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Induction of Anesthesia: Induction refers to the process of starting general anesthesia.
Induction methods include:
Awake intravenous catheter (IV) placement and intravenous induction: This method is most appropriate for moderately cooperative patients who can sit still without becoming combative during IV placement. Your anesthesiologist may also suggest this method if there are any concerns with the patient's airway; an IV allows for immediate administration of reversal agents and emergency medications, if necessary.
Mask induction with inhalational anesthesia: Anesthetic gas will be delivered to the patient through a face mask for approximately 1 minute. Parents of small children may be asked to hold their child's hands during the mask induction period, to ensure that the mask is not removed prematurely. Changes in breathing and snoring may be observed. Eye movement and uncoordinated shifting of the arms or legs are also commonly observed. An IV line will be placed once the patient is asleep to deliver IV fluids and medications.
Intramuscular induction with sedative medications: An intramuscular injection is placed in the patient's upper arm or thigh. This is done very quickly to minimize anxiety and fear. Your cooperation is critical to allow for a smooth and safe induction, for a smooth and safe process. The medications generally take 3-5 minutes to be fully effective. Then, the patient will be transported to the dental operatory chair to deliver oxygen, place vital sign monitors, and insert an IV line.
Your anesthesiologist will discuss with you the induction methods and help you decide on which of them will be the most appropriate. Parents of minor children will be asked to wait in the lobby, after the anesthesia induction period has ended.
During the Procedure: Your anesthesiologist and dentist will stay with patient the entire time to ensure their comfort and safety. Once patient is asleep, a breathing tube may be placed to help protect the airway and deliver anesthetic gases. Vital signs are monitored during this period, including oxygen levels, heart rate and rhythm, blood pressure, and ventilation. Patient is unlikely to have any memories of the procedure and will have limited recollection of most of the recovery period.
Recovery: The typical recovery period is 30 to 60 minutes. We will ask you to stay with patient during this period so that a familiar face is present when they wake up. Temporary pink marks will be present on patient skin from tape used to protect his/her eyes, stabilize the head, and secure the breathing tube, heart monitors, and IV line. Bruising may occur from the IV placement. Swelling of the face or mouth may be present due to the dental treatment. Confusion, weakness, tiredness, and grumpiness are all normal behaviors displayed after waking up from anesthesia. Blurry vision, dizziness, and mouth numbness may also be experienced. These side effects will resolve with time. Upon returning home, carefully follow the post-anesthetic guidelines in this packet regarding diet, activity, and pain management.
Food & Drink: It is extremely important that patients have an empty stomach during general anesthesia. Clear liquids (i.e., water, apple juice, Gatorade) may be consumed up until three (3) hours before the scheduled procedure. However, all food and non-clear liquids should be avoided for eight (8) hours before the anesthetic procedure. Consuming food or non-clear liquids within eight (8) hours of the procedure will result in the rescheduling of your child's appointment. FAILURE TO STRICTLY FOLLOW THESE INSTRUCTIONS COULD RESULT IN ASPIRATION AND MAY LEAD TO SERIOUS, LIFE-THREATENING COMPLICATIONS.
Transportation: Patients under age eighteen (18) must have a parent or legal guardian present at the time of surgery to give written consent for anesthesia. The parent or guardian must remain physically present in the office during the entire procedure.
Personal: Children should arrive for their procedure wearing loose fitting, comfortable clothes with a short-sleeve shirt. Please also bring an extra set of clothes for your child. If desired, you may bring a small blanket from home. Avoid long sleeved shirts, jeans, or onesie pajamas. Patients should not wear contact lenses, fingernail polish, or apply any lotion on the day of their procedure.
Medications: Medications should be taken with a small sip of water or postponed on the day of dental treatment, as directed by your primary care physician. Please bring a list of all medications your child is currently taking. Include with this list the dosage and how often the medication is taken.
Arrival: Patients who arrive late may have their procedure rescheduled for another day with a potential loss of the deposit. The anesthesiologist reserves the right to cancel or postpone the scheduled appointment for any reason that may jeopardize the safety of the patient.
Health: If your child starts to develop or show signs of a cold, fever, or any other acute illness, please call your dentist's office immediately. Patients with signs of illness will be assessed on the day of their procedure and will be rescheduled, if necessary, to reduce any anesthesia associated risks.
Activity: Your child may feel sleepy for several hours and may nap on and off throughout the day. Your child should NOT drive, ride a bike, swim, jump on trampolines, or do any other activity that requires his/her full coordination for at least the remainder of the day. He/She can usually expect to resume normal activities on the day following his/her surgery.
Fever: Your child may become flushed with a slight fever following the anesthesia. He/She should be kept indoors in a cool place for the remainder of the day. Seek medical attention for excessive fever (over 103 ℉).
Diet: Begin slowly with mild, clear liquids (e.g., water, Gatorade, Pedialyte), while avoiding dairy for the first 1-2 hours. After 2 hours, you may start introducing soft, cold foods (e.g., applesauce, mashed potatoes, Jell-O). Your child may resume a normal diet when soft foods are tolerated well.
Pain/Discomfort: It is common for the patient to experience some discomfort or pain following his/her dental procedure. The anesthesiologist will administer IV pain medications during the surgery, but these generally wear off within a few hours after the procedure. The dentist may have administered local anesthesia ("Lidocaine") so the patient may be numb in certain areas of his/her mouth. Please have Tylenol or Motrin on hand before the day of the procedure, to assist with post-operative oral pain. In addition, it is common for some discomfort to be felt at the IV site for a few days after the procedure.
Nausea/Vomiting: Nausea and vomiting occasionally occur following anesthesia. Your child will be given anti-nausea medications in his/her IV during the procedure. If your child becomes nauseated or vomits following discharge from the dental office, restrict him/her to clear liquids until the nausea subsides. You should contact the dentist anesthesiologist if vomiting persists for longer than 4 hours or if you are concerned.
Medications: Typically, your child should resume taking any prescribed medications at the next normally prescribed time following his/her anesthesia care. The dentist anesthesiologist will advise you of any exceptions.
Bleeding: Follow the dentist's instruction regarding post-operative bleeding. If bleeding persists longer than you were told to expect or seems excessive, please contact the treating dentist. A small amount of bleeding from the nose may occur if a breathing tube was placed.
Federal & state laws require Anesthesia Smiles PLLC to maintain the privacy of all patient healthcare information. Furthermore, we are required by law to provide all parents or legal guardians with this notice reviewing our privacy practices, our legal obligations, and your rights regarding your child's healthcare information. Anesthesia Smiles PLLC must follow the privacy practices as describe within this notice while this policy is in effect. This notice took effect on April 14, 2003, and will remain in effect until replaced, amended, or eliminated.
Anesthesia Smiles PLLC reserves the right to change these privacy practices and the terms of this notice at any time, provided such applicable laws permit such changes. We reserve the right to make any needed changes to our privacy practices and these new terms will be effective for all health information that we maintain, including health information we create or receive before such made changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request.
Parents or legal guardians may request a copy of this notice, at any time. For additional information about our privacy practices or to review our company's Health Insurance Portability & Accountability Act (HIPAA) annual, please contact us using the information provided below.
Anesthesia Smiles PLLC will use and disclose patient healthcare information during your child's treatment, while obtaining payment from insurance companies and during general healthcare operations. For example:
Treatment. Anesthesia Smiles PLLC may use your child's health information during his/her direct treatment or by disclosing such information to other dentists, physicians or healthcare providers who may provide specialized treatment for your child.
Payment. We may also use and disclose your child's health information to obtain payment for services rendered. We may disclose your child's health information to another healthcare provider or entity that is also subject to these same federal & state Privacy Rules & Regulations for payment activities.
Healthcare Operations. We may use and disclose your child's healthcare information during our routine healthcare operations. Healthcare operations may include quality assessments and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing, or credentialing activities. We may disclose your child's healthcare information to another healthcare provider or organization that is subject to the same federal & state Privacy Rules & Regulations and that has a relationship with you during the support of healthcare operations. We may use your child's information to help such organizations conduct quality assessment and improvement activities, review the competence or qualifications of healthcare professionals, or detect or prevent healthcare fraud and abuse.
On Your Authorization. You may give Anesthesia Smiles PLLC written authorization to use your healthcare information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing, at any time. Your revocation will not affect any uses or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your child's healthcare information for any reason except those described within this notice.
To Your Family & Friends. We may disclose your child's health information to a family member, friend, or other person to the extent necessary to help with your child's healthcare or with payment for previously performed healthcare services. Before we disclose your child's health information to these people, we will provide you with an opportunity to object to our use or disclosure. If you are not present, or in the event you are incapacitated and cannot make a decision for your child, or in the event of an emergency, we will disclose your child's medical information based on our professional judgment of whether the disclosure would be appropriate and in your child's best interest. We will use our professional judgment and our experience with common practices to make reasonable inferences of your child's best interest in allowing a person to pick up filled prescriptions, medical/dental supplies, radiographs or other similar forms including health information. We may also use or disclose information about your child to notify or assist in notifying a person involved in his/her care.
Appointment Reminders. Anesthesia Smiles PLLC may use or disclose your child's healthcare information to provide you and your family with appointment reminders (such as telephone calls, voice messages, postcards, or letters).
Disaster Relief. We may use or disclose your child's healthcare information to a public or private entity authorized by law or by its charter to assist in federal or state disaster relief efforts.
Public Benefit. We may disclose your child's medical/dental information, as authorized by federal or state law for the following purposes deemed to be in the public's best interest or benefit:
Access. You have the right to look at or get a copy of your child's health information, with select limitations. You may request that we provide a copy in a format other than photocopies. We will use the format you request unless we cannot practically do so. You must make all requests in writing to obtain access to your child's healthcare information. You may request access by sending us a letter. If you request a copy, we will charge you a reasonable fee, which may include labor, copying costs and postage. If you request an alternative format, we will charge a cost-based fee for providing your child's health information in that format. If you prefer, we may, but are not required to, prepare a summary or an explanation of your health information for a fee.
Disclosure Account. You have the right to receive a list of instances in which Anesthesia Smiles PLLC or any of our business associates disclosed your child's health information over the past six-years (but not prior to April 14, 2003). That list will not include disclosures for treatment, payment, healthcare operations, as authorized by you, and for certain activities. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
Restriction. You have the right to request that we place additional restrictions on the use or disclosure of your child's healthcare information. We are not required to agree with such additional restrictions, but if we do, we will abide by our agreement (except in the event of an emergency). Any agreement we may make to a request for additional restrictions must be in writing and signed by our privacy officer. Your request is not binding unless our agreement is in writing.
Alternative Communication. You have the right to request that we communicate with you about your child's health information by an alternative means or at an alternative location. You must make your request in writing. You must specify in your request the alternative means or location and satisfactory explanation how you will handle payment under the alternative means or location you request.
Amendment. You have the right to request that we amend your child's healthcare information. Your request must be in writing and should explain why you are requesting this amendment. We may deny your request under certain circumstances.
If you want more information regarding our practice's Privacy Practices & Regulations or have a specific question or concern, please feel free to contact us. Furthermore, if you believe that:
You may submit a written complaint with our privacy officer or directly to the U.S. Department of Health & Human Services. We will provide you with these addresses to file your complaint, upon your request. We support your right to the privacy of your child's health information. We will not retaliate in any way if you choose to file a complaint with us or the U.S. Department of Health & Human Services.
You have the right to:
You have some choices in the way that we use and share information as we:
We may use and share your information as we:
To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say no to your request, but we will tell you why in writing within 60 days.
You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address. We will say "yes" to all reasonable requests.
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no," for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say "yes" unless a law requires us to share that information.
You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
You can complain if you feel we have violated your rights by contacting us using the information on page 1. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html . We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
In the case of fundraising:
We may contact you for fundraising efforts, but you can tell us not to contact you again. If we have your substance use disorder patient records, subject to 42 CFR part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.
How do we typically use or share your health information? We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.
We can share health information about you for certain situations such as:
We can use or share your information for health research as permitted by law.
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
We can share health information about you with organ procurement organizations.
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
We can use or share health information about you:
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
By signing below, I acknowledge that I have received, read, and understand this Notice of Privacy Practices, which explains how the patient's health information may be used and disclosed and describes the patient's privacy rights.
A completed copy will be sent securely to the patient and the receiving clinic.
