Associates In Facial and Oral Surgery
Oral Surgery
Monroeville PA

Before Anesthesia Sedation

Before Intravenous Anesthesia Sedation and Oral Surgery in the Office

Doctor Catone’s office provides intravenous sedation and other anesthesia services for selected oral surgical procedures on patients who do not require or qualify for in or outpatient hospital admissions. The office has an equipped operating room for oral surgical procedures and for patients receiving intravenous sedation; an Anesthesiologist will be available for the conduct of the intravenous sedation. The operating and recovery rooms are equipped with vital signs monitoring devices including automatic blood pressure and pulse, pulse oximetry, carbon dioxide sensors, and continuous electrocardiogram tracing. There are several outlets in the operating and recovery rooms for the delivery of oxygen and suction.

The office is located on the first floor of the Professional Office Building One on the campus of the Forbes Regional Hospital in Monroeville, PA. The office includes examination rooms and the operating room which has an adjacent recovery room for patients to rest after the procedure. There are television monitors in the examination rooms and recovery room for patient education DVD’s.

Patient Alerts

On the day before the oral surgery, a staff member will call to confirm your scheduled surgery time and to answer any further questions that you may have. It there is a need for you to cancel your appointment please call at least 24 hours before your scheduled time so that our schedule can be appropriately adjusted for the convenience of our patients and staff. The anesthesiology service will call you on the day before the oral surgical procedure to review your medical history and answer any questions regarding anesthesia issues that you may have.

Before Your Procedure

Please do not bring any valuables with you into the main office. Please bring identification or photo ID and your insurance cards. It is recommended that you come to the office 15-minutes earlier than your scheduled appointment so that last minute issues can be addressed. Please make sure that you are prepared to pay the fee for the anesthesia portion of the procedure.

  • You may not have anything to eat or drink (including water) for eight (8) hours prior to the appointment.
  • No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery.
  • A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home.
  • The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
  • Please wear loose fitting clothing with sleeves which can be rolled up past the elbow, and low-heeled shoes (example sweat clothes).
  • Contact lenses, jewelry, and dentures must be removed at the time of surgery.
  • Do not wear lipstick, excessive makeup, or nail polish on the day of surgery.
  • If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office.
  • If you take routine oral medications, please check with Dr. Catone prior to your surgical date for instructions.
  • Please bring a small blanket for your use in the recovery room following the procedure.

Operative Permit

Prior to surgery an operative permit must be signed by all patients. This gives the Anesthesiologist and Dr. Catone permission to perform the procedure. This includes a permit or consent for anesthesia services as well as oral surgery. Signatures for patients younger then 18 must be signed by a parent or guardian.

Anesthesia Choices

The types of anesthesia available are:

Local Anesthesia
Dr. Catone will numb the area of the surgery with an injected anesthetic solution (like “Novacaine”) that is appropriate for your condition.
Local Anesthesia with Intravenous Sedation
In addition to the local anesthetic (“Novacaine”), the anesthesiologist will give you intravenous sedation. Medications will be given to you by an intravenous line and one or more sedative/analgesic drugs will be used. This will create what is referred to as “conscious sedation.” You will not be aware of the procedure or remember any significant part of it. After the procedure will be ambulatory although your reflexes will be impaired. Post anesthetic instructions will be given to you by the Anesthesiologist.
Nitrous Oxide/Oxygen Analgesia
Dr. Catone will ask you to breathe a nitrous oxide/oxygen gas mixture through a small nasal portal placed over your nose. This will create a general feeling of relaxation and comfort and control of any uncomfortable stimuli during the oral surgical procedure. The mixture of gas is readily “blown off” after the procedure enabling you to be as alert as when you arrived at the office.

For Your Safety

As a general rule, take prescribed medication as you normally would, especially for high blood pressure and heart problems, as well as medications for seizure disorders. Use a small sip of water to take these drugs.

If you develop a fever, cold, rash sore throat or nausea or vomiting, call the office immediately. Dr. Catone may want to postpone your procedure. We will make every attempt to contact you should your surgical time be changed unexpectedly for extenuating circumstances.

Because the drugs used for intravenous sedation may linger n the body up to 24 hours, you must make arrangements to have someone not only take you home but also stay with you overnight. Your procedure may be delayed or cancelled if these arrangements are not made prior to your arrival at the office.

More on Nothing by Mouth Status

If you are having intravenous sedation or nitrous oxide oxygen analgesia (laughing gas) or and oral surgical procedure more involved than a dental extraction, you are not to eat, drink or smoke after midnight the night before oral or facial surgery. This includes water, gum or lozenges. This is to be followed unless you are instructed differently by Dr. Catone or the Anesthesiologist, or the staff person during your preoperative telephone call. You must be fasting until after the procedure

Use of Medications Preoperatively

Stop using any blood thinning medications one (1) week prior to your procedure. These include aspirin (including baby aspirin), Coumadin, warfarin, heparin, Plavix, Tic lid, and Lovenox. This rule stands unless otherwise directed by Dr. Catone. In some cases it is important to maintain anticoagulation and in these cases a special mouthrinse which promotes oral coagulation (Tranexamic acid solution) will be prescribed before and after oral surgery.

Stop using also any aspirin containing products or non-steroidal anti-inflammatory drugs such as Motrin, Advil, and Naproxen one week prior to the procedure. Discontinue Vitamin E similarly. In some cases it may be advantageous to begin taking certain similar medications prior to the procedure and you will be so informed by Dr. Catone.

Other Specific Instructions Regarding Medications

  • Oral hypoglycemics (for Type 2 diabetics): Metformin (Glucophage) should be held for a minimum of 12 hours before significant oral surgical procedures. Rosiglazone (Avandia), Glyburide (Diabeta, Glynase, Micronase); Chloropropamide (Diabenase); Glypizide (Glucotrol) and all other non-insulin hypoglycemics should be held on the morning of the oral surgical procedure.
  • Nitroglycerine: Continue if regularly used for angina pectoris. Make sure that you bring your own nitroglycerine on the day of the procedure (it may be a dosage specific to your condition) to be used for cardiac chest pain.
  • Monoamine oxidase inhibitors: Phenelizine (Nardil), Tranylcypromine (Parnate), Isocarboxiazide (Marplan), Furazoxlidone (Furoxone), Pargyline (Eutonyl), Procarbazine (Matulane), and others. These drugs should be held at least two weeks prior to oral surgery. Patients with severe depression may be more at risk if these drugs are withdrawn therefore, you should consult your physician or psychiatrist for guidance.
  • Antiepileptic medications: Dilantin, Phenobarbital, Tegretol, etc. Should be continued if for grand mal seizures.
  • Pulmonary medications: Albuterol, Flovent etc. Continue until procedure and resume after the procedure. Bring your inhaler with you on the day of the oral surgery and take a puff(s) before starting the procedure.
  • Tranquilizers: Valium, Ativan, Klonopin etc. Continue until procedure date and resume after the procedure. Make sure that the Anesthesiologist is aware of the use of these drugs.
  • Antihypertensive medications: Diuretics (HCTZ, Diuril, Bumex), Betablockers (Atenolol, Metoprolol, Betapace etc.), Clonidine, Captropril, Vasotec, Norvasc etc. Continue until the procedure and resume after the procedure.
  • Corticosteroids: Prednisone, Prednisolone, Hydrocortisone, Kenalog excuse of these medications may indicate an increase in dosage before oral surgery if the steroids were taken or injected in the last 6 months then discontinued. If may be necessary to give an intravenous steroid or an oral steroid before the procedure such as Medrol dose pack which can be started on the day before the procedure.
  • Herbal medications: Should be held for two weeks before the day of surgery including preparations of ephedra (patients may be purchasing ephedra preparations on the Internet).
  • Special Caution: Use of Bisphosphonates: Zometa, Aredia, Fosamax, Boniva, Actonel, Skelid, Bonefos, Loron, Ostac, Didronel. Patients taking these medications need to discuss the risks of osteonecrosis of the jaws with Dr. Catone and the physician prescribing these medications before planning any oral surgical procedure. It may be appropriate to proceed with oral surgery if the patient has been off the medication for several months but patients may need to have a “drug holiday”, usually 3 months before oral surgical procedures.

For surgery under intravenous sedation certain preparations and laboratory tests may be necessary. Dr. Catone and the Anesthesiologist will inform you if any tests are necessary. Usually for patients in good or stable health no test will be necessary. However, if they are needed Dr. Catone will give you a requisition or inform your PCP to obtain them. Sometimes tests are required because of conditions such as anemia, brittle diabetes, chronic dialysis or ongoing diuretic therapy. If there is a significant existing medical condition Dr. Catone will seek a medical clearance by your physician and/or appropriate medical specialist. This will dictate whether or not additional testing or examination by your physician will be required. Please note that all of this is done for the sole purpose of protecting your well being.