Several types of anesthesia techniques are available for you at Dr. Kienle & Associates’ surgical facilities. Dr. Kienle, Dr. Steinkeler or Dr. Gunawardena will help you choose and/or recommend what type of anesthesia is best and most appropriate for the type of procedure you need to have performed. There are many factors that influence the best choice of necessary anesthesia. These include the type and complexity of the procedures, apprehension level of the patient, age of the patient, medical or physical issues and the ability to provide a comfortable and pain-free experience.  The following table illustrates the choices of anesthesia, a description of the anesthetic technique, and the usual indications for that technique.

Method of Anesthesia Description of Technique Usual Indications
Local Anesthetic The patient remains totally conscious throughout the procedure. A local anesthetic (e.g. lidocaine) is injected in the area where the surgery is to be performed. Local anesthetic is used in conjunction with the other methods of anesthesia in all oral surgical procedures. Simple oral surgical procedures such as minor soft tissue procedures and simple tooth extractions.
Nitrous Oxide Analgesia with Local Anesthetic A mixture of nitrous oxide (laughing gas) and oxygen is administered through a nasal breathing apparatus. The patient remains conscious in a relaxed condition. Nitrous oxide has a mild sedative and analgesic (pain- controlling) effect. Simple oral surgical procedures to more involved procedures.
Sedation or General Anesthesia with Local Anesthetic Medications are administered through an intravenous line (I.V.). The patient falls asleep and is completely unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Diprivan. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored. Sedation and general anesthesia is available for all types of oral surgery. A patient may choose general anesthesia for simple procedures depending on their level of anxiety. Most people having their wisdom teeth removed or having a dental implant placed will choose sedation / general anesthesia. General anesthesia may be necessary if local anesthesia fails to anesthetize the surgical site which often occurs in the presence of infection.
Hospital or Surgery Center Based General Anesthesia A patient is admitted to a hospital or surgery center where both the anesthesia and surgery are performed in that setting. Indicated for patients undergoing extensive procedures such as face and jaw reconstruction and TMJ surgery. Also indicated for patients with medical conditions such as heart disease or lung disease who require general anesthesia in a hospital setting.

Drs. Kienle, Steinkeler or Gunawardena are licensed physicians and dentists who specialize in oral and maxillofacial surgery. They have all undergone rigorous extensive training in both anesthesia and surgery. They are all board certified by the American Board of Oral & Maxillofacial Surgery (ABOMS) and the National Board of Dental Anesthesiology (NBDA). All of our surgical facilities are fully accredited by the Joint Commission as ambulatory surgery centers and are the only oral and maxillofacial surgical facilities in the greater Philadelphia area to be so accredited.

Again, when it comes to anesthesia, our first priority is your comfort and safety. If you have any questions or concerns regarding the type of anesthesia that will be administered during your oral surgical procedure, please do not hesitate to discuss these with Drs. Kienle, Steinkeler and Gunawardena at the time of your consultation.

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How is the IV Sedation or General Anesthesia Administered?

A thin catheter will be introduced into a vein in your arm or hand. The catheter will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated and may not sleep at all.

General anesthesia results in the patient being fully asleep and unaware of the surgical procedures. IV sedation provides relaxation; anxiety elimination and the medications used prevent awareness or memory of the procedures.

Drs. Kienle, Steinkeler and Gunawardena use computer controlled medication pumps to provide the correct and continuous flow of the desired anesthesia. Your specific parameters are entered into the computer controlled medication pumps to provide you with the correct amount of anesthesia you require. You breathe on your own and are administered supplemental oxygen via a nasal canula. All of your vital signs are fully monitored during the anesthesia and recovery.

Please remember that Drs. Kienle, Steinkeler and Gunawardena are board certified in both Oral & Maxillofacial Surgery as well as anesthesia. The surgical staff members are all licensed nurses. The doctors and nurses are all certified in Basic Cardiac Life Support (BCLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS). Our primary concern is for your safety and comfort.

Nitrous Oxide (Laughing Gas)

Nitrous Oxide is a sweet smelling, non irritating, colorless gas which you can breathe. Nitrous Oxide has been used as a mild analgesic in medicine and dentistry for many years. It does have limitations and may not be effective in many surgical procedures.