill up to 10 times per day, five days per week. Our equipment is new and up-to-date and we are completely prepared for any and all emergencies. Dr. Gill has extensive training to handle any emergency situation, should it arise.


Will I remember any part of the surgery?


If you are young, healthy and have no history of medical problems, there is a greater than 95% chance that you will remember nothing from the surgery. Many people do not remember going home. However, there is a small percentage of people who have a very high tolerance to medication, either due to genetic predisposition or previous history of substance abuse, or who have difficult airway management issues (for example, severe sleep apnea). If you are in this group of patients, there is a small chance that you will remember some talking or conversation towards the end of surgery. This will not be a traumatic or painful memory, since you will be numb and will not be feeling any discomfort. Although our priority is your comfort, our ultimate goal is your safety.


Will I need an IV to be asleep?


Yes. The IV is the method we use to give the medication to help you fall asleep. If you have anxiety about the IV, you will be given an oral premedication such as Valium prior to the surgery to help get relaxed. To minimize any discomfort, we apply a freezing topical anesthetic. The IV is a small, child-size catheter; so it is much less traumatic than a conventional emergency room IV. For most of our patients, the IV is not stressful.


What are the side effects of the anesthesia?


With our method of anesthesia, the chance of undesirable side effects is greatly reduced. There is always a risk of nausea and vomiting from any anesthesia. Since the total amount of medication is less than for a conventional hospital anesthesia, the probability of this side effect is significantly lessened. Also, there is a small percentage of people who become emotional or combative when waking up from the anesthesia. They are not crying because they are hurting; rather, it is a side effect of the medication. Most of the time these patients do not remember their reactions, but it can be difficult for loved ones to witness. It is only temporary for a few hours after the surgery and there are no long-term effects.


Are there any contraindications to the I.V. Sedation in the office?


Our age limit is approximately 6 years of age. Patients younger than 6 will be evaluated on a case by case basis as some of these cases are done best in an out patient surgical facility/ hospital setting.


Is there an anesthesiologist present at the surgery?


Dr. Gill is a diplomate of the National Dental Board of Anesthesiology and a Fellow of the American Dental Society of Anesthesiologists. He also completed a 4 year residency that consisted being part of the medical anesthesiology department at Loma Linda University with extensive training in outpatient anesthesia. Dr. Gill is also certified in Advanced Cardiac Life Support. He is an extremely well qualified expert in the field, and has performed thousands of cases.


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