Gas anaesthesia at dentist

[damo70]

was i the only one one who got held down in the dentists chair and got sent to sleep with the black rubber masks and hoses in the l8 70s and 80s?Did any one else find it better than injections and hearing cracking noises and having teeth extracted under injections,I liked the sleep and prefered the gas does anyone else feel the same???

[wildwood]

I too am a real woosh when it comes to the dentist. I much preferred the gas.

[malpal]

It was having teeth out with that gas mask that made me terrified of dentists ever since! It made me sick.

[delboy3]

I was only gassed once, as a small boy back in the early 70s. I think dentists are far too worried about potential side-effects to continue using it nowadays.

[Peter Pedant]

General anaesthesia in a dental chair at a dentists turned out to be far too dangerous

(too many children died)

and so it is, I think only done in Dental Hospitals

Dental sedation is diferent and safer and lighter


The final nail in the coffin - excuse the pun - was a case where Dr John Evans Appiah had a dental chair death at the Peppermill - things changed rapidly after that

Try googling Evans Appiah Peppermill

[theprof]

Actually Peter, although there is a recognised risk involved in using gaseous anaesthetics during dental procedures, the procedure is not per se, banned. Discouraged might be a more appropriate word.

In my home town, virtually all children under fourteen are referred to a private dental clinic in a city twelve miles away when extractions are necessary. Naturally, because of their age, the children are entitled to free treatment although the clinic fee's are partly paid by the NHS and partly paid by the referring practice through a complicated arrangement.

The clinic is owned and run by a consultant anaesthetist who is present during all procedures involving induction and he has general practice dentists, consultant hospital dentists and maxillofacial surgeons working for him on a rota basis. Both intravenous anaesthetics and gaseous anaesthetics are used in a conventional dentist's chair. The resuscitation equipment to hand is not far short of what you would see in a hospital operating theatre. NHS and private patients are treated to exactly the same standard of care.

Due to these circumstances, all the nearby health authorities are happy with their contracts with the clinic owner and have considerable confidence in the competence of the clinic. The clinic has been open for close on twenty-five years and no procedural mistakes or concerns have ever occurred there.

(continued)

[theprof]

Yes, children have died following induction by gaseous inhalation anaesthetics, but for many years it was an acceptable risk as there was no real alternative. Also, you have to remember that nitrous oxide mixtures and the like permit complete recovery of the patient within around 10 minutes, allowing them to walk unaided out of the dentist's. This does not occur following intravenous induction. All this allowed us to feel like we were taking part in conveyor-belt surgery as children in the school dental clinic, when we sat in that long room with half a dozen dentists operating at the same time on half a dozen kids in chairs, each with their gas apparatus, black face-mask, dental nurse and stainless steel sink nearby.

Nitrous oxide is nowadays used the maintenance of anaesthesia in combination with other agents and oxygen, and in sub-anaesthetic concentrations, for analgesia. Alone, nitrous oxide is not that potent compared to other anaesthetics used nowadays. Also, operating theatre and dental staff can develop a dangerous form of anaemia following prolonged exposure to nitrous oxide and the gas can interfere with white blood cell formation.

(continued)

[theprof]

The Evans-Appiah case did make many in the dental and medical professions sit up and take notice. You may be interested in the following GMC Fitness To Practice hearing:

http://www.gmc-uk.org/concerns/hearings_and_de cisions/ftp/ftp_panel_evan_appiah_20060928.asp

The other reports on the web tend to be fragmented and even sensationalised in parts.

All the same, although the report undoubtedly shows considerable negligence on the part of Evans-Appiah on a number of matters, two key issues revolved around Evans-Appiah's failure to administer further anaesthetic when it was necessary and the fact that he ordered the dentist to administer a local anaesthetic which contained contra-indicated adrenaline knowing that general anaesthesia had been induced with halothane.

Now, whichever way you look at it, these issues are down to incompetence and negligence on the part of Evans-Appiah. As a anaesthetist, he should have been aware of the interactions between halothane and adrenaline and the cardiac risk to the child. They do not allow us to conclude that inhalation anaesthetics used in a dentists are dangerous.

Competent dental surgeons are aware of the risks involved and this is the reason why such procedures are not solely left to those working in dental hospitals.

[RTFishall]

At the age of 61, I can still remember the horrible smell of the rubber mask being placed over my mouth by the dentist. And, my mother saying..."Now it won't hurt and if you are a good boy I'll buy you some sweets after". Perhaps in my childhood mind, I wondered why use the "hurt" word!
;)

[RTFishall]

Despite all the sweets, beer and avoiding the dentist for most of my life, I still have nearly all my teeth and very little mercury in them!

[DaveThomas]

I never got held down in the dentist's chair, no, but I certainly got sent to "sleep" five times with the black rubber mask and hoses in the 1970's at a dental surgery in Yorkshire for tooth extractions. It didn't get easier each time, either - I came to dread the procedure. On one occasion I was aware of agonising pain during the operation - I could feel the dentist ripping a tooth out. When I came round I complained but he said I'd just dreamed about the pain - but it was real enough. Oddly enough I was never asked to "Count to ten" like most of my friends. At the age of 21 I had to have a wisdom tooth removed and I asked to have gas in preference to injection!
Only to be told they didn't do gas any more.

[damo70]

Surely there must be some dentists out there who would accomadate us IV phobics and allow Gas in the chair.I too hate the thought of being injected either in the mouth or hand.The Gas was so much more pleasant.I never experienced any bad Gas sleeps.The mask was always wafted over my nose until I was slightly starting to drift,then the anaesthetist(Gasman) always gently pressed it down to make me drift under very pleasantly.Does any one else know of any UK clinics that will give gas inductions.My last one was in 2000 just before new regulations seemed to make most dentists run a mile from the technique.

[DaveThomas]

If dental gas was so pleasant, Damo70, why did you need to be held down in the chair whilst anaesthesia was induced?
It was coming round afterwards which I hated - muzzy headache, dizzy and unco-ordinated, metal dish full of bright red blood under my chin ...
Can't understand why I was never asked to count myself out either when most of my friends did. Some never made it to "Four" and others were still counting into the low 'teens - presumably the latter were hardened drinkers who'd built up a cross-tolerance from Lager to Nitrous?
My then girlfriend was the only person I knew who was told to count BACKWARDS from 100 whilst she was gassed. She said that her body felt heavier whilst her head felt lighter - and she got to ninety before blacking out!

[damo70]

Hi Dave,I always remember being told by the dentist who would stand at the side of the chair with the gasman stood behind me telling me to breathe deep and count from ten down to one.I always remember that after getting to seven or six,the gas seemed to be very overpowering,the next few sniffs would seem to be the ones that sent me to sleep.I always used to look at the black anaesthetic hose and that seemed to grow bigger with ever sniff from the mask.Maybe that was part of the gas making me dream before the KO came in.

[DaveThomas]

Oddly enough, I don't recall an anaesthetist being present when I had teeth removed under general anaesthetic in the 1970's - just the dentist and a nurse who didn't look much older than me. And it was the nurse who handled the gas.
Once I'd sat down in the chair the dentist would give me a quick pep talk and suddenly I'd get a whiff of nitrous as the nurse turned it on and fiddled with the mask. The dentist would stare at my eyes and when they couldn't focus any more, and the buzzing inside my head began, the gentle hiss of the gas would suddenly get louder ......
Then the fantastic dreams and hallucinations would begin - or perhaps I should call them "Gasmares" - and they were always terrifying.

[damo70]

I do remember the nurse holding my hand,I was about 8yrs old,The Dentist chatting to me to relax and smell the nice Space gas.Then this big black rubber mask came over the back of the chair,"Nice Deep Breaths For Me Now",Then as you describe the Hissing,the feelings of Buzzing.Iactually liked the smell of the Gas,always think it was the dentist hand holding my forehead back in to the chair so the gasman could get a good seal on the mask.It was about 1976 The first time I had my first gassleep.You are right in saying Gasmares I did have one of them type gassings later as a 13yrold.Im almost sure it was down to too much Halothane in the Nitrous mixture.Buzzing 1st then a feeling of suffocation as i went under.Not nice that time.

[DaveThomas]

Many of my college friends had their wisdom teeth extracted around the age of 20 - 21 in the local hospital under general anaesthetic, which in the early 1980's was presumably maintained with 5% Halothane, 75% Nitrous Oxide and 20% Oxygen. None of those who were prepared to discuss the procedure mentioned dreaming whilst under the gas. My best mate Mike was told by the nurses that he'd count to eight before going under.
"I'm not even sure if I made it to four," he said afterwards. Considering that the gas has to get fom the nose into the lungs, and from the lungs to the brain, that's pretty quick.

[damo70]

Isnt it the actual halothane that gives you that heavy petrol type gas vapour in the mask.I had a tooth removed at my local dentist just before the new regulations on gas anaesthesia in the surgery.Its pretty quick stuff that they used on me when I had my wisdom teeth out.That was done in the dental clinic as to the dental surgery.That only took 4 deep breaths and I was asleep.The last gas at dentist session I had was 2001 and the wisdom teeth 2004.The gas I presume was nitous,but the Vapour used I was informed was Sevflourane.Personally I prefered the smell of the Halothane.I thought it may have been the plastic hoses used for the wisdom teeth as usually had the black rubber hoses and mask.Another debate I think?

[jbz2079]

When I was younger I had general anaesthesia at the dentist 8 times over the years.
First couple of times it was scary, but once I knew what to expect I used to really look forward to getting gas.

I've had Nitrous and ether, nitrous and ethyl chloride and nitrous and halothane.

Ether is my least favourite, very unpleasant to breathe, slow acting and awfull after effects.

Ethyl chloride is ok, very fast acting when combined with nitrous oxide, bearable to breathe, four good breaths and youre out.

My favourite has to be halothane, pleasant to breathe, heavy musty smell that is rather quick acting and always seems to give a really nice feeling as you take each breath and slip closer to unconcious.

Bad or uncomfortable inductions are usually caused by the anethetist rushing to get you under quickly.
With a little care mask induction can be a great experiance.

Given the choice I would take general anaesthesia by gas every time for dental treatment.

[DaveThomas]

I thought that ether was highly explosive (mixed with oxygen) and that ethyl chloride was carcinogenic. As far as I'm aware, if you had "gas" for tooth extractions in the UK it was always nitrous oxide and oxygen (sometimes) for short operations and nitrous, oxygen and halothane for complicated, multiple extractions. Although Halothane was expensive, and if your dentist wanted to save money ....
Or have I got this completely wrong?