Expert: Ronald Levy, M.D. - 6/21/2011

Question
I have had HPB all my adult life which started when I had toxemia with the birth of my son. I have taken all sorts of medications-diuretics, beta-blockers,calcium-channel blockers,etc. all of which did not control my BP until I had a stroke at age 54.  I then started taking a new drug-Exforge and now Exforge HCT which has given me a new life without the constant fear of having another stroke or a heart attack(I also take Inderal LA for arrhythmia).  However,I am having a problem trying to have oral surgery & being numbed.  I have had 2 visits already & nitrous oxide & 7 shots of anesthesia have not worked so far.  I am going to have "twilight sleep" next week & am scared that that won't work either.  I have always had a problem with anesthesia working & would like to know why nothing short of a sledgehammer to the head seems to work on me. Why does nothing except general anesthesia work on some people?  Or are some people like me just not able to be numbed with ordinary drugs?  Thank you.

Patti Carbone

Answer
If you've already had nitrous oxide + local and it did not work, I wonder about "twilight sleep" which is basically the same thing (assuming what you are calling twilight is what I think it is). There is no reason local shouldn't work on you. Pain is a very subjective thing and I am also one who generally requires several doses of local when I get dental surgery (I've been told I have long nerve roots). Depending on what kind of dental surgery you need, you might opt for a general anesthestic. These are generally done by oral surgeons as opposed to dentists who practice sedation dentistry.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston