Types of Anaesthesia

You have met with your Oral and Maxillofacial surgeon, Mr. Jason Erasmus, and it has been jointly decided that an operation is required for a specific reason. Different types of anaesthesia may have been discussed for your particular needs. Some operations can only be performed under full general anaesthesia in hospital, while other operations can be performed in our rooms at Milford Chambers, using one of the following techniques:

• Local anaesthesia alone
• Local anaesthesia with conscious sedation

What is meant by “local anaesthesia”?

Local anaesthesia means that your surgeon will use a local anesthetic agent to numb the required surgical field, similar to a dentist’s injection. This technique eliminates pain for a few hours, which enables your surgeon to perform the operation painlessly while you maintain full consciousness. You should be able to drive home yourself and can have anything to eat or drink before the scheduled operation. It is the preferred technique for smaller procedures.

What is meant by “general anaesthesia”?

To understand the concept of general anaesthesia, it is important to understand that different levels of consciousness exist, as is illustrated in the diagram below.

General anaesthesia means that a qualified specialist anesthetist administers medication that induces a state of deep sleep. This technique is only performed in well-equipped and accredited facilities, such as a hospital. During the “sleep state” all normal vital life functions are maintained and carefully monitored, while the operation is being performed by the surgeon. A tube is inserted via the nose or mouth to maintain breathing. At the end of the operation the anaesthetist will “reverse” the process and the patient will gradually come around, until full alertness is regained. Operations that are technically demanding or require more intense pain control are generally performed under general anaesthesia.

Two important practical points about general anaesthesia:

• You are not allowed to have anything to eat or drink for 6 hours before the operation
• You are not allowed to drive yourself for 24 hours after the operation

What is meant by “intravenous or conscious sedation”?
Conscious sedation implies a sedated state of reduced alertness which is characterized by calmness and drowsiness, but still being able to breathe effortlessly on your own with all upper airway reflexes maintained. The medication makes you very sleepy, significantly reduces anxiety and makes you lose your memory for 1-2 hours. In selected cases, we also use an intravenous opiate (i.e. strong painkiller) to further reduce pain. Although local anesthesia is also used as part of the technique, the vast majority of patients doesn’t remember, or care about, the numbing up process. Patients generally find conscious sedation an affordable, pleasant and safe experience with very little side-effects.

Conscious sedation is achieved by administering a sedative (such as midazolam) via an intravenous luer; this technique and is widely used for oral surgical procedures on adults and older children. As a technique, IV sedation has an excellent safety track record, but it can only be performed in an accredited and suitably equipped facility by trained staff. IV sedation is considered a safe anesthetic technique, but it is important to remember that certain medical conditions may pose a risk. Mr Erasmus will assess all factors in order to determine whether conscious sedation is a safe anaesthesia for you.

After the operation, patients may still be a little drowsy and a recovery period of 30 minutes is normally necessary. You will be observed in the recovery room facility by a trained staff member during this period.

Two important practical points about intravenous sedation:

• You are not allowed to have anything to eat for 4 hours before the operation
• You are not allowed to drive yourself for 24 hours after the operation

Which technique is the right one for me?

Not all patients or their needs are the same. Some are more nervous than others; some require technically more demanding operations, while others may require a longer operation. Mr Erasmus will consider all these factors in order to determine the most suitable type of anaesthesia for your particular needs. It is important to realize that the surgeon will recommend a particular type of anaesthesia, but it is only after thorough consultation with you, the patient, that a final decision will be made. Your input is thus equally important.