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Old 08-20-2002, 02:23 PM   #1
dmw16
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Default Question about drugs used during oral surgery

I recently had my wisdom teeth out and I was supposed to be put under general anesthesia but instead I was only given whatever they give you to put you in what the doctor called conscience sedation. So I'm going in for my post-op tomorrow and I want to address the issue with him and I just want to be a little informed incase he tries to pawn me off or just throw doctor terms at me. So I was wondering what drugs they normally give to induce both the sedation and general anesthesia?
thanks,
-doug

To clarify my question, I wasnt asking if they use a general anesthesia. I wanted to know what chemicals are used to administer it. I had the teeth out, and it is standard practice to use either general anesthesia or conscience sedation. Esspecially since 3 of the teeth were bony impacted. Novicaine is given along with the anesthesia but it is mainly used to reduced bleeding. So does anyone know what drugs are actually used to enduce the sedation or anesthesia?
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Old 08-20-2002, 02:33 PM   #2
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It sounds like he used Novicaine. Novicaine is perfectly fine for getting you wisdom teeth out unless you can't deal with a little amount of pain.
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Old 08-20-2002, 02:35 PM   #3
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Quote:
Originally posted by: LostHiWay
It sounds like he used Novicaine. Novicaine is perfectly fine for getting you wisdom teeth out unless you can't deal with a little amount of pain.
between this thread and the wart thread, i would have to guess you are a masochist.
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Old 08-20-2002, 02:36 PM   #4
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Originally posted by: iamwiz82
Quote:
Originally posted by: LostHiWay
It sounds like he used Novicaine. Novicaine is perfectly fine for getting you wisdom teeth out unless you can't deal with a little amount of pain.
between this thread and the wart thread, i would have to guess you are a masochist.

Yep
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Old 08-20-2002, 02:44 PM   #5
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General anestetic is dangerous man, every time you have it done you have a chance of death. Be glad they didn't use it.
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Old 08-20-2002, 02:52 PM   #6
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i thought it said oral sex sorry
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Old 08-20-2002, 07:12 PM   #7
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Quote:
I recently had my wisdom teeth out and I was supposed to be put under general anesthesia but instead I was only given whatever they give you to put you in what the doctor called conscience sedation. So I'm going in for my post-op tomorrow and I want to address the issue with him and I just want to be a little informed incase he tries to pawn me off or just throw doctor terms at me. So I was wondering what drugs they normally give to induce both the sedation and general anesthesia?
General anesthesia for wisdom teeth? I highly doubt it, it just isn't done, unless you're mentally impaired (retarded) and non-compliant.

Did you go to an oral surgeon/dentist's office vs. an out-patient surgery center or hospital? They don't do general anesthesia in a doctor's office.
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Old 08-20-2002, 07:16 PM   #8
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General anesthesia IS given (in some cases, depending on the doctor's confort/education level and insurance) for wisdom teeth.

Novocaine hasn't been used in years (afaik), Xylocaine (basically a synthetic version of the same stuff) is much more common.

Many/most dentists will put a topical anesthesia on the gum or cheek before hitting you with the needle so you don't feel the stab (as much).

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Old 08-20-2002, 07:19 PM   #9
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General anesthesia for wisdom teeth?
It's done all the time for oral surgery. I believe it's around $300 + extra for EKG monitoring.
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Old 08-20-2002, 07:37 PM   #10
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i wonder why they don't use cocaine for the anesthesia
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Old 08-20-2002, 07:42 PM   #11
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I was put under for my wisdom teeth. I'm not sure what they used.... they just called it "IV sedation". I was out like a light. It ended up being a generally pleasant experience overall. Hardly any pain or soreness. I went to an oral surgeon.
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Old 08-20-2002, 08:50 PM   #12
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Quote:
General anesthesia IS given (in some cases, depending on the doctor's confort/education level and insurance) for wisdom teeth.
Yeah, like I said:

"....it just isn't done, unless you're mentally impaired (retarded) and non-compliant."

I consider having such an irrational fear of the procedure that you require a general anesthetic falls under the categories of "mentally impaired" or "non-compliant".
Quote:
It's done all the time for oral surgery. I believe it's around $300 + extra for EKG monitoring.
Sure, its done all the time for malocclusion osteotomies where they will be using a power saw to cut wedges and shims out of your jaw bone, maxillofacial surgeries reducing and fixating facial fractures using plates, screws, or wires, and other complex oral surgical procedures...but not for wisdom teeth extractions, with exceptions noted above. When it is done, it isn't done in a doctor or dentist's office.

I think some are confused about what a general anesthetic is. A general anesthetic involves induction and requires FULL MEDICAL FACILITIES complete with resuscitation equipment, a crash cart, a board certified anesthesiologist (M.D. or D.O.) and/or a CRNA (Certified Registered Nurse Anesthetist), plus anesthesia equipment that starts around $100,000 (e.g. out-patient surgery center or hospital).

A typical anesthesiologist charges more than $300 for his INDUCTION FEE alone!

$300 + EKG monitoring is more approximate to the cost for IV or conscious sedation, not a general anesthetic.
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Old 08-20-2002, 09:13 PM   #13
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In addition to what tcsenter said,

there are a couple different forms of anesthesia. The lightest is local, e.g. novicaine or even cocaine. This is where you get (usually) a shot on the area. You probably got this. Apparently some teeth are taken out with just local sed. but if it's a problem tooth it would suck to be the person without some real drugs.

You also got (almost undoubtedly) what's variously called IV sedation or conscious sedation. This involves a number of drugs, from valium and versed to stadol and demerol and sublimaze. (sp on all these names). There's another one called "milk of anesthesia;" i forget what it is exactly. These cause temporary amnesia; you won't remember the time when you were under. It's like a super-shot of the opiate you got for the pain. You were also probably featuring EKG monitoring when you were semi-out.

There's also MAC, or monitored anesthetic care, and general sedation. You can respond when you're under IV sed; not the other two. MAC involves a needle in your spine IIRC.

Anyway hope this helps.

ps: a smart doctor, regardless of education, would never give you general anesthesia for wisdom teeth. you only want to knock somebody out as far as you have to.

ps ii: I worked in a hospital recovery room for a couple years, and there must have been hundreds of people going under from general anesthesia, and not one died--really didn't even get close. It's really well figured out for the most part.
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Old 08-20-2002, 09:29 PM   #14
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Quote:
Originally posted by: tcsenter
Quote:
I recently had my wisdom teeth out and I was supposed to be put under general anesthesia but instead I was only given whatever they give you to put you in what the doctor called conscience sedation. So I'm going in for my post-op tomorrow and I want to address the issue with him and I just want to be a little informed incase he tries to pawn me off or just throw doctor terms at me. So I was wondering what drugs they normally give to induce both the sedation and general anesthesia?
General anesthesia for wisdom teeth? I highly doubt it, it just isn't done, unless you're mentally impaired (retarded) and non-compliant.

Did you go to an oral surgeon/dentist's office vs. an out-patient surgery center or hospital? They don't do general anesthesia in a doctor's office.
my oral surgeon uses general anesthesia on quite a few of his impacted wisdom tooth removal operations (including mine). his office is very close to the hospital and he has a licensed anesthesiologist from the hospital working with him during those surgeries... and no im not mentally impaired or non-compliant... he was the one who suggested using it...
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Old 08-20-2002, 10:23 PM   #15
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It's pretty obvious someone doesn't know what he's talking about. People do indeed go to oral surgeons to have their wisdom teeth yanked, are put under by general anesthesia, are monitored via an EKG, and it all costs about $350. It's done in the dentists office. There's no IV or catheter. It's not "conscious sedation", you're knocked out. And the bill clearly states "general anesthetic". Please stop spreading misinformation.
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Old 08-20-2002, 11:14 PM   #16
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It's pretty obvious someone doesn't know what he's talking about. People do indeed go to oral surgeons to have their wisdom teeth yanked, are put under by general anesthesia, are monitored via an EKG, and it all costs about $350. It's done in the dentists office. There's no IV or catheter. It's not "conscious sedation", you're knocked out. And the bill clearly states "general anesthetic". Please stop spreading misinformation.

People do go to oral surgeons to have their wisdom teeth yanked. People are rarely put under general anesthesia. People nearly always have an IV. People ought to be monitored by an electrocardiogram. A catheter is not at all necessary; indeed it's a little weird. You are knocked out, and no matter what the bill calls it, it's IV sedation. Now I admit that this may differ in some places, but I've worked in a couple (2) oral surgery offices, with a total of 5 (five) doctors, and this was the Way it Was. There was gas in the form of laughing gas/oxygen

In every instance of general anesthesia I've seen, there's been an IV. The reason for this is that you need quick access to the person's cardiovascular system if something goes wrong. You are conked out during IV sed/conscious sedation, depending on how deep you get.

If you'd really like, I'll talk to one of the doctors (dentist, really) and ask him about the differences between IV sedation and general sedation. If you're going to tell someone that he or she is spreading misinformation, please explain yourself more thoroughly.



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Old 08-21-2002, 12:10 AM   #17
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There's another one called "milk of anesthesia;" i forget what it is exactly. These cause temporary amnesia; you won't remember the time when you were under. It's like a super-shot of the opiate you got for the pain. You were also probably featuring EKG monitoring when you were semi-out.
Its also known as "milk of amnesia" because of the associated retroactive amnesia often being one of the side effects (considered beneficial for most people) of Diprivan (propofol). Nice milky-looking stuff that uses a vegetable or cotton seed oil (IIRC) emulsion.
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There's also MAC, or monitored anesthetic care, and general sedation. You can respond when you're under IV sed; not the other two. MAC involves a needle in your spine IIRC.
Monitored Anesthesia Care (MAC) doesn't necessarily involve a spinal or epidural block, although it could.

Monitored Anesthesia Care is essentially when an anesthesiologist or CRNA will be required to constantly monitor the vital signs of a patient who is having a form of anesthesia that is somthing less than a general anesthetic but something 'deeper' than light sedation; IV or conscious sedation, local infiltration or regional block, inhalation agent, or any combination thereof. The anesthesia team member will also be responsible for managing the patient's medical conditions, maintaining the patient's airway when deep sedation 'knocks out' the patient's own airway management reflexes, and titrating the level of anesthesia to the surgeon's requirements, often fluctuating between deep sedation and responsiveness to answer a surgeon's questions or directives.

This is in contrast to light IV sedation where the patient may be intermittantly monitored by a lesser-trained person such as a RN, patient care assistant, or technician.
Quote:
It's pretty obvious someone doesn't know what he's talking about. People do indeed go to oral surgeons to have their wisdom teeth yanked, are put under by general anesthesia, are monitored via an EKG, and it all costs about $350. It's done in the dentists office. There's no IV or catheter. It's not "conscious sedation", you're knocked out. And the bill clearly states "general anesthetic". Please stop spreading misinformation.
No IV, no general anesthetic, period. No endotracheal tube or laryngeal mask airway device, no general anesthetic, period.

In many cases, a urinary catheter is not required for a general anesthetic, so that is not a necessary condition for general anesthesia. If the bill states 'general anesthetic' then one of the two are true: the biller is using the wrong term, the biller is pulling a scam by billing for a more expensive procedure than was actually received.

Stop arguing with people who have years of operating room experience, including maxillofacial and oral surgery.
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Old 08-21-2002, 12:21 AM   #18
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Here's what happened to me when I had my wisdom teeth removed:

I went to a out patient oral surgeon. My wisdom hadn't even poked through the skin yet and nor were they sideways, compacted, etc., just a very basic removal. I was put completely under with an IV I believe, could have just been an injection. Anyways, there was very minimal staff there, 3 people?, and everything went fine. Local anesthesia was not even discussed as it is normal prodcedure to be completely put down during this procedure.

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Old 08-21-2002, 12:39 AM   #19
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LOL... Stop the insanity!!!

General Anesthesia != IV Sedation

It may feel like you're totally unconscious, but you're just heavily sedated. When they're done with the procedure, they stop the IV drip and you are "awake" again within minutes. With true General Anesthesia it takes longer to "come to". With IV Sedation an anesthesiologist is not required. When I had my wisdom teeth out my dentist administered it himself.

I would imagine that bona fide General Anesthesia is very rarely used in a dental office setting.

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Old 08-21-2002, 12:48 AM   #20
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Local anesthesia was not even discussed as it is normal prodcedure to be completely put down during this procedure
Local anesthetic is the 'shot' the doctor gives you in the mouth to numb everything up. Local anesthetic may be combined with any other anesthetic types including IV sedation.

They pulled all four of my wisdom teeth, two of which were impacted. The doctor localized my mouth using 'shots' of numbing stuff, they started an IV in my arm, and let me sit for about 15 minutes to 'numb up'. A few minutes before the procedure started, I was given some IV Versed (benzodiazepine) and nitrous oxide gas through a mask. They told me slowly inhale and exhale that stuff a few times, the Versed and nitrous kicked-in at the same time, I was as high as a kite. The doctor asked me how I was feeling, and I started giggling my ass off. He said, "You're ready."

He said open wide, so I just closed my eyes and opened my mouth as wide as I could. I heard some 'popping' and 'snapping' noises, then I fell into a lesser state of awareness where I was almost alseep. The next thing I remember was waking up with my mouth stuffed full of cotton. The procedure from start to finish took 15 minutes, I was 'out' for about 13 of them.

This is called IV sedation (with local).
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Old 08-21-2002, 01:24 AM   #21
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Quote:
Originally posted by: LostHiWay
It sounds like he used Novicaine. Novicaine is perfectly fine for getting you wisdom teeth out unless you can't deal with a little amount of pain.
Its novacaine btw, all the places that i know of dont use it anymore due to allergic reactions and use lidocaine. It does the same thing though...

Woops, I just noticed ScottMac replied with the same thing..
Quote:
General anesthesia IS given (in some cases, depending on the doctor's confort/education level and insurance) for wisdom teeth.

Novocaine hasn't been used in years (afaik), Xylocaine (basically a synthetic version of the same stuff) is much more common.

Many/most dentists will put a topical anesthesia on the gum or cheek before hitting you with the needle so you don't feel the stab (as much).

FWIW

Scott
Xylocaine = Lidocaine

Thats what they used when i had to have a portion of my big toenail removed last year.
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Old 08-21-2002, 01:31 AM   #22
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Quote:
Originally posted by: SHoddyCOmp
Quote:
Originally posted by: LostHiWay
It sounds like he used Novicaine. Novicaine is perfectly fine for getting you wisdom teeth out unless you can't deal with a little amount of pain.
Its novacaine btw, all the places that i know of dont use it anymore due to allergic reactions and use lidocaine. It does the same thing though...


It's Novocaine, IIRC.

which was either an improvement or brandname (forget..) of procaine, which was supposedly synthetic cocaine (again, IIRC..)
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Old 08-21-2002, 02:22 AM   #23
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Novacaine (procaine) is RARELY used any more because its the old 'ester' type local and has a higher risk of reaction than newer amides such as xylocaine and bupivicaine. Cocaine also has an ester link in its structure. The development of Novacaine is related to cocaine somehow, I forget.
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