complication in dental chair
TRANSCRIPT
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DENTAL ANESTHESIA
COMPLICATIONS IN THE DENTAL
CHAIR
Dr SAAD A SHETA
Assistant Professor, Anesthesia
Dental College
KSU
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Dental Anesthesia
Out-Patient anesthesia (Dental Chair Anesthesia)
Day-Case anesthesia
In-Patient anesthesia
Complete Dental rehabilitation
Complicated oral surgery proceduresMajor Maxillofacial surgeries
In addition, Sedation Techniques
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Out-Patient Dental Anesthesia
Dental Chair Anesthesia
Out-Patient dental extraction
Children (4-10 years): high incidence of URTI
Steadily decreased
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Out-patient Dental Anesthesia
Patient Select ion (& Ind icat ions)
ASA grade I&II
Disability (mental& physical)
Review: coexisting disease
current medications
Fearful adults rather sedation
Procedure short
not so extensive
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Out-Patient Dental Anesthesia
Contra indicat ions
Serious cardiopulmonary diseases
COPD
Diabetes or other endocrinological diseases
Neuromuscular disorders
Coagulopathies & Hemoglobinopathies
Marked oro-facial swelling (edema& trismus)
Potential difficult airways
Marked congenital heart defects
Extreme obesity
Drugs: MAOIs , Anticoagulant
Not fasting
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Out-Patient Dental AnesthesiaEquipment (Up to the standards of in -pat ient GA)
Dental Chair
Anesthetic equipment
Monitoring
Resuscitation equipment
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Dental Chair
Adjustable: horizontal (supine)
Head down
Manual release
Adjustable head rest
Hospital out-patient:operating table
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Anesthesia Equipment
Continuous flow anesthesia machine
Quantiflex (Relative Analgesia)
Mouth props, packs, gags, nasopharyngealairway, rubber dam
Separate suction unit
Scavenging system
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Quantiflex Machine Nasal Mask
Rubber Dam
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Monitoring
Pulse
ECG NIBP
Pulse Oximetry
Capnography
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Resuscitation Equipment
Full range of tracheal tubes& accessories
Two working laryngoscope
IV agents: Succinylcholine& atropine
Emergency drugs
Defibrillator
Training: B&ALS
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Out-Patient Dental AnesthesiaInduct ion
Inhalational (mask) induction
N2O/O2(>30%)
+Halothane (3%) common, smooth
Enflurane (>3%) less potent
Isoflurane Respiratory irritation
Sevoflurane New, smooth, less potent
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Out-Patient Dental AnesthesiaInduct ion
Intravenous InductionAdvantages Avoidance of face mask
Less salivation
Less atmospheric pollution
Disadvantages CV depression
Drugs
Methohexitone Low incidence of nausea &vomitingGood recovery
Pain on injection,
involuntary movements,
hiccups &
respiratory depression
Propofol
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Out-Patient Dental AnesthesiaMaintenance
Inhalational agents/N2O
Nasal mask, mouth gag, pack
Maintain airway
Posture (Supine Position)
Less hypotension
less bradycardia
However
high risk of aspiration
Airway obstruction&
Decrease ERV
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Out-Patient Dental AnesthesiaRecovery
Left lateral position
100% O2 Suction Observation & monitoring
Discharge criteria
Instructions
Analgesia (NSAIDs)
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Out-Patient Dental AnesthesiaCompl icat ions
Respiratory Complications
Airway Obstruction (Tongue, Adenoid, Pack,debris}
Respiratory arrest
Laryngeal spasm
Pulmonary aspiration
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Out-Patient Dental Anesthesia
Compl icat ions
Cardiovascular Complications
HypotensionInduction of anesthesia
Carotid sinus compression
BradycardiaTooth extraction
Halothane(nodal rhythm)
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Out-Patient Dental Anesthesia
Compl icat ions Dysrhythmias (Tachy-arrhythmias)
Aet io logy (Tooth extract ion)
- High preoperative catecholamines
- Light anesthesia
- Airway obstruction & hypoxia
- Halothane & local anesthesia
- Local anesthesia with vasopressor
Signif icance
- Controversial
- Significant with unexpected cardiacdisease(viral myocarditis)
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Out-Patient Dental Anesthesia
Compl icat ions
Allergic Reaction
Incidence -Very rare
-More commonly (vaso-vagal,Toxicreaction, epinephrine)
Aet io logy
- Ig E-mediated reaction
-Easter-linked:p-amino benzoic acid
- Amide-linked: preservatives(Paraben)
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Out-Patient Dental Anesthesia
Compl icat ions
Allergic Reaction
Manifestat ions
- Hypotension, tachycardia, arrhythmias
-Bronchospasm,cough, dyspnea, pulmonaryoedema, laryngeal oedema, hypoxia
- Urticaria, facial oedema, pruritus
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Out-Patient Dental Anesthesia
Compl icat ions
Allergic Reaction
Management
-Discontinue drug
- 100% O2
-Epinephrine (0.01-0.5 mg IV or IM)
- Intubation
-IV fluids (LRS 1-2 liters)
- Diphenhydramine
-Hydrocortisone (up to 200mg IV)
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Out-Patient Dental Anesthesia
Compl icat ions
Fainting
Causes Previous factors (CV, allergic,..)
Emotional factors (more common)
Aetiologyl imb ic co rtex-hyp othalamus -ref lex vasodi latat ion
Increase parasympathet ic act iv i ty-bradycardia
Management
Head down-leg elevated
100% O2
Cessation of anesthesia
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Out-Patient Dental Anesthesia
Compl icat ions
Miscellaneous
Nasal trauma, epistaxis Diffusion hypoxia
Continued bleeding
Postoperative
Sore throat
Nausea & vomiting
Pain & swelling
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THANK YOU