General anesthesia is synonymous with putting you to sleep during the treatment.
Unlike conscious sedation with nitrous oxide, commonly known as laughing gas, or IV sedation with midazolam, you won’t be able to communicate, and your protective reflexes won’t be responsive either.
General anesthesia is rarely used in a dental setting because it requires massive expertise, specialized equipment, and trained staff. Intravenous sedation with midazolam works well in managing anxious patients, so rarely do we need GAs these days.
Modern technology and safety standards have made general anesthesia highly accessible options when it comes to treating patients with severe anxiety and physical and mental disabilities.
Let’s delve in general anesthesia to give you an idea about this particular anesthetic type used in dentistry.
What is Dental General Anesthesia?
General anesthesia is a process through which a sleep-like state is induced through certain medications to make you unaware of the surgery and the pain while the surgery is carried out.
It is commonly used for surgical procedures like wisdom tooth extraction, implant surgery, and multiple extractions in children.
It primarily stops the signals from reaching your brain, making you feel comfortable and relaxed, which is not possible in a conscious state for highly anxious individuals.
An oral maxillofacial surgeon, an anesthesiologist, and a certified nurse anesthetist will closely work together in a team to carry out a dental procedure.
While you’re under the effect of GA, the team members will closely monitor your vitals, breathing, and heartbeat to ensure these are normal and steady while you’re under the impact of medication.
Generally, the purpose of anesthesia is to block the pain signals from reaching your brain.
General anesthesia offers three different functions, which are not achieved alone with local anesthesia and conscious sedation. These are:
- Pain management
- Anxiety control
- Amnesia – loss of memory for the interval.
Why is general anesthesia not that common in a dental office?
We may say GA has gone out of fashion since the advent of conscious sedation.
Local Anesthesia
People who are comfortable getting their treatment done under local anesthesia and conscious sedation should not be placed in an unconscious state because it poses a certain risk to health, which can’t be ignored.
GA for dental treatments for adults should be the last resort only if the IV sedation doesn’t work out for them. If necessary, it should be given in a hospital setting or specialist clinics that have critical care facilities.
Why can’t you get treatment under GA if you insist?
Risks. Although the risk for serious complications like death is almost 0 in healthy individuals, there are multiple downsides of the anesthetic route alone.
1) A treatment might cover a span of 2 to 3 appointments. Putting you under GA for every appointment is neither feasible nor risk-free.
2) Treating under GA is challenging for a dentist because of muscle spasms and breathing tubes coming in the way of the treatment.
3) For elective GAs, certain laboratory tests are carried out to rule out any existing medical condition.
4) You are kept on NPO (Nothing per oral) 6 hours beforehand.
5) You must have an attendant with you for 24 hours until you stay admitted to the hospital after the surgery.
6) It costs a lot.
When is A Patient Treated Under General Anesthesia?
1) Patients with special needs like mental and physical disabilities are mainly treated under GA, provided their general physicians have permitted the surgery.
2) Conscious IV sedation doesn’t work in a few individuals and might need a high concentration of drug to bring about the action. Increasing the dose may cause a toll on mental health in the long run, so GA is considered as an alternative.
3) Few individuals are unable to tolerate the idea of dental treatment. Such people are put under GA for surgical treatments like tooth extractions and implant placement, while nonsurgical treatments are performed under local anesthesia or sedation if needed.
The Process of General Anesthesia
Certain protocols have to be followed before GA administration. Here’s how it happens:
1) Explaining the Procedure
Once your dentist or Max-fax (maxillofacial surgeon) has decided to treat you under GA, he’ll give you a complete insight into the procedure, including steps, risks, complications, and costs.
2) A Pre-Operative Assessment
This assessment includes checking your medical history and getting a few laboratory tests done for better insight.
Your Max-fax will discuss your treatment with the anesthesiologist to choose the type of anesthetic agents, considering your medical and allergic history.
3) Surgery Day
You’ll be asked not to eat anything 6 hours before the surgery. You’ll be advised to be on time for the surgery.
4) Start of The Operation
You’ll be given anesthesia through an IV route, where a liquid is injected into your blood through an IV cannula. You’ll get unconscious within a minute or so.
Your anesthetic will stay beside you throughout the procedure. Your vital signs will be monitored closely, and your oxygen saturation will be kept between 98 to 100% on a normal body temperature.
5) Deep Sleep State
The effect of the medication will keep the individual in a resting state. The breathing aid is provided with an intubation tube and supplemental air to keep the body under the functioning condition.
6) Recovery Phase
Once your dental treatment is completed, the supply of anesthetic agents is stopped by the anesthesiologist.
You’ll wake up and will be kept under observation, depending on your circumstances. Usually, you’ll be kept in the ward for 24 hours after operation.
Side Effects of GA
There are certain side effects of the drugs that induce a sleep-like state, which include:
– shivering for a few hours.
– feeling of vomiting that lasts for a day or two.
– confusion
– difficulty peeing
– dizziness
– sore throat
– damage to mouth or teeth
There are certain risks associated with GA. The risk majorly arises due to the intravenous caused due to the intravenous medication and intubation for breathing.
1) Death
In an elective GA procedure for a healthy individual, 1 out of 100,000 individuals is due to the given anesthesia. Though its a rare figure, it may happen with any individual.
Risks & Serious Complications of GA
2) Embolism or Thrombosis
Embolism of thrombosis is referred to as an occlusion of blood vessels with a blood clot or air. If this happens in the major blood vessels like coronary arteries taking blood to the heart or arteries taking blood to the brain, you may suffer serious consequences like heart attack and stroke.
3) Anaphylaxis
You might be allergic to the anesthetic agents. If the operation team hadn’t obtained the history, you may suffer from an allergic reaction throughout the body, which may block your breathing and can lead to death.
Common Misconceptions about Dental General Anesthesia
Misconception 1: It’s only for complex procedures
A misconception that is prevalent among the masses is general anesthesia is only for complex procedures. However, this is not true. The basic indication for GA is for individuals with massive anxiety threshold and dental procedural fear.
It can be done in children who are uncooperative and need multiple fillings for the tooth.
And it may be done in adults for a wisdom tooth extraction. The indications vary from individual to individual but are available for wider demographics.
Misconception 2: It’s not safe for dental treatments
As GA makes one completely unconscious, many think it’s not a safe procedure. Although it’s a type of anesthesia that poses multiple risks and side effects, anesthesia is safe for use.
A dental team and an anesthetic team will evaluate your medical history before recommending this to you. Adults with special needs are always treated under GA to make them comfortable during dental procedures.
Misconception 3: It’s not suitable for children or elderly patients
With the right precautions and Pre-Operative assessments, older individuals and young children can undergo general anesthesia. Oral and maxillofacial surgeons and pediatric surgeons work together to treat children.
FAQs
Q. What is the cost of general anesthesia?
A) The cost varies between $2000 to $4000 per hour. It is expensive due to the instrumental cost and the skillet required to do the procedure.
Q. How quickly will general anesthesia work at the dentist?
Almost instantly. As soon as your anesthesiologist gives you IV anesthetic medication, you’ll be completely unconscious.
Q. How long do you sleep after general anesthesia?
As soon as the medication supply is stopped, you’ll move from the unconscious state to a conscious one.
