So I’ve been put under general anesthesia 3 times. Once for eye surgery as a kid, once for a stomach endoscope a few years back, and this weekend for oral surgery. I needed to have an impacted wisdom tooth dug out.
The first two times with general anesthesia were a big deal - they put me on an EKG IIRC, had a dedicated anesthesiologist during the procedure - the anesthesia put me quickly and forcefully out (I remember being unable to struggle to keep my eyes physically open as they clamped shut). And waking up took much longer and was much more disorienting.
But at the oral surgeon, it was far gentler. There was no anesthesiologist - the oral surgeon administered it himself. No EKG, just a pulseox monitor. It was a milky white substance through the IV. I felt dizzy and kind of drunk after it was administered, but not the harsh eyes forced shut feeling I had from the other stuff.
The procedure was really quick - it took about 20 minutes, and then after that it only took me a few minutes to wake up. I was under for less than a half hour, and I wasn’t completely disoriented and confused when I woke up. I was a little goofy like I was drunk, but it was much more pleasant.
What anesthesia did my oral surgeon use? If it’s so much safer that you don’t need an anesthesiologist on hand to monitor it, why isn’t it used more often? Is it the length of the procedure? Maybe whatever it is can only be used for short procedures? It seems unlikely that it’s not somehow tranquilizing enough to be used for surgical anesthesia - drilling out my gums and digging out an impacted wisdom tooth was probably more traumatic than the endoscope, and it kept me asleep through that.
So what was it that was used, and why isn’t it used for more procedures?
I’m guess this… Intravenous “I.V.” Sedation whic I found here.
Intravenous Sedation, also known as “Twilight or Conscious Sedation”, will put you in a safe, relaxed, and comfortable state throughout your surgery. It is the most effective means of reducing awareness and anxiety for dental procedures. It is administered through an intravenous line (I.V.), and is therefore much more predictable in terms of effectiveness due to the quick onset of action. Although the patient is technically conscious throughout the procedure, in most cases, they will be completely unaware of the dental procedure. The disadvantage of conscious sedation is, of course, the increased cost and the need for an escort home after the procedure. But, for the patient who wants to be “the most” comfortable during the procedure, it is certainly the best way to go.
It sounds like propofol, based on the appearance and the effect.
Propofol is used by anesthesiologists for both general anesthesia and sedation. In fact, almost every general anesthetic nowadays is induced with propofol. It may feel more “forceful” because the dose is much higher for general anesthesia. It’s virtually ubiquitous for upper and lower GI endoscopies.
The safety of any drug depends on the context. It’s questionable whether an oral surgeon can provide adequate monitoring for a deeply sedated patient while focusing on the surgery, so it’s crucial that the propofol dose is not too high, and ideally that other personnel qualified to give sedation are present, such as a nurse. Additionally, propofol can be much more dangerous in the presence of various other conditions such as heart disease, sleep apnea, and others.
Propofol is definitely not tranquilizing enough for surgical anesthesia, at least not in doses at which you can be expected to breath and keep your airway open. However, it doesn’t need to provide surgical levels of anesthesia for the oral surgery - that is provided by local anesthetic administered after you are sedated. For many procedures, such as podiatry surgeries, propofol is used for sedation, with the highest dose used during the painful local anesthetic injection. After that, patients will “sleep” comfortably on quite low doses.
I’ve heard that the steroid injection that podiatrists give you for plantar fasciitis (and other tissue injuries) is extremely painful. Do they ever use propofol before this injection?
Not that I know of, although I’ve seen propofol ordered for epidural steroid injections. Local anesthesia is usually given for these injections.
I second, third, and fourth that the OP was given a small dose of propofol.
Shortly before I decided to retire as a pharmacist, I had a lot of dental work, and the day before the main procedure was scheduled, we got a shipment of propofol that the pain clinic had ordered, and it was packaged in small syringes. I joked that I should take one with me for the next day ; I told the dentist about it and he said that he did use it sometimes, but only on procedures done in a hospital. I had an apicoectomy, which most people have never heard of and I had nightmares about it; the procedure took less than 10 minutes and was less traumatic than a filling. It also led to the salvage of a front tooth.
In the days when I had my wisdom teeth out, etc. we got sodium pentothal which is also still used quite a bit, because it’s relatively safe and also short-acting. Neither it nor propofol produce true anesthesia, so local anesthesia is used as well.
The standards vary between states and also between hospitals and free-standing clinics.
In my hospital, today, they would not permit deep sedation like that without someone (not necessarily a doctor or anesthetist, could be a nurse) dedicated to observing your vitals. But standards are often more relaxed in free standing clinics.
Propofol is a useful drug. As mentioned up thread it is used to induce anesthesia for general anesthesia, as a constant drip to maintain anesthesia (when intubated for example), and as the most frequently used drug in procedural sedation.
Procedural sedation has had at least three different monikers in my time. At first, around 20 years ago, we called it conscious sedation. Then it became moderate sedation. Now it is generally known as procedural sedation. We used to use a combination of Versed and Demerol. It worked well but the Versed took quite a while to wear off. At* least* 30 minutes. As the patient needs to be monitored 1-1 by a nurse during this time, this was fairly resource intensive.
Propofol has a much shorter acting time and the patient can be discharged or transferred much sooner.
As both Blue Blistering Barnacle and outlierrn mentioned most facilities have a very detailed procedure for it’s use. Usually both a physician and an RN have to be present, at minimum,( this may be different in a dental setting). Both must be certified in ACLS and have intubation equipment at hand.
Lastly, in my department, Propofol is the ONLY IV drug that is pushed (administered) by the doctor. All other drugs are pushed by the RN. And we use succinylcholine which is definitely more dangerous than propofol.
My cousin is a veterinarian, and when he was in private practice, he was about to sedate a Rottweiler with a syringe full of ketamine and diazepam, and the dog lunged at him and he got an ML or two injected into the palm of his hand. :eek: His partner told him to go lie down in a back room and they cancelled all his appointments for the rest of the day, and he said he was really loopy for quite a while.
I’ve also heard of it being used in battlefield surgery, and it was the amnesic used for the woman who had to have her leg amputated to get her out of the building after the Oklahoma City bombing.
I can only speak for my ED, but no, they mix it at the bedside, I’ve given lots of ketamine and lots of propofol over the years, but that counts as componding a medicine, so doctors only.
ETA they mostly use the mixture on adults.
I had an EGD recently due to a cirrhotic liver diagnoses and the GI doc wanted to check for enlarged varices in my esophagus, which he found and said he “rubber banded them off”, whatever that exactly means.
The gave my 20ml of propofol for the procedure and all I recall is waking up as the were transferring me back into the hospital bed in my room for the surgical gurney and yelling repeatedly “Trump just put a chip in me!” several times until I got reoriented.
Afterwards I had some soreness, hiccups and couldn’t eat anything solid for a couple days due to discomfort but the pumped me full of albumin and let me eat a lot of ice cream.
; I told the dentist about it and he said that he did use it sometimes, but only on procedures done in a hospital. I had an apicoectomy, which most people have never heard of and I had nightmares about it; the procedure took less than 10 minutes and was less traumatic than a filling. 
It also led to the salvage of a front tooth. 
