General anesthesia offers the deepest form of sedation that can be used to provide relaxation and analgesia during dental procedures. General anesthesia use in dentistry is actually necessary only in special circumstances and it is reserved for a very limited number of cases such as very anxious children, extremely phobic or patients with special needs, or extensive dental surgery procedures.
General anesthesia is defined as a state of drug-induced unconsciousness, during which there is a loss of feeling or sensation and patients can not respond to verbal commands or physical stimulation (even to painful stimulation). There is also a complete loss of protective reflexes including those required for independently maintaining the airway.
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General Anesthesia services can be provided either by a medical doctor anesthesiologist or by a dentist anesthesiologist. A Dentist Anesthesiologist is a dentist who has taken special training in the field of anesthesia, which consists of a two-year general anesthesia residency in a medical hospital. Oral and maxillofacial surgeons are qualified in administering dental general anesthesia, because they already have the necessary training as part of their medical training.
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The majority of dental patients can be treated using local anesthesia or some form of conscious dental sedation (nitrous oxide, oral sedation or iv sedation). Although the advances in conscious sedation medications and techniques have reduced significantly the number of patients who require general anesthesia in order to get dental treatment, general anesthesia is still needed for some procedures or specific dental patient groups. Some complex cases, highly phobic and special needs patients, and children may require the more controlled and deeper sedation level of general anesthesia.
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Although general anesthesia today is much safer than it was until some years ago, it still remains the sedation method which carries the highest amount of side effects and risks for the patient. Cardiovascular and respiratory function may be impaired by anesthetic drugs. For this reason general anesthesia should be viewed as a last reserve for most patients seeking general dental treatment, and be used only when other sedation methods can not provide the desired results. Conscious dental sedation should be used in preference to general anaesthesia whenever possible. Patients with underlying serious medical conditions are most susceptible to the risks of general anesthesia, while a healthy person will rarely experience any serious side effects or complications.
Before any dental procedure under general anesthesia, a pre-anesthesia evaluation of the patient by the dentist / anesthesiologist is necessary in order to determine not only the suitability of the patient for undergoing general anesthesia, but also the necessity of using GA versus conscious sedation.
During the pre-operative consultation the dentist will explain the procedure and the risks involved. Finally the patient is given a list of general anesthesia pre-operative instructions to follow on the evening before and on the day of the procedure.
General anesthesia can be achieved with the action of several anesthetic medications. During the general anesthesia procedure these anesthetic drugs can be administered either by breathing a volatile anesthetic through a breathing mask (inhalation induction of general anesthesia), or by injecting the medications intravenously (intravenous induction of GA), or by a combination of the two methods.
At all phases of the general anesthesia procedure, the anesthesiologist continuously monitors the patient’s vital signs, by measuring parameters such as heart pulse and rhythm, blood pressure, oxygen saturation, and temperature level. Following the strict general anesthesia guidelines regarding continuous patient monitoring throughout the general anesthesia procedure is extremely important for ensuring patient safety.
Full recovery from general anesthesia may take several hours after regaining consciousness until all effects of the anesthetic drugs completely wear off. Patients must follow carefully the post-operative instructions after general anesthesia to speed up recovery and minimize the risk of any complications and adverse side effects.