Anaesthetic Assessment for Dental Patients Flashcards
what variables should dentists consider when giving anaesthetic? (patients)
anxiety
compliance
medical history
what variables should dentists consider when giving anaesthetic? (pocedure)
perceived difficulty
expected duration
presence of infection
ease of access
what variables should dentists consider wh0en giving anaesthetic? (operator)
operator skill
operator experience
what variables should dentists consider when giving anaesthetic? (Clinic)
equipment
support
cost
what factors should be considered for giving anaesthetics?
available
practical
safe
acceptable
affordable
what is pain?
an unpleasant sensory and emotional experience with actual or potential tissue damage.
what is pain influenced by?
it is subjective and influenced by:
biology
social
psychology
why is pain management important?
oral cavity is one of the most sensitive areas
why people seek the sentsit
why people are scared of the dentist
what is anxiety?
a feeling of unease such as worry or fear perceived when we feel under threat.
may be mild to severe and varies from protective to phovia. a common barrier to dental care
what is anxiety influenced by?
it is subjective and influenced by:
biology
social
psychology
what is compliance?
act of conforming, cooperating, agreeing and allowing.
maybe voluntary or involuntary
requires understanding and ability
may prevent the safe delivery of care
are there complication of LA?
complications are rare, however, risks increase with medical comorbidity.
What are the advantages of LA?
-effective for most dental procedures
-low risk
-patients can offer full cooperation
-cost effective
What are the disadvantages of LA?
-pressure and movement are still felt
-may not work effectively
-no reduction in conscious awareness/anxiety-provoking
-occasional medical contraindication
What are the advantages of intravenous sedation?
-reduced anxiety and awareness
-low risk
-less expensive than GA
-available in primary and secondary -care
What are the disadvantages of intravenous sedation?
-some awareness still remains
-not suitable for all patients
-loss of patient cooperation
-specialist equipment and training required
what are the advantages of inhalation sedation?
- well tolerated in children
- provides analgesia due to NO
- can avoid needles
- may offer an alternative to IV for difficult airway
what are the disadvantages of inhalation sedation?
-some awareness remains
-Patient has to be able to breathe through the nose
-not suitable if claustrophobic
-face mask can obstruct access
specialist equipment required along with training.
what are the advantages of GA?
-there is no muscular activity giving better access
-the patient has no memory of the procedure
-no patient interference
-enables treatment when acute infection / severe anxiety
what are the disadvantages of GA?
-only delivered in secondary care by anaesthetics
-no patient cooperation
-it is expensive
-risk of mortality and morbidity
what are the indications for GA?
- repeated failed LA (ether-danios)
- sedation not effective/appropriate (illicit drug use)
- prolonged surgery (>40mins)
- surgery that would be extremely unpleasant
- Patient can not remain still eg: Parkinsons
- extreme phobia or anxiety
what are patients advised before GA?
risk of regurgitation of gastric contents can lead to aspiration into the lungs with life-threatening consequences.
Patients are advised to:
-not to eat food 6 hours before the operation
-only drink clear liquids two hours before in small quantities
what is the risk assesement for GA?
American Association of Anesthesiology grading system.
there are 6 stages
what is ASA 1?
healthy
non-smoker
minimal alcohol intake
what is ASA 2?
current smoker
social alcohol drinker
obesity
controlled diabetes or hypertension
well-controlled mild Ashtma
what is ASA3?
poorly controlled diabetes or hypertension
poor controlled asthma/COPD
morbid obesity
alcohol/drug dependency
dialysis/kidney disease
controlled cardiac disease
who are not suitable for day surgery GA?
unstable systemic disease
limited mouth opening
no escort
obesity
surgery likely to last more than 2 hours
does age limit the use of anaesthetics?
there is no upper age limit for GA/IVS
IVS: careful with elderly patients go low go slow
what problems can obesity cause when undergoing anaesthesia?
-hypertension/diabetes is associated with obesity
difficulties with airway
difficult to ventilation
DVT risk increases
difficult to cannulate
what problems can pregnancy cause when undergoing anaesthesia?
early pregnancy: risks to foetal development
later pregnancy: risks to the mother due to the uterus placing pressure on the chest and abdominal veins
IVS is also contra-indicated
LA ideally in 2nd and 3rd trimester
what problems can COPD cause when undergoing anaesthesia?
COPD: irreversible airflow limitation associated with progessive lung inflammation.
must check:
if disease is managed
GA and IVS may be risky
what problems can diabetes cause when undergoing anaesthesia?
risks:
loss of glucose control
hypoglycaemic emergency
associated medical comorbidity
obesity
