Dentist uses Nitrous Oxide?

Scott Seidman writes:

He's developed a dental anesthesia practice, where he
travels with full gear, including emergency gear and
crash cart, to dentists' offices for bigger procedures.

The one thing I'm curious about here is: Don't most forms of GA involve
an inhaled anesthetic agent? And if so, doesn't that interfere with the
dental work? I mean, usually you intubate a patient for GA with
inhalants, but I don't see how you can do that for dental work without
crowding out the dentist. So how is it done?

In the case of my wisdom extractions, I insisted on being asleep (I
cannot tolerate extractions while awake--almost went that way once, had
to stop urgently as the procedure began). The oral surgeon attached an
EKG and a mask, and administered nitrous oxide. As soon as he saw
ptosis, he injected me with something that I suspect was sodium
methohexital, which put me to sleep. When I woke up, I noted that my
jaw was somewhat numb, so I assume he administered a lot of local
anesthetic after I was out, and I presume that the local anesthetic was
actually what prevented pain, the Brevital and nitrous oxide alone being
insufficient for this.

The patients love it. The dentists love it. He swears
the dentists hand him money, and still act like he's doing
them the absolute biggest favor in the whole world.

It sounds like an excellent deal to me, the only disadvantages being the
expense and the increased risk (plus the mystery described above, but
maybe someone can explain that).

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Dr Steve writes:

Or, the kid just hears the "sharp', "hard", "powerfully
bright" part, and gets scared.

I think it is heard like this:

"Well, you'll just sit in this nice chair, and then the dentist will use
something that will PINCH a little bit, jdf yaeri sdfu zpoer SHARP, jfi
.... bryyz, ereyu iuzer HARD sh a euirs! Ruy ziuo s BRIGHT sudfyz STING
shdfy zzer DRILL sdfyzer sui qiudsf hh ezr HURT sdf jhze. Fyzo iurs?"

Kids are like the NSA, searching for keywords in text. The "trigger"
list includes things like hurt, pinch, sting, hard, mask, drill, tools,
and so on.



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Mxsmanic wrote:

Scott Seidman writes:

He's developed a dental anesthesia practice, where he
travels with full gear, including emergency gear and
crash cart, to dentists' offices for bigger procedures.

The one thing I'm curious about here is: Don't most forms of GA involve
an inhaled anesthetic agent? And if so, doesn't that interfere with the
dental work? I mean, usually you intubate a patient for GA with
inhalants, but I don't see how you can do that for dental work without
crowding out the dentist. So how is it done?

In the case of my wisdom extractions, I insisted on being asleep (I
cannot tolerate extractions while awake--almost went that way once, had
to stop urgently as the procedure began). The oral surgeon attached an
EKG and a mask, and administered nitrous oxide. As soon as he saw
ptosis, he injected me with something that I suspect was sodium
methohexital, which put me to sleep. When I woke up, I noted that my
jaw was somewhat numb, so I assume he administered a lot of local
anesthetic after I was out, and I presume that the local anesthetic was
actually what prevented pain, the Brevital and nitrous oxide alone being
insufficient for this.

Actually, a local is always used, even if general anesthetic agents are
as well. This eliminates any involuntary reaction to pain (say, reflexive
movement) which can happen even when unconscious.
Most oral surgeons I know use an ultrashort acting barbiturate for
induction. The nitrous potentiates this, but it is the IV barbiturate that
is really the general anesthetic agent. Back in the stone ages when I was a
resident, real short procedures did not get intubated--an airway way placed
though. Cases in the OR got nasotracheal intubation, and an inhalation
agent--usually halothane or ethrane.

Steve



The patients love it. The dentists love it. He swears
the dentists hand him money, and still act like he's doing
them the absolute biggest favor in the whole world.

It sounds like an excellent deal to me, the only disadvantages being the
expense and the increased risk (plus the mystery described above, but
maybe someone can explain that).

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

--
Mark & Steven Bornfeld DDS
Brooklyn, NY
718-258-5001
http://www.dentaltwins.com

madiba writes:

I get the feeling the morphine trips in hospital sensitised him. Careful
when he reaches his teens..

In what way would he be sensitized?

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In misc.kids madiba wrote:
I don't think giving him anti-anxiety meds before a procedure is such a
bad idea.

After having heard the whole story, you're probably right. But there are
plenty of tranquillisers out there besides Valium.

Valium is all I know and I haven't even been able to get that for
him. The first dentist didn't work on kids who needed that much
work. The second dentist wouldn't use valium because he used NO. The
third dentist didn't use sedatives at all and didn't want to. We're
headed for the fourth dentist and I tried to prescreen her on the phone to
discover if she'd prescribe a sedative before I make the 1/2 day journey
to her office for his 11th visit to the dentist in 4 months, but her
assistant just said she has in the past. I'm taking that as a hopeful
sign.

Is there any other sedative I should discuss with her?

By the way, I had a long talk with his pediatrician's nurse today, who
recommended yet a 5th dentist, but no solution to the anxiety. In fact,
he's slightly anemic and they want to draw more blood in a retest. I said
the hell with that, let's just assume he IS anemic and not bother testing
him again. (I'm slightly anemic and so are both of my other children - we
just are low normal in our family.) I cannot believe that these people
want to do yet another stick on this child without a damn good reason!

I get the feeling the morphine trips in hospital sensitised him. Careful
when he reaches his teens..

Sigh. Okay, what's THIS new danger?

Wendy, who needs a new hobby

One comment: Change your description to .....
xylocaine (our standby) for novocaine (last used in 1945!).

Joel

On 30 Sep 2003 17:30:53 -0400, Wendy
wrote:

In misc.kids Dr Steve wrote:
Pain is a relative thing. It can not be measured or described. It is also
directly proportional to emotional state.

So, those patients who are afraid of dentistry, are notoriously difficult to
get fully numb. They get their system worked up to a point that sometimes
NO amount of local anesthetic will work.

I think you've confused correlation and causality. I don't like dentistry
specifically BECAUSE I am unresponsive to novacaine. And because of that
I am especially conscientious about my dental ca I get regular
cleanings, brush twice a day and floss: BECAUSE I don't want to have to
have any more painful cavities filled.

My kids get regular cleanings and exams, orthodontic care, brush & floss &
rinse with flouride rinse and took flouride supplements when they were
little. My two older kids have a combined age of 26 and one cavity
between 'em. (My third is the one in the OP.)

I just don't think that "fear of pain" translates into "lousy dental
patient".

Wendy

--
Joel M. Eichen, .
Philadelphia PA

DISCLAIMER FOLLOWS:

*********

Dental health-related material
is provided for information purposes
only and does not necessarily
represent endorsement by or an official
position of the SciMedDentistry gang
or any other official agency either
actual or fictitious or Steve Mancuso.

Advice on the treatment or care
of an individual patient should
be obtained through consultation
with a dentist who has examined
that patient or is familiar with
that patient's dental history.

STANDARD DISCLAIMER

Oh please don't misunderstand me. I meant that comment in a general fashion
as part of a greater discussion, not about you.

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve Q Mancusodds.com
{change the center letter to "at" (and drop two spaces) for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"Wendy" wrote in message
...
In misc.kids Dr Steve wrote:
Pain is a relative thing. It can not be measured or described. It is
also
directly proportional to emotional state.

So, those patients who are afraid of dentistry, are notoriously
difficult to
get fully numb. They get their system worked up to a point that
sometimes
NO amount of local anesthetic will work.

I think you've confused correlation and causality. I don't like dentistry
specifically BECAUSE I am unresponsive to novacaine. And because of that
I am especially conscientious about my dental ca I get regular
cleanings, brush twice a day and floss: BECAUSE I don't want to have to
have any more painful cavities filled.

My kids get regular cleanings and exams, orthodontic care, brush & floss &
rinse with flouride rinse and took flouride supplements when they were
little. My two older kids have a combined age of 26 and one cavity
between 'em. (My third is the one in the OP.)

I just don't think that "fear of pain" translates into "lousy dental
patient".

Wendy

agreed

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve Q Mancusodds.com
{change the center letter to "at" (and drop two spaces) for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"Mxsmanic" wrote in message
...
Dr Steve writes:

Or, the kid just hears the "sharp', "hard", "powerfully
bright" part, and gets scared.

I think it is heard like this:

"Well, you'll just sit in this nice chair, and then the dentist will use
something that will PINCH a little bit, jdf yaeri sdfu zpoer SHARP, jfi
... bryyz, ereyu iuzer HARD sh a euirs! Ruy ziuo s BRIGHT sudfyz STING
shdfy zzer DRILL sdfyzer sui qiudsf hh ezr HURT sdf jhze. Fyzo iurs?"

Kids are like the NSA, searching for keywords in text. The "trigger"
list includes things like hurt, pinch, sting, hard, mask, drill, tools,
and so on.



--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

~~~GA in a hospital~~~

--
~+--~+--~+--~+--~+--
Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve Q Mancusodds.com
{change the center letter to "at" (and drop two spaces) for email}
.................................................. ...

This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
.......................
Please ignore j..d...
~~~~``````````#####----

"Wendy" wrote in message
...
In misc.kids madiba wrote:
I don't think giving him anti-anxiety meds before a procedure is such a
bad idea.

After having heard the whole story, you're probably right. But there are
plenty of tranquillisers out there besides Valium.

Valium is all I know and I haven't even been able to get that for
him. The first dentist didn't work on kids who needed that much
work. The second dentist wouldn't use valium because he used NO. The
third dentist didn't use sedatives at all and didn't want to. We're
headed for the fourth dentist and I tried to prescreen her on the phone to
discover if she'd prescribe a sedative before I make the 1/2 day journey
to her office for his 11th visit to the dentist in 4 months, but her
assistant just said she has in the past. I'm taking that as a hopeful
sign.

Is there any other sedative I should discuss with her?

By the way, I had a long talk with his pediatrician's nurse today, who
recommended yet a 5th dentist, but no solution to the anxiety. In fact,
he's slightly anemic and they want to draw more blood in a retest. I said
the hell with that, let's just assume he IS anemic and not bother testing
him again. (I'm slightly anemic and so are both of my other children - we
just are low normal in our family.) I cannot believe that these people
want to do yet another stick on this child without a damn good reason!

I get the feeling the morphine trips in hospital sensitised him. Careful
when he reaches his teens..

Sigh. Okay, what's THIS new danger?

Wendy, who needs a new hobby

Mark & Steven Bornfeld DDS writes:

Most oral surgeons I know use an ultrashort acting barbiturate for
induction. The nitrous potentiates this, but it is the IV barbiturate that
is really the general anesthetic agent.

I'd guess that the nitrous oxide made me woozy in about 30 seconds, and
I think I was out for only about 20 minutes under the barbiturate (I
think he told me it was Brevital, but I'm not sure).

Cases in the OR got nasotracheal intubation, and an inhalation
agent--usually halothane or ethrane.

I didn't even know you could intubate someone through the nose. It
sounds difficult to do. Even intubation through the mouth is said to be
pesky enough that an anesthesiologist is often called in just to do
that.

I assume, then, that this nasotracheal intubation leaves the mouth
unencumbered while keeping a sealed path to the lungs for the
anesthesia?

Another thing I noticed about the wisdom extraction was: no post-op
nausea. I had a simple IV induction for a hernia operation, and
whatever he used (inhalant of some kind, I presume) left me sick for 24
hours. I was worried about the extraction for this reason, but other
than an odd sort of fatigue (I felt fatigued, but when I tried to lay
down to sleep, I didn't fall asleep), I experienced no aftereffects,
which was fine with me.

Indeed, had I known that removing bony impacted wisdom teeth four at a
time could be such a breeze, I wouldn't have endured the discomfort of
those teeth for so long.

--
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