Expert: JM Starkman, MD - 6/26/2009

Question
Dr.Starkman,
I am a CHF & CAD patient who has been told by my cardiologist to avoid general anesthetic. I have to undergo `considerable' dental work at the hospital dental clinic (extraction of roots left inside the gum from previous extractions, removal of loose teeth, & perhaps some root canals).
My cardiologist said no to sedatives and no to ephinephrine and in his words make sure there is "good freezing". My question is, what is safe for me?? Are there any ways to numb the area or medicines to allow these surgical procedures? I realize why I can receive traditional anesthesia or sedation but I don't want the pain etc to make my heart worse either. Your help is appreciated.

Answer
Anesthesiologists fight this fight regularly--namely, that your cardiologist, irrespective of how well meaning he is, has no anesthesia training and is not providing you with useful or current advice.  Ironically, YOUR notion of what is safe (an anesthesiologist's primary concern) for you, and the degree of risk that is involved with UNDER-anesthetizing a patient such as yourself (pain--leading to release of your body's epinephrine---leading to high pulse rates and high blood pressures, systemically and pulmonary-wise) is more informed than the cardiologist's. (pardon the doctor lingo)

CHF/CAD patients must be unstressed to void the above.  A proper anesthetic for your dental work should include a degree of sedative medications, local anesthetics, supplemental oxygen and a considerable variety of supporting monitoring and respiratory equipment to facilitate your dental work.

Perhaps your cardiologist is assuming that the dentist and not an anesthesiologist would be the person responsible for your anesthesia. (?)  In that case, I agree with him, ie most dentists are not equipped to manage safely a patient with your degree of risk.......Ask your dentist if he does any of his work at a hospital or surgery center with an anesthesiologist--that anesthesiologist can formulate a safe plan for your dental surgery (We do this every day).