Anaesthesia

Local anaesthesia involves an injection in your mouth to numb the area being operated on. While you may still feel pressure and vibration during the procedure, it should not be painful. In cases where there is an abscess, the effectiveness of the local anaesthetic may be compromised. In such instances, the options include postponing the procedure until antibiotics treat the abscess or considering IV sedation. Local anaesthesia is ideal for straightforward teeth extractions. There’s no need to fast or be accompanied afterward. Your dentist typically identifies straightforward extractions and performs them using local anesthesia. If you’ve been referred for extraction, it’s likely because the tooth presents a higher degree of difficulty or the procedure may be stressful for you. As a result, many of our patients opt for either IV sedation or general anesthesia.

Target Controlled Infusion (TCI) is our approach to IV sedation. A computerised pump calculates your individual dose based on your height, weight, age and sex, and delivers the medication through a drip.

During the procedure, we continuously monitor your brain wave activity (EEG) to ensure a comfortable level of sedation, your breathing and oxygen levels via capnography and pulse oximetry, your heart rate and blood pressure, and your responsiveness.

The medications take effect within about a minute. Once we stop the infusion, they wear off quickly, and most patients recover rapidly without the prolonged grogginess that can occur with some other sedation approaches. Many patients have little or no memory of the procedure.

You will need to fast for six hours before your appointment. Afterwards, someone must collect you and accompany you home. You should not drive, operate machinery, or make important decisions for the rest of the day.

How TCI Differs from Standard IV Sedation

In manually titrated IV sedation, the clinician estimates and adjusts the drug dose based on clinical observation. TCI takes a different approach — a pharmacokinetic model (typically the Marsh or Schnider model for propofol) calculates the infusion rate needed to reach and maintain a target drug concentration in the brain, adjusted for your individual characteristics.

This means the sedation depth can be precisely controlled and adjusted throughout the procedure. Combined with real-time EEG monitoring, which provides a direct measure of brain activity rather than relying solely on clinical signs, this approach allows fine-tuned sedation management.

The practical result for patients is a smooth onset, stable sedation throughout the procedure, and rapid recovery once the infusion stops — propofol is metabolised quickly, and most patients feel clear-headed within 15 to 30 minutes.

General anaesthesia is performed at Bowen Hospital in Crofton Downs. A specialist anaesthetist will administer the anaesthetic, and you will be completely unconscious for the duration of the procedure. David performs the surgery while the anaesthetist monitors you throughout.

General anaesthesia is appropriate for longer or more complex procedures, for patients who require it for medical reasons, or for those who would prefer to be fully asleep.

As with IV sedation, you will need to fast beforehand and arrange for someone to accompany you home after discharge from the hospital.