Antibiotics and Medication

Antibiotics and Medication

How are antibiotics used after oral surgery?

Antibiotics are sometimes used in oral surgery to prevent or treat infections. The following are some situations where antibiotics may be indicated:

  • Preoperative prophylaxis: Antibiotics may be given as a preventive measure to minimize the risk of infection. Studies have shown that a dose of antibiotics prior to surgery decreases the risk of post-surgical wound infections. Often, antibiotics are used in immune-compromised individuals and those with certain heart conditions who are at higher risk for infection.
  • Treatment of existing infections: If a patient already has an infection, antibiotics may be prescribed to control the infection before or after surgery.
  • Postoperative management: After oral surgery, antibiotics may be prescribed to minimize the risk of infection at the surgical site. This can be indicated for procedures involving extensive surgery and those at risk for infections. In those situations, antibiotics may be given to aid in the healing process.

Antibiotic stewardship is following evidence-based guidelines for the appropriate use of antibiotics. Dr. Maranon is well aware of his role in their appropriate use. Dr. Maranon only prescribes antibiotics when necessary. His choice of antibiotics is based on each specific clinical situation with the understanding of when antibiotics are necessary and when they are not. Inappropriate prescribing of antibiotics can lead to the loss of their effectiveness, increasing the chance of the emergence of antibiotic-resistant bacteria which is a major public health threat. Dr. Maranon is aware that there are potential adverse reactions and side effects of antibiotics. If antibiotics are prescribed, it is essential that Dr. Maranon’s instructions on antibiotic use, dosage, and duration of treatment are followed.

How are probiotics used after oral surgery?

It has been found that approximately 20% of patients taking antibiotics in outpatient settings develop antibiotic-associated diarrhea (AAD). The disruption of the gastrointestinal flora that normally acts as a barrier to infection and aids in the digestion of carbohydrates is a common cause. Probiotics replenish the natural gastrointestinal flora with nonpathogenic organisms.

Probiotics are live microorganisms that may provide various health benefits when consumed in adequate amounts. Antibiotics, on the other hand, are drugs that are used to kill or inhibit the growth of bacteria that cause infections. When taking antibiotics, probiotics that contain Lactobacillus or Bifidobacterium strains, have been shown to help replenish beneficial bacteria in the gastrointestinal tract (stomach and intestines).

The beneficial effects are maximized with a high dose probiotic (≥ 5 billion CFUs per day), high-quality probiotic supplement from a reputable manufacturer. Specifically, strains of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium bifidum, and Saccharomyces boulardii have been found to be particularly effective in reducing the risk of antibiotic-associated diarrhea and other systemic side effects associated with antibiotic use.

It is important not to take probiotics at the same time as antibiotics. The National Institutes of Health recommends waiting at least two hours before or after taking an antibiotic to take probiotic supplements.

Probiotics may be safe to use in immune compromised patients. But if you are immune compromised, before taking them, ask your physician if probiotics are safe and effective for your specific health condition and medications.

Here are some potential benefits and risks of probiotics during antibiotic treatment:

Benefits

  • Reducing the risk of antibiotic-associated diarrhea: Antibiotics can disrupt the balance of bacteria in the gut, leading to diarrhea. Probiotics may help restore this balance and reduce the risk of diarrhea.
  • Boosting the immune system: Probiotics may enhance the immune system’s response to infections, potentially reducing the duration and severity of illness.
  • Preventing overgrowth of harmful bacteria: Taking probiotics may prevent the overgrowth of harmful bacteria in the gut, which can cause infections.
  • Improving digestion: Probiotics may improve digestion and reduce digestive symptoms such as bloating, gas, and constipation.

Risks

  • Interference with antibiotic effectiveness: Some probiotics may interact with antibiotics, potentially reducing their effectiveness.
  • Infection risk: In rare cases, probiotics can cause infections, especially in people with weakened immune systems or those with a central venous catheter.
  • Allergic reactions: Some people may be allergic to probiotics, leading to symptoms such as hives, itching, and swelling.
  • Not all probiotics are gluten-free (although most are) and some may contain dairy (an issue if you’re also sensitive to the lactose and/or casein found in dairy products).
  • Digestive symptoms: In some people, probiotics may cause digestive symptoms such as bloating, gas, and diarrhea.

Anesthesia

Do I need to be under anesthesia?

The least amount of anesthesia necessary to manage pain and perform a procedure is always best. The choice of anesthesia technique is dependent on the patient’s personal needs and the type of procedure to be performed. Factors that patients should consider include the level of comfort wanted; the patient’s pain tolerance, the level of difficulty of the procedure, the time necessary for the procedure, and each patient’s medical considerations.

What types of anesthesia are offered?

Dr. Maranon is trained in all aspects of anesthesia administration. He and his staff are well-prepared to identify, diagnose and assess the source of pain and anxiety of his patients and to appropriately administer all forms of sedation, and general anesthesia.

  • Local anesthesia – When local anesthesia is used, the patient is conscious during the procedure but cannot feel any pain associated with the surgical site. This anesthetic is often used with other types of sedation.
  • Nitrous oxide and oxygen – Also known as laughing gas, is an option for patients who wish to feel more relaxed during their procedure. This type of sedative is inhaled and allows patients to remain conscious. It is often used with local anesthesia.
  • Intravenous (IV) sedation –The most common anesthetic technique used for outpatient oral surgery procedures. The anesthetic is administered directly into a vein to induce a temporary loss of sensation or awareness. Under sedation, the patient enters a relaxed and sleep-like state. Patients are monitored in the same way that would be monitored in an operating room. Using a team approach, Dr. Maranon and his staff have been providing these services safely for over 30 years.
  • Full general anesthesia provided by an anesthesiologist – The office is equipped to provide general anesthesia services. Depending on the patient and the nature of the procedure, these services are provided by a separate anesthesiologist while Dr. Maranon performs surgery.
  • Hospital or surgery center-based general anesthesia – Complicated or extensive procedures often require general anesthesia in a surgery center or hospital setting. General anesthesia is administered by an anesthesiologist.

Will I be nauseous after IV sedation? What is causing it and what should I do?

There are several causes of postoperative nausea and vomiting. Nausea is a side-effect of some medications used for sedation. The most common is the use of opioids during anesthesia and after surgery. Dehydration is another cause of postoperative nausea and vomiting. The best treatment is to start out with clear liquids (water or Gatorade) on the day of the surgery. The goal is to maintain good hydration. After drinking clear liquids for several hours without nausea, your diet can progress. Dairy products should be avoided if there is nausea and vomiting. Call the office if the nausea is prolonged.

The best treatment is prevention. On the days prior to surgery, it is important to be well hydrated. Drink plenty of fluids on those days before surgery. Clear liquids are very important in maintaining an adequate level of hydration. Dr. Maranon also uses non-opioid anesthesia techniques and uses medications that are protective against nausea and vomiting. He also uses opioid-sparing postoperative pain medication.

Is it okay to eat before the scheduled surgery?

Prior to your surgery, Dr. Maranon will make it clear to you if you have a fasting requirement. In general, if the procedure will be under only local anesthesia, you may eat a light meal before the surgery. For some patients undergoing surgery under only local anesthesia, eating can help them feel comfortable and may lessen anxiety. However, if you are having any form of sedation or general then you are advised to refrain from eating 8 hours before your scheduled surgery. For children, this schedule could be modified. Contact the office if you have specific questions about eating prior to surgery. It is also important that you hydrate well on those days before surgery.

Do I take my routine medications if I am not able to eat or drink before surgery?

Some medications are important to take prior to surgery. After a thorough evaluation of your medical conditions, Dr. Maranon will advise you on which medications you should take. This could be done with a sip of water prior to surgery. If you are unsure about what medications you should take, it is important to contact the office before your procedure.

When should I stop smoking tobacco before and after surgery?

It is recommended that patients stop smoking two weeks or as soon as possible before the procedure, as smoking interferes with blood circulation. Stopping smoking before surgery helps your body recover from those effects. It is important not to smoke for at least a week after surgery. Not only are there systemic effects from smoking on circulation, but the local effects of smoking can interfere with wound healing. This first week is very important to the healing process. Lastly, with respect to your long-term health, you should consider quitting smoking altogether. It is well known that smoking can have long-term health risks.

When should I stop using marijuana before and after surgery?

Marijuana should not be used prior to oral surgery, especially for procedures performed under sedation. Smoking marijuana can irritate the lungs and increase the risk of respiratory complications during surgery. Anesthesia medications and marijuana (smoked or edible) both have effects on the central nervous system and cardiovascular system. The cognitive effects of marijuana can persist for up to 24 hours. Regular marijuana use can alter the amount of anesthesia medications needed. For regular users, Dr. Maranon recommends that marijuana use should be discontinued 24 hours before surgery. After oral surgery, Dr. Maranon recommends that marijuana use be avoided during the recovery period. First, marijuana can alter the effects of pain perception coordination and judgment. Pain perception is important because pain can be an indicator of problems related to surgery. During consultation, it is important for Dr. Maranon to be made aware of your marijuana use.

Pain Management

Will my oral surgery procedure hurt?

Dr. Maranon is well-trained in pain management protocols. He strives to make each patient’s procedure and their recovery as comfortable as possible. This is accomplished by preparing patients for their recovery prior to surgery. He prepares a pain management protocol specifically for each patient and the procedure they have performed. At their postoperative appointment, the vast majority of his patients say that they just had soreness and say that their recovery was like what was described prior to surgery.

How does Dr. Maranon manage pain in his patients after surgery?

Surgery is surgery, and it is not possible for patients to feel nothing after surgery. The goal is to make the recovery as comfortable and fast as possible while having as few side effects as possible. Dr. Maranon manages pain in many ways. The first is through education. Patients learn what to expect at every stage of their recovery. They are also informed about how they should take care of themselves and things they can do to manage their pain and speed their recovery. Dr. Maranon also uses Opioid Sparing Multi-Modal Analgesia (see below).

What is a multimodal analgesia pain control protocol?

Multimodal analgesia uses different medications and treatment modalities that target different sites on the pain pathway to improve pain control. Dr. Maranon’s technique is narcotic-free and does not put his patients at risk for the side effects associated with opioid-based pain medication. Dr. Maranon’s pain management technique eliminates the possibility of dependence and overdose from prescription opioid-based pain medications. The risks and benefits of post-operative pain management will also be discussed at the pre-operative consultation, as well as a thorough review of the patient’s medical history and a complete examination.

What is Exparel and does Dr. Maranon offer it?

Exparel is a sustained and continuous-release local anesthetic that typically does not cause patients to feel numb. This local anesthetic, when administered around the surgical site at the time of surgery, has been clinically proven to reduce postsurgical pain for several days, reducing the need for postoperative narcotic pain medication.

What are the risks of using opioids after surgery?

Opioids are sometimes needed to manage post-surgical pain because of their analgesic (painkilling) effects. But the side effects of these medications can be significant. These side effects include nausea, vomiting, constipation, urinary retention, drowsiness, impaired thinking skills, poor respiratory function, and the potential risk of addiction. Therefore, these medications should be used at the smallest dose effective for the shortest possible time because of the risks associated with opioids and their potential side effects. Studies have shown that the effective implementation of Enhanced Recovery After Anesthesia protocols and Multi-Modal Analgesia can significantly reduce the need for opioids after surgery.