dental anaesthesia masters dental

8/14/2019 Dental Anaesthesia Masters Dental

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DENTAL ANAESTHESIASherif El-Hadi MD

Neuroanaesthesia Unit

Faculty of medicine


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Analgesia Anaesthesia in Dentistry1. Local Analgesia

2. Local Analgesia + Sedation

3. Local Analgesia + General Anaesthesia4. General Anaesthesia


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Why GA?? Cooperation absent

Child

Mentally retarded LA cannot be given

Allergy

Local Infection

Anxiety


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Dental Phobia


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Referred to hospital: Serious diseases e.g. cardiopulmonary, diabetes,

neuromuscular.

Patients taking significant amount of drugsincluding anticoagulants.

Hematological diseases e.g. haemophilia.

Major oral infection (swelling) or trauma (airwayobstruction).

Children with congenital cardiac defects.

Extreme obesity.


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Preoperative Assessment Age, weight Anaesthetic before, any problems?

Trouble with your heart (e.g. chest pain)? Do you have any problems with your lungs (dyspnea.

cough ?( Have you had a cold recently or have you now?

Do you find that you bleed or bruise easily? Are you taking any medicines (e.g. aspirin .. .etc) ? Do you suffer from any allergies? Do you faint easil


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Preparations before induction of GA

Patients:

Eight hours no food.

Bladder should be empty. Examine nose (patency), mouth (loose teeth),

remove dentures. Tight clothing loosened.

Patient must be accompanied by a responsibleadult.

Oral anxiolytic . PPI (Parental Presence during Induction)


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Apparatus Standard anaesthesia machine.

O2 source.

Suction. Full intubation set. Full resuscitation equipment. Fluids, crystalloids, colloids, IV cannulae.

Intravenous anaesthetics, atropine, succinylcholine. Emergency drugs e.g. epinephrine, xylocaine ...etc. Monitors: ECG, BP, pulse oximetry. Defibrillator.


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Mouth props, packs and airways: The mouth prop to keep mouth open during

anaesthesia.

Mouth pack is essential Blood and saliva to prevent aspiration

Swallowed blood causes PO vomiting

Avoid pushing the tongue backward causingairway obstruction.

Soft nasopharyngeal airway


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Posture Sitting: can cause hypotension (vasodilatation and

bradycardia), fainting (or even cardiac arrest.

Supine: can cause airway obstruction, pharyngealsoiling with blood and aspiration of gastric contents. Semi-supine (i.e. supine with some degree of head

up): Commonest position because:Best balance of respiratory and haemodynamic conditions.Blood and debris in the floor of the mouth.The airway easily maintained by the anaesthetist.

Ability to tilt the dental chair to supineposition is essential


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Induction of GA:Either by:

Inhalational (children) or

IV technique (old children, adults).


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Inhalational induction Usually started using N2O/O2 for few breaths then

a volatile agent is added.

Halothane: most commonly used, pleasant smell,smooth, rapid induction, cheapest agent.

Sevoflurane: recent agent, very pleasant smell,more smooth, rapid induction and recovery than

halothane, very expensive. Isoflurane: is not suitable in children, pungent

smell, irritant to airways, causing coughing,laryngospasm and hypoxia.


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Intravenous inductionPreferred method of many dental anaesthetists.Rapid smooth induction, no face mask, less salivation.

Disadvantages: hypotension, respiratory depressionor apnea, adults may faint at the sight of a needle.ThiopentonePropofol: very smooth induction, no hangover effect.

Dose 2-2.5 mg/kg (adult), 3 mg/kg (children).

Pain on injection (xylocaine is added),Greater degree of cardiorespiraty depression

Ketamine: Strong analgesia., hallucinations


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Monitoring Observing colour of lips, mucosal surfaces.

Watching the movements of reservoir bag.

Feeling the carotid pulse Equipment:

ECG.

Arterial blood pressure.

Oxygen saturation (pulse oximetry).


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Recovery Lateral position. Oxygen mask until patient open eyes.

Suction must be ready. Monitoring of airway and breathing. Period of stay in the recovery room is at least 30

min.

Responsible adult should accompany patienthome

Patient should be able to walk unsupported. No drive or for the rest of the day.


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Thank You

dental anaesthesia masters dental

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