Treatments under anesthesia
What is “analgosedation”?
the name of this procedure comes from combining two words – analgesia and sedation, where analgesia is analgesic effect and sedation means calming, limiting consciousness.
Analgesia used by an anesthesiologist in dental procedures is only an auxiliary, the patient is anesthetized locally by his or her dentist, and usually this anesthesia is completely sufficient, however, for people more sensitive it is helpful when they are given intravenous agents that will reduce the discomfort which can be felt even while giving local anesthesia . The drug that is used for this purpose is called fentanyl, it is a drug from the group of opioids which are the strongest painkillers.
Sedation is obtained by sedatives and sleeping pills given in such doses that the patient was on the very edge of sleep, so that he or she could work with us, e.g. open his/her mouth, but later he or she may not remember it or judge it in the sleep category. Of course, it is very essential to adjust the dose precisely and to define the time interval between the subsequent doses, so that on the one hand the patient will not fall asleep deeply – because he or she will not cooperate and he or she will not be awake. The patient is to be relaxed, not stressed and he or she does not have to remember everything, then he will not be afraid of the next visit.
During intravenous analgosedation, we administer various medicaments intravenously, so we must put a heplock into one of the veins in the arm. Basic vital functions are monitored – heart rate, blood pressure and blood saturation – thanks to a special sensor – a pulse oximeter placed on the finger. All medications given to the patient, even those used locally by the dentist, can cause systemic reactions, from disorders of blood pressure, arrhythmia and ending with allergic reactions. During the entire procedure, the anesthetist supervises the patient’s condition, monitors his/her well-being and may take appropriate treatment if necessary.
Apart from drugs typical of analgosedation, we provide supportive drugs, most often they are antiemetics, as we all know that different stimulants affecting consciousness can also affect the work of our labyrinth and cause nausea. Personally, I always give antiemetics at the very beginning of the treatment without waiting for the patient’s discomfort. Another group of drugs used during analgosedation are steroids, they have many valuable properties, the most important for us is – reducing bleeding in the operating field by improving blood clotting, antiemetic and anti-allergic effect, especially valuable for patients with diagnosed allergy and for smokers.
Other medications are not used routinely but only when a particular situation requires this, e.g. blood pressure-lowering drugs, medications that speed up your heart rate when it spontaneously slows down, additional anti-allergic drugs.
Preparation for analgosedation
Before analgosedation at the dental office, a patient has to think about a few things.
First of all, you need to do basic blood laboratory tests. This is extremely important, since deviations from the norm regarding, for example, morphology, electrolyte levels, liver or kidney function indicators may indicate a load that in combination with potent intravenous drugs may cause undesirable effects. It is absolutely necessary to ensure maximum safety. The scope of research depends, of course, on our patient. Basic tests are enough for young people who do not cope with any chronic diseases, in the elderly or heavily burdened, however, study panel increases accordingly.
Secondly, you should be on an empty stomach, i.e. you do not eat for 4-6 hours and you do not drink clean liquids for 2 hours, this requirement is associated with possible nausea and vomiting. Although their risk is low and minimal after the use of our standard antiemetics, however, if it happened to a patient with impaired consciousness, it could lead to choking with the stomach content resulting in a really serious situation. Of course, you must not drink alcohol or take any intoxicants before treatment, because they react with our medicines, which can be dangerous.
Thirdly, most often when the patients are admitted to the Clinic, they fill in an anesthetic questionnaire, in which there are questions about the diseases they are cured for, medications they take, possible allergies and other important information. At the end of the questionnaire, the patient must sign, because it is a document.
For whom analgosedation
The first and largest group are people with dentophobia. Unfortunately, this is a very frequent phenomenon that we ourselves are responsible for making children feel scared of the dental visit when we treat the visit as an act of courage, as a result of which during the next visit a child encodes that he or she must expect something terrible since he or she was so brave before. And so the years go by but the fear remains. It is common to scare each other with the dental visit, there is even a saying “a dentist being a sadist”….. the years go by but the fear remains. A person becomes an adult, but he or she feels his or her fear somewhere deep in the subconscious, and nothing will do the explanations that nothing hurts, our patient is just afraid, and that’s it! A dentist has to understand this and propose a method that will affect patient’s fears calming his or her subconscious mind. A patient with dentophobia is not really afraid of pain, in extreme cases he or she just scares to open his or her mouth on the dental chair. Similarly, a person with arachnophobia will never be convinced that this cool, hairy spider is absolutely safe and cuddly and you can stroke him, he or she will sooner faint, get a heart attack or at best escape shouting wildly! Our patient feels the same way, phobias are not rational, and you should not explain that a dental visit will be nice and painless. You have to help overcome these fears and eliminate them with medication.
The second group of patients are particularly the elderly, burdened, exposed to long procedures. For such people it is just safer to be close to an anesthetist who will control their current general condition, support with painkillers and sedatives. It is safe because it provides the patient with the stability of the circulatory system, you can immediately diagnose the tendency for hypertension, heart rhythm disorders and react properly.
It is assumed that patients undergoing intravenous analgosedation are under the influence of drugs still a few hours after visiting the Clinic. They may not even feel the drug action anymore, they are no longer dizzy and sleepy. It is deceptive, because small amounts are still there, and therefore you must not drink alcohol and drive a car on the day of sedation.