12. Oral and maxillofacial anesthesia features. Premedication. Guidelines for anesthesia by maxillofacial surgeries.

Question 1

Premedication and its two components

Answer 1

• Psychological and pharmacological preparations before anesthesia
• Psychological premedication => anesthesiologist’s preoperative visit and interview with the patient and their family
• Pharmacological premedication => administering drugs 1-2 hours before anesthesia

Question 2

Primary goals of pharmacological premedication in oral and maxillofacial anesthesia

Answer 2

*Anxiety relief, sedation, Analgesia
* Amnesia
* Antisialogogue effect (reducing saliva production)
* Decrease in anesthetic requirements
* Prophylaxis against allergic reactions

Question 3

Secondary goals of pharmacological premedication

Answer 3

• Optimizing the patient’s physiological state=>
• smoother anesthesia induction and maintenance
• Minimizing potential adverse effects during and after surgery

Question 4

Drugs commonly used as anxiolytics for premedication, and why they are important

Answer 4

• Benzodiazepines (such as midazolam, diazepam, lorazepam, and triazolam)
• Nitrous oxide
• Preoperative anxiety can increase the demand for anesthetic agents=>
• Cause patient dissatisfaction with anesthesia

Question 5

Why midazolam frequently used among benzodiazepines for premedication

Answer 5

• Water-soluble
• Rarely causes thrombophlebitis
• Acts shorter than diazepam
• Provides greater sedation
• More profound anterograde amnesia
• Anticonvulsant and muscle relaxant properties w/ minimal cardiovascular effects

Question 6

Role of nitrous oxide in premedication

Answer 6

• Relieves anxiety
• Reduces intraoperative awareness
• Reduces required dose of the primary anesthetic agent
• Analgesic effect

Question 7

Opioid analgesics commonly used in oral and maxillofacial anesthesia, and their characteristics

Answer 7

• Fentanyl: A µ receptor agonist
• 100 times as potent as morphine
• Rapid onset of less than 1 minute
• Short duration of 30-60 minutes
• Preferred for its minimal histamine release=> suitable for asthmatics.
• Remifentanil: A newer µ agonist
• Rapid onset (1 minute)
• Short duration (5-10 minutes) after infusion,
• Analgesia with better cardiovascular stability and rapid recovery

Question 8

Anticholinergics uses in anesthesia, and which one is preferred

Answer 8

• Control salivary and bronchial secretions
• Prevent laryngospasms
• Glycopyrrolate preferred over atropine => milder tachycardia
• Does not cross the blood-brain barrier=> no mood or psychotomimetic effects

Question 9

Why antiemetics important in anesthesia, and combinations that are effective

Answer 9

• Prevent postoperative nausea and vomiting (PONV)
• Enhance patient comfort and recovery
• 5-HT3 receptor antagonists (such as ondansetron) w/ potent corticosteroids like dexamethasone