Anaesthetic Assessment For Dental Patients Flashcards
When choosing anaesthesia we need to think about:
Patient
Operator
Procedure
Cost
Facilities
What are the types of anaesthesia?
Local Anaesthetic (LA)
IV
General anaesthetic (GA)
What are the variables we need to consider when choosing between LA, IV or GA.
What does it boil down to ?
Available
Practical
Safe
Acceptable
Affordable
Mainly will be easy decision however sometimes can be complex
What is pain?
Sensory + emotional
Biology, psychology and social
What’s anxiety?
Unease, worry or fear
Feel under threat
Biology, psychology and social
What’s compliance?
Conforming, cooperating, agreeing, allowing
Involuntary or voluntary
Requires understanding and ability
May prevent safe delivery of care
LA
Adv?
Disadv?
Intra-Venous Sedation
Adv?
Disadvantage?
Inhalational Sedation
Adv?
Disadvantage?
General anaesthetic
Adv?
Disadv?
Indications for GA?
Safety + Cost
What is essential for general anaesthetic?
GA risk assessment
What helps you assess risk of GA?
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
What type of patient is in ASA 1?
Fit and well
- healthy
- non smoking
- minimal alcohol intake
What type of patient is in ASA 2?
Mild disease No Effect on daily living
• Current Smoker
• Social alcohol drinker
• Obesity (30< BMI >40)
• Controlled Diabetes or Hypertension
• Well controlled mild Asthma
What type of patient is in ASA 3?
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)
Who is not suitable for Day surgery GA?
• Unstable systemic disease (ASA 4)
• Limited mouth opening
• No escort / Poor home support
• Obesity (>40 BMI)
• Surgery likely to last > 2 hours
Does Age matter for different types of anaesthetic?
• 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)
Obesity - what problems can it cause?
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
Should GA be used in pregnancy?
Should IVS be used in pregnancy?
Both NO
Contraindicated = should NOT be used
For GA:
Can you use GA in COPD patients?
Can you use IVS in COPD patients?
What do you need to know about patient ?
What are the risks of diabetes?
Risks:
● Loss of glucose control
● Hypoglycaemic emergency
● Associated medical co morbidity
● Obesity
Summary
