Expert: Ronald Levy, M.D. - 6/6/2009

Question
Thanks first for this great venue of information!

I had oral surgery to remove roots of 2 back teeth, molar and 1 in front.  I am absolutely terrified of this surgery. I had it a few years ago for extractions and it was smooth sailing; out, done, on the way home with a 'buzz'.
The only oral surgeon I could find told me that I would not be put 'under' but 6 people in his office, including him, told me ''you will not be aware and you will not care''.   I based those answers on faith I would not be fearful and though still dreading it, anxiety disorder, I
went for the surgery with faith in all reassurances.
I did not get ANY feeling of being 'unaware or not 'caring.
Never.  I talked to the dentist throughout, told him it was not working, 3-4 times, and he proceeded w/o any care of my feeling near traumatized.  (I was praying hard and doing some deep breathing excercises)
I knew everything from arriving there and all the rest of the day.  The meds given was 40 mcg fentanyl, 5 mg. versed, 40 mg. profonol.   I discussed the heinous situation afterwards but was only told it was basically protocol for that type surgery, and works well for most patients.  (like one size fits all)  Well, it didn't work.
I take medications for fibromyalgia and anxiety which he was aware of, and I told him that the dosage for me was not appropriate, obviously, and he argued the same, 'works well....typical dosage''.
PLEASE tell me if this dosage would seem to be enough for someone who is already taking medications for above mentioned health problems, (klonopin, remeron, parafon forte', atarax - all mild doses regularly.)
I do not agree that it was enough.  It was so bad I almost asked to just stop, let me go; forget about it, and $500. paid for 30 minute procedure.
I do not know about these meds but I did have other outpatient surgeries, was totally uncaring about them all, and the first oral surgery I was out completely.
Please give your opinion.  
Would it not have been appropriate under the circumstances, begging for help, being terrified, that he could have administered a bit more of 'something' to get me leveled out to make it through it without horror??

Thanks again for your expertise and look forward to an informed answer.


Answer
Assuming you are of normal weight and size, the dosage was actually an appropriate and reasonable dose...but if it didn't work for you then YOU needed more! Versed is an anti-anxiety drug and also causes amnesia. So does Propofol. Both these drugs should be titrated to effect and not just given as a fixed amount. If the dentist was administering the drugs himself, I cannot speak for the care. An anesthesiologist would have made sure you were comfortable prior to the procedure. Other than the Atarax, your medical problems and meds should not have anything to do with the effectiveness of the meds.


Ronald Levy, MD
Professor of Anesthesia
UTMB-Galveston