Performing implant placement during full sedation?

I am going to be placing 6 upper implants and 2 lower implants for a patient in 2 weeks who insisted on being fully sedated during the procedure. I do not perform this service and found an office who "rents out" their space for such a thing, providing an anesthesiologist for a fee.

I am very familiar with the actual surgery, but I have never performed a surgery on a fully unconscious patient. I will be using a fixed guide for placement on the upper arch which is edentulous. The patient has a full complement of teeth on the lower except for #19 and 29 which is where I will be placing single implants via freehand. What I am wondering is if there are any pointers, large or small, that people may give that they have gained through their experience? I am looking at this as working with "dead weight"...that is, every little bit of opening, etc, will have to be done by my assistant and/or some other method(s). Thank you for your time.

ajaykashi comments:

I am not sure which state you practice in but to my knowledge full sedation would imply general anesthesia if I am not mistaken and most states do not allow this in an outpatient dental clinic setting. As far as I am aware general anesthesia can only be administered in a hospital setting where adequate resuscitation assistance and adequate help is available in the unfortunate event of a patient having a medical emergency or an anesthetic complication. Besides this I think you can administer general anesthesia in a surgical center. If you can do this case in a hospital setting (which may require hospital privileges) with the anesthesiologist that might be the safest and most appropriate way to approach this. Would love to hear others' inputs on this. Good luck with the case. Ajay Kashi, DDS, PhD

randollerton comments:

These questions can be answered easily by the one providing anesthesia. Give him / her a call.

robpainless comments:

Not sure what you mean by ‘full’ sedation . There is GA , and there is sedation . Sedation patient will be conscious , can swallow and breathe and talk but be unconcerned about what is going on . Local anaesthetic will be used as well . Makes working on patient a delight for you and the patient . Just do what you normally do , but it will be easier .

kmischley comments:

I heard back from the anesthesiologist and they informed me that they are planning on deep IV sedation which is what I expected. When I said "full sedation" I was inferring that, however I should have known better! So, yes, deep sedation followed by local anesthetic. Specifically, I am looking for some input regarding patient positioning, keeping an unresponsive patient in a workable position, things along that line of thinking. For the maxillary as well as mandibular work...tricks and tips on achieving this. Thank you.

timcarter comments:

I find it hard to imagine that anyone would go to such measures just to keep from referring a patient out to another provider. Given that you are asking such questions demonstrates that you may not have the patient's best interest in mind and are more concerned about compensation. If you have never treated a sedated patient then perhaps a case involving 8 implant fixtures is not the most appropriate place to start. Refer this patient and start small if indeed you plan to expand your practice to include more complex procedures. Just a thought from a concerned colleague.

alan comments:

your patient will have a compromised cough reflex so be careful and use a guaze at the back of the throat to prevent accidental swallowing of any small item., such as a scfrew driver. Have floss tied around each tiny item that goes into the mouth . Procedural xrays while doing your osteotomies will be challenging but not impossible. Postion the patient in a 45 degree upright postion , similar to the postion for an extraction.