Expert: Ronald Levy, M.D. - 5/19/2009

Question
Dear Dr. Levy,

In a few weeks, I will have my wisdom teeth removed by an Oral and Maxillofacial surgeon.

His website is as follows:
http://www.drdexterjohnson.com/oral-surgeon-ottawa/doctor.asp

During the consultation, he said that I would be put under general anesthesia as he will be cutting open my gums and doing drilling work. The drugs used will be an intravenously administered mix of four drugs, one of which is the narcotic fentanyl; I can't recall the other three.

He said that he will be doing the procedure with a nurse trained in anesthesia, but no fully-licensed anesthesiologist.

I acknowledge the fact that medical legalities may be different in different countries, but in the United States or specifically where you practice, is it legal for an oral and max surgeon to administer general anesthetics to patients without the guidance of a fully-licensed anesthesiologist?

Secondly, is there a great deal of danger or complication in this specific anesthetic compound? Another one of the drugs in the slurry is one that will help me relax but will cause me to lose my memory of the operation.

Thanks,
James

Answer
Generally speaking, oral/maxillofacial surgeons also get training in providing sedation anesthesia. This is common. Furthermore you state that they will be using a nurse anesthetist (which is more than most OMF docs use). A nursed anesthetist does have 2 yrs of aneshtesia training for all aspects of anesthesia (including general). Assuming his facility has the capability to deal with any possible complications, I wouldn't worry. He certainly has had excellent training. As for the meds, you will probably get Fentanyl, Midazolam and Propofol (I am not sure what the 4th would be). This is a common combination and (if given correctly) will provide appropriate sedation and amnesia.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston