General Anesthesia

In our times there are many types of surgical interventions or diagnostical examinations where no hospitalization is needed. In most cases the period of recuperation may be spent in the comfort of your own home. Ambulant surgery and anaesthesia are proven to be a safe and cost-efficient solution, available at more and more clinics. Such interventions are offered by dental and operative dentistry clinics. The anaesthesia is performed and overseen by an anaesthesiologist doctor.

Meeting the anaesthesiologist

The anaesthesiologist or one of his colleagues will question the patient prior to the anaesthesia is order to asses his/her current health status. This could be done in person at the clinic, but also over the telephone. In general some laboratory examinations and the documentations of earlier medical interventions are also necessary. Further, a questionnaire will have to be filled out by the patient concerning anaesthesia in the past, as well as general health status, allergies, medications taken, etc. All individual problems or needs have to be discussed by the anaesthesiologist.

Types of anaesthesiology

There are numerous techniques of anesthetising, ranging form local to general anaesthesia. The method suggested to the patient by the specialist depends of various factors. In many cases, the planned surgery will decide the method to be used, while previous illnesses, medical conditions could also be powerful factors. Generally the more simple methods are suggested to ambulant patients, because of the shorter recuperation periods and fewer accompanying symptoms. Naturally the requests of the patient are also strongly taken into account.

There are four types of anaesthetic methods used in operative dentistry:

• General anaesthesia – in this case the patient is unconscious, thus he/she is unable to feel, see or hear anything during surgery. The sedatives are supplied either intravenously or through a breathing mask.
• Local anaesthesia – in this case the anaesthetic drug is supplied to the nerves that lead to the affected area, thus the treatment may be executed without any sensation of pain. In this case there is no need for an anaesthesiologist to be present. With the administration of extra sedatives, the inconvenience of the procedure may be minimized.
• Monitored anaesthesia, sedation – in this case the patient will receive anaesthetic and sedative drugs injected into a vein by an anaesthesiologist, while the surgeon will inject the affected area with local anaesthetic drugs. The anaesthesiologist monitors life functions during the intervention.
• Sedation through a mask – in this case the doctor will perform superficial sedation through a mask, thus the patient is partially awake during the intervention.

Prior to any interventions, the doctor and/or the anaesthesiologist will explain the pro and contra of the specific methods, as well as the risks to be taken into consideration. However careful the preparation and the monitoring may be, in case of all methods there is a slight risk of the occurrence of side-effects or unexpected accompanying symptoms. This Information pamphlet is intended to aid your decision, together with your doctor’s advice, regarding the suitable method of anaesthesia.

Important information prior to the procedure

As a general rule, it is not allowed to eat or drink anything after midnight, prior to anaesthesia. Under some circumstances, your doctor may allow you to consume some clear liquids a few hours before surgery. Please refrain from smoking and alcohol in the 24 hours before the intervention. In all cases there should be an adult, responsible person escorting you home after the procedure, as you will not be able to drive home alone nor will you be allowed to leave the clinic by yourself.

We advise you not to stay alone in the 24 hours following the intervention. In case the surgery will be performed under local anaesthesia, the above rules are not valid, so please check with your doctor regarding procedures. These rules are intended for your safety. If you do not follow the above instructions, you surgery may be cancelled.

You need to discuss you usual medications (if any) with you doctor and your anaesthesiologist. You should not discontinue taking your usual medications if you are not directly instructed to do so. If possible, dress in a loose, comfortable, easy on- easy off fashion on the day of surgery. Please leave your jewellery and valuables at home!

What will happen during surgery?

The anaesthesiologist will care for your comfort and safety. He is leading the team performing the anaesthesia, which is monitoring the basic vital functions of the body during surgery. The anaesthesiologist is also responsible of the possible health issues arising in course of the intervention, which may be caused directly by the procedure, or maybe the result of some general illness, such as disease of the heart or circulation, asthma, diabetes, etc. One member of team performing the anaesthesia will be by your side during the whole procedure.

Monitoring period after the intervention

Directly after the surgery, you will be taken to an observation room. The anaesthesiologist will determine the medication required for recuperation. During the first 30 minutes, a specially trained nurse will look after you. In this period, the circulation and breathing is being monitored closely, supplying extra oxygen, if needed. When you become stable and confident, you may get up, meet your escort, and if the anaesthesiologist allows, you may drink some fluids.

The discomfort and pain experienced after the intervention is determined mainly by the type of the procedure. Doctors and nurses deal with pain using tablets, local painkillers or intravenous injections. As a result of this the pain is usually within the bearable borders, but total lack of pain may not be expected in the first 12 – 24 hours.

After anaesthesia nausea, vomiting may occur, but these symptoms get less and less likely due to the use of modern techniques and medications. The anaesthesiologist will supply you with anti-nausea medications if necessary.

Possible side-effects of interventions under anaesthesia

• Head ache, dizziness, nausea, vomiting
• Nose-bleed, damage of gums or teeth
• Sore throat, coarse voice, damage to vocal chords
• Catarrhal airways, damage to lungs, mis-swallowing
• Failure of breathing or circulation

Releasing you home

The time of release will be determined by the regulations of the institute where the surgery will be performed, as well as by type of procedure and anaesthesia. In most case the patient will be allowed to leave1- 4 hours after the intervention. The anaesthesiologist will be able to give you a closer estimate right before the surgery. All institutes where ambulant surgery is being performed is in close contact with a hospital, where the patient can be treated in case of complications. The patient will be supplied with written and verbal advice before release. These are in part general instructions, in part special instructions in connection with the given procedure.

The standard instructions for the first 24 hours are the following:

• Do not drink alcohol, do not smoke and do not take any medications not suggested to you by your doctor or anaesthesiologist!
• Do not drive and do not work with any dangerous machinery!
• Please avoid situations where you might rely on your sense of balance!
• Do not make any important decisions and do not sign any legal documents!
• Please call the institute where your surgery took place in case you need medical assistance!

Recuperation at home

Patients at home may experience drowsiness or other minor side-effects, such as muscle pain, sore throat, dizziness and headache after anaesthetic procedures. Slight nausea may occur, but vomiting is very rare. These symptoms subside quickly after the procedure, but may take days to entirely disappear. The day after the surgery, most of the patients will not be as active as usual, due to the inconveniences and fatigue caused by the procedure. Thus, it may be advised to allow for some days of rest after the intervention.