Anaesthetic Assessment For Dental Patients

Question 1

When choosing anaesthesia we need to think about:

Answer 1

Patient
Operator
Procedure
Cost
Facilities

Question 2

What are the types of anaesthesia?

Answer 2

Local Anaesthetic (LA)
IV
General anaesthetic (GA)

Question 3

What are the variables we need to consider when choosing between LA, IV or GA.

Answer 3

Question 4

What does it boil down to ?

Answer 4

Available
Practical
Safe
Acceptable
Affordable

Mainly will be easy decision however sometimes can be complex

Question 5

What is pain?

Answer 5

Sensory + emotional

Biology, psychology and social

Question 6

What’s anxiety?

Answer 6

Unease, worry or fear
Feel under threat

Biology, psychology and social

Question 7

What’s compliance?

Answer 7

Conforming, cooperating, agreeing, allowing

Involuntary or voluntary

Requires understanding and ability

May prevent safe delivery of care

Question 8

Question 9

LA
Adv?
Disadv?

Answer 9

Question 10

Intra-Venous Sedation
Adv?
Disadvantage?

Answer 10

Question 11

Inhalational Sedation
Adv?
Disadvantage?

Answer 11

Question 12

General anaesthetic
Adv?
Disadv?

Answer 12

Question 13

Question 14

Indications for GA?

Answer 14

Safety + Cost

Question 15

What is essential for general anaesthetic?

Answer 15

Question 16

GA risk assessment
What helps you assess risk of GA?

Answer 16

Risks depend on many factors which must be taken into account to ensure patient safety

The ASA (American Association of Anaesthesiology) grading helps you assess the risk of GA

Question 17

What type of patient is in ASA 1?

Answer 17

Fit and well

• healthy
• non smoking
• minimal alcohol intake

Question 18

What type of patient is in ASA 2?

Answer 18

Mild disease No Effect on daily living

• Current Smoker
• Social alcohol drinker
• Obesity (30< BMI >40)
• Controlled Diabetes or Hypertension
• Well controlled mild Asthma

Question 19

What type of patient is in ASA 3?

Answer 19

Systemic Disease Effects daily living

• Poorly controlled Diabetes or Hypertension
• Poorly controlled Asthma / COPD
• Morbid obesity BMI>40
• Alcohol / drug dependancy
• Dialysis / Kidney Disease
• Controlled Cardiac disease (stable angina)

Question 20

Who is not suitable for Day surgery GA?

Answer 20

• Unstable systemic disease (ASA 4)
• Limited mouth opening
• No escort / Poor home support
• Obesity (>40 BMI)
• Surgery likely to last > 2 hours

Question 21

Does Age matter for different types of anaesthetic?

Answer 21

• There is no upper age limit for GA or IVS
• ‘Biological age’ of the patient should be assessed
• ASA classification is helpful
• IV Sedation: Be careful in the elderly (Go low Go slow)

Question 22

Obesity - what problems can it cause?

Answer 22

Increasingly common

This can result in:
● Hypertension / Diabetes
● Difficulties with airway management
● Difficult ventilation and intubation
● DVT risk increases
● Difficult to cannulate

BMI > 40 = morbidly obese

Question 23

Should GA be used in pregnancy?
Should IVS be used in pregnancy?

Answer 23

Both NO
Contraindicated = should NOT be used
For GA:

Question 24

Can you use GA in COPD patients?
Can you use IVS in COPD patients?
What do you need to know about patient ?

Answer 24

Question 25

What are the risks of diabetes?

Answer 25

Risks:
● Loss of glucose control
● Hypoglycaemic emergency
● Associated medical co morbidity
● Obesity

Question 26

Summary

Answer 26