Dental Surgery

Oral surgery

by AgentX86 - 2020-06-26 18:29:05

My cardiologist didn't have an issue but the oral surgeon refused to use a general. He would only use gas. In hindsight, I think I was better off. I felt almost nothing and didn't have any anesthetic hangover.

Not sure what your question is

by crustyg - 2020-06-26 18:48:24

Hi: I'm wondering if your question is 'Am I OK to have a GA after a PM?', *or* is the question more around the lines of 'I'm having a dental procedure so serious/that involves such digging into the tooth roots that it needs a GA - and is this OK after a PM?'

Apart from the obvious issue that single-handed dentistry with significant sedation is now severely frowned upon, I would be concerned about any dental procedure where a dentist feels that a GA might be necessary.  IMHO, this sounds like oral surgery (not the same thing at all as dentistry) and yes, we know that there is a bacteraemia after dental procedures like this which *could* infect your leads.  Antibiotic cover may well be wise.  And before anyone shouts at me, the current NICE guidelines for this (updated July 2016) seem to me to be utterly useless.

Perhaps I'm biased - years ago with significant wisdom tooth pain my dentist showed me my X-rays and said 'this is a tooth extraction that should only be done by an oral surgery department'.  Oral surgery confirmed this by taking me through the likely/possible complications...  And this was decades prior to my PM.

I would say no to this procedure without a lot of careful consideration.  A GA after a PM - depends on your heart condition, as many agents affect heart muscle or rhythm.  Specialist anaesthetic opinion required.

Dental

by Bcassidy - 2020-06-26 19:29:26

It’s for a tooth extraction that requires the dentist (who is a certified anesthetist) to go into the gum and remove the tooth. Said it would only take about 30 mins.

My GP says he does not see it being an issue and to proceed with the procedure but I have read mixed reviews. 

have your dentist talk to your cardiologist

by CyborgMike - 2020-06-26 20:27:06

The PM itself will not be an issue for the anesthesiologist, but understanding of the underlying condition causing the need for the PM and what meds you are/could be taking is very important. I had GA for an endoscopy about six months after my PM implant. About five minutes into the GA my BP crashed and they had to wake me up and call off the procedure. After a consult between the doc, the anesthesiologist, and my cardiologist they decided to take me off of my beta blocker for three days first, while inhibiting exercise, and then try again with GA. The second time, without the beta blocker (nadolol), it turned out fine. 

ask more questions

by Tracey_E - 2020-06-27 09:57:53

I'm with Mike, I'd ask the dentist to talk to the cardiologist first just to be sure everyone is on the same page. In the past, my dentist wouldn't do more than a local with me in the office. Since then he's added an anesthesiologist to the staff and he himself is just finishing up the classes to be an anesthetist (he's a friend as well as my dentist). I haven't needed any work lately so I haven't asked if this changes the rules for me. 

Crusty, when I had my wisdom teeth out (1985), it was before I was paced so they admitted me to the hospital and did it under general. You should have seen the looks I got when I went for pre-op testing. (and no one saw that as a sign that maaaaaaybe it was time to give me a pacemaker *insert giant eye roll*)

It's amazing what our medical advisors don't see for looking!

by crustyg - 2020-06-27 12:45:31

I suppose it's a form of 'tramline' thinking that we don't see the bigger picture.  After my second colonoscopy my gastro consultant (friend) said 'you give a perfect history for Irritable Bowel Syndrome' - and did nothing about it!  But neither did I.  25years later I pushed my way to the Dieticians and they said 'Oh yes, you need to be on a low FODMAP diet'.  Progress, although I think I've seen glaciers move more quickly.

I blame the old fool I see in the mirror every morning when I shave.

Sorry to hear about your caffeine problem.  Acute caffeine withdrawl can give horrible headaches.  And a really good coffee is *wonderful*.  In Cusco, Peru a couple of years back we found a coffee shop where the coffee actually tasted every bit as good as it smelt - heaven!  The UK isn't renowned for good coffee, although I think it's immeasurably better than 25years ago.

have your dentist talk to your cardiologist

by AgentX86 - 2020-06-27 13:37:09

Absolutely.   Bypass your GP and go directly to your cardiologist for clearance.  The oral surgeon wouldn't touch me without a clearance from either my cardiologist or EP.  GPs need not apply.  They may be good at what they do but really don't know the entire story.

general

by dwelch - 2020-06-30 10:46:41

If the question is has anyone had general after getting a pacer, yes, not sure why there would be anything to worry about.  If the question is dental work with a pacemaker, then you are not the first nor last one.  You can try to get the dentist to talk to your EP, but as with EP's that say dont lift your arm for weeks/months they are going to err on the side of caution, which means the result will be far on the side of safety...If you can get them to talk, good luck with that.  My experience is the docs try to use me as the go between rather than talking to each other.