PROCEDURES UNDER THE INFLUENCE OF GENERAL ANESTHESIA IN ORAL SURGERY
Nowadays, the definition of what Health is goes beyond the simple absence of malaise. It’s a somehow elastic concept; it can be solely defined as the absence of malaise or disability, or it can be given a much more positive meaning, such as the one of the Constitution of the World Health Organization (1948):
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Thus, our daily work perfectly fits this aforementioned concept of Health, with which our aim is to fight disease and pain, whilst keeping the well-being in mind.
In Dentistry’s current state, and specifically when it comes to Oral Surgery, we can, as we speak, carry out our procedures with a level of pain and discomfort almost close to zero or, in a worst-case scenario, confined within the permissible and tolerable limits for our patients.
In the other hand, we have situations in which local anesthesia, the conscious and/or chemical sedation, are not sufficient for us to operate under safe, effective and efficient conditions.
We talk about the following situations:
– Patients with pathophysiological conditions who need a stricter control (monitoring) by the medical team, carried out by both surgeons and anesthesiologists.
– Patients who struggle to keep their mouth open during the required period to carry out their specific treatment.
– Patients with phobias, fears and traumatic past experiences, who doesn’t gather the set of premises which allow the medical team to carry out their work under the best conditions possible.
– More complex and extensive surgeries which demand their procedures to be carried under the scope of general anesthesia, such as the zygomatic implant surgery.
In terms of safety and trust felt by our patients, we think it’s important to reinforce the main mission of the medical team, which is to make sure that the medical procedures preserve the health and life of the patients, above any other situation, and to do so we encompass a team comprised of an anesthesiologist, a nursing team, the main surgeon, an assistant surgeon, and an oral rehabilitation team.
The current procedures operating under general anesthesia are extremely safe, and they constitute a viable option when that’s the go-to option.
The selection of patients for general anesthesia starts in the first appointment when, in many situations, is the patient himself who tells us that he only wants to be treated if he’s asleep.
As it is obvious and self-explanatory, a great share of people says such thing as a way to expose their fears and phobias right from the beginning. Many do it as a way to put the health professional in a state of alert, acknowledging that he’s in the presence of someone whose treatment may be strenuous.
It’s during the appointment, and as the medical team gets itself familiar with the diagnose, that the first Treatment Plan is conceived step by step, with its complexity and span specifically adapted to each clinical case and, for this reason, to each patient.
In our C.E.R.O., we don’t treat mouths and teeth, we treat people and individuals, each one of them with their specific goals, each one of the team with their ways of being and thinking, and each one of them with their associated pathologies, medication and risk potential.
When both the Patient and the Medical team reach the conclusion that the treatment must occur under the effect of general anesthesia, a process that will take the patient to the anesthesiology appointment begins.
Medical examinations requested by the medical team:
– Blood testing
– Chest X-Ray
– E.C.G. (Electrocardiogram)
Location of the anesthesiology appointment:
– In accordance with the Anesthesiology team’s availability for the intended dates, such can take place in the Hospital, or at one of our CERO Clinics, in Lisbon or Almada.
Costs to the Patient:
– It has a flat rate for the patient, who will pay the rental costs associated with the Operating and Recovery Rooms, of having to stay over the night if necessary, of the medical auxiliary personnel, of the Nursing and Anesthesiology Teams – structures that belong to the Hospital.
Type of treatments carried out under general anesthesia:
– Surgical procedures that justify, due to its length, the use of such procedure.
– If there is no alternative when it comes to minor surgical procedures.
– Regardless of their length, all surgical procedures will be carried out in a single surgery, with few exceptions to the rule, which will be carefully explained to the patient during the Oral Surgery appointment.
Is everyone suitable for General Anesthesia?
– General anesthesia is used in routine surgical procedures, which are scheduled and studied beforehand, as well as in urgent procedures in which the risk of non-intervention is greater than the risk of intervention when the patient’s own life is at stake.
– There is an international classification for patients who will be submitted to a general anesthesia, with such classification being given by the Anesthesiologist Team.
– For surgical procedures like the ones we carry out, in which the surgery is scheduled, and the procedure is not urgent nor emergent, we only operate patients who obtain a really good classification, i.e., those who have a non-existent or rather minimal risk, perfectly manageable in the Operating Room during the surgery, as well as after the surgery in the Recovery Room.
– Maximum Security
– If there’s a pathology at the patient’s core, i.e., one that is already installed and is prior to the surgery, we send the patient to his assistant physician if possible, in order to have the pathology controlled, stabilized or treated before considering submitting the patient to a General Anesthesia.
We usually look and talk between the Team and, even though this is a poorly established comparison, and setting aside the differences between both cases, and without wanting to speculate or disrespect other professions, quite the opposite in fact, for us a surgery, and in this specific case, a surgery in a Hospital’s Operating Room, under General Anesthesia, is like a flight. We – the medical team – can take off and, after having carried our check-up or double check-up, and sometimes even triple check-up considering the amount of times we execute our pre-surgical work (or flight plan), we only advance to departure after receiving the green light from the control tower – in this case, the anesthesiologist –, in such a way that, a bit before finishing the surgery, we have to warn that same anesthesiologist that we’re requesting permission to land, thus the anesthesiologist will be able to get us on tarmac, competing our flight.
It was a pleasure for to be able to share ideas and knowledge with you.
On my behalf, and on behalf of all the Team of Centro de Estética e Reabilitação Oral de Lisboa, I will sum it by saying ‘see you soon’, as we’ll talk about another subject of interest for the patient who constantly hears about this and that, others who live their lives based on false myths and empiricism, and the internet has tons of misinformation amidst valuable knowledge and I know that patients feel lost when it comes to this particular subject.
I will soon talk about Bone grafting and its use in Oral Surgery and Dental Implants.
See you soon, and don’t forget to be happy.
Luis Pinheiro, dentist, responsible for Oral Surgery and Dental Implants.
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