How Will You React to Anesthesia? Sedation Facts for Patients
Dr. Michael B. Lee, Cincinnati Oral and Maxillofacial Surgeon
Our Patient’s Experience is Unique
Delivering office intravenous sedative and anesthesia is the cornerstone of Dr. Lee’s Oral and Maxillofacial surgery profession. No other dental or medical specialist is better trained to deliver this safe and cost effective service. Dr. Lee and his nursing staff carefully evaluate each patient’s medical history before performing office IV anesthesia.
No two patients react the same way to IV anesthesia. The Cincinnati Center for Corrective Jaw Surgery is prepared for any response because so many things affect how one may react to sedating medications. They include:
- Weight / Size
- Physical characteristics
- Medications you take
- “Medications” you don’t want to admit you take
A patient’s age is very important to take into consideration when planning an office IV anesthesia procedure. Children are not “little adults”. They react differently to medications both physically and psychologically. They have very different physical characteristics in the size of their mouths and airways. Not only are they smaller, but they usually have large tonsils blocking their throats. Older patients are quite different too. They are universally more sensitive to medications, more compromised by their other ailments, and more prone to medication altercations – because they take so many other medications.
Weight / Size
No other factor has changed the delivery of IV sedation in the office setting more than the increased size and weight of the patient population. 30% of Americans are now obese, and another 10% are overweight. Add to this the general increase in the size of young women and men (from increased muscle mass), and you have a population that generally can take much more medication to achieve sedation and anesthesia.
The increasing amounts of medication given is directly proportional to the increasing numbers of complications. Overdosing a patient on both ends of the weight spectrum is problematic but especially on the patients who are overweight. Their increased weight effects their neck size and breathing, and ultimately, their airways are harder to control.
From a genetic standpoint, there are some patients who are resistant to the medications we give to accomplish IV sedation and anesthesia. Also, there are some patients who seem to just naturally fight the effects of the drugs that we administer. These are usually the patients who hate to be out of control of their emotions or environment, or patients who are naturally aggressive. If these genetic traits describe you, you may want to reconsider the location of where you have your surgery and what technique is used (i.e. IV anesthesia verses inhalation anesthesia with gas). No one successfully fights a gas anesthetic and wins – the anesthetist or anesthesiologist always does. While Dr. Lee is good at picking up these traits, he isn’t 100% successful. That is why he and the nursing staff are trained to handle all types of situations. If it seems likely that you will have a problematic response to the medication we use, Dr. Lee will recommend an outpatient setting for your surgery with a qualified anesthesiologist.
Blood tests are being developed and will be available soon to help detect problematic genetic markers. Anecdotally, we see special problems with patients genetically featuring red hair. We know from experience that they will take more local anesthesia to get numb during the procedure and that they are more likely to bleed during the surgery.
Physical characteristics of the mouth and airway
When considering a patient for office IV sedation or anesthesia, we carefully evaluate their airway size and the access we will have in their mouth to efficiently and successfully perform surgery. Not all mouths open as wide as the next. Some tongues are larger than others. Some cheeks are fuller. Some gag reflexes are stronger. All of these factors can add to surgical difficulties and increased surgical time.
Increased surgical time increases medication given. An increase in medications given is proportionality related to increases in complications. Remember, airway sizes also affect office IV sedation and anesthesia. A large neck sometimes means a smaller airway. Larger tongues certainly mean a smaller airway. Smaller lower jaws and recessed chins definitely equate to more difficult airway management. Add to any of these physical characteristics an increase in body weight and the job of keeping your airway open and you breathing gets more problematic. However, Dr. Lee’s top priority is to avoid problems.
Medications you take
Many of medications that Dr. Lee’s patients take can influence and alter the medication we use in IV Sedation and anesthesia. These interactions are beyond the scope of this review, but during Dr. Lee’s evaluation of your medication list and your medical history, potential interactions will be carefully considered. If potential interactions are problematic and increase your risks, Dr. Lee and the nursing staff will contact your medical doctors and consult. Sometimes medications are changed, sometimes Dr. Lee’s IV sedition and anesthesia techniques are changed and sometimes the setting for your surgery is switched to an outpatient facility. Safety first! This problem frequently arises with patients on medications for depression and for hyper activity disorder. All of these medications can affect the medications used for office IV sedation and anesthesia and can cause physical and psychological issues.
Medications you don’t want to admit you are talking
Even more problematic than the medications you are taking are the medications you don’t want to admit you are taking – alcohol, pain killers, stimulants, psychedelic medications and marijuana. Nothing ads more variability to a patient’s response to IV sedation/ anesthesia medications than “recreational” medications. That includes routine use of alcohol and marijuana. All recreational drugs increase resistance to the medications Dr. Lee and his nursing staff give you. Additionally, they can all increase their effect causing prolonged sedation and even breathing difficulties and depressed heart function. Therefore, always be honest about the recreational drug and other “medications” you use. Dr. Lee and his staff don’t care what you use. All they care about is your safety and putting you to sleep in the safest environment possible. Remember the old saying, “You don’t pay the doctor to put you to sleep, you pay the doctor to wake you up”.