Dental Anaesthesia Masters Dental

DENTAL ANAESTHESIA Sherif El-Hadi MD Neuroanaesthesia Unit Faculty of medicine

Analgesia Anaesthesia in Dentistry 1. 2. 3. 4.

Local Analgesia Local Analgesia + Sedation Local Analgesia + General Anaesthesia General Anaesthesia

Why GA?? • Cooperation absent ▫ Child ▫ Mentally retarded

• LA cannot be given ▫ Allergy ▫ Local Infection

• Anxiety

Dental Phobia

Referred to hospital: • Serious diseases e.g. cardiopulmonary, diabetes, neuromuscular. • Patients taking significant amount of drugs including anticoagulants. • Hematological diseases e.g. haemophilia. • Major oral infection (swelling) or trauma (airway obstruction). • Children with congenital cardiac defects. • Extreme obesity.

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

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 responsible adult. • Oral anxiolytic . • PPI (Parental Presence during Induction)

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.

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 causing airway obstruction. • Soft nasopharyngeal airway

Posture • Sitting: can cause hypotension (vasodilatation and bradycardia), fainting (or even cardiac arrest. • Supine: can cause airway obstruction, pharyngeal soiling 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 supine position is essential

Induction of GA: Either by: • Inhalational (children) or • IV technique (old children, adults).

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.

Intravenous induction Preferred method of many dental anaesthetists. Rapid smooth induction, no face mask, less salivation. Disadvantages: hypotension, respiratory depression or apnea, adults may faint at the sight of a needle. Thiopentone Propofol: 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

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).

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

Thank You