Anaesthetic Assessment for Dental Patients

Question 1

what variables should dentists consider when giving anaesthetic? (patients)

Answer 1

anxiety
compliance
medical history

Question 2

what variables should dentists consider when giving anaesthetic? (pocedure)

Answer 2

perceived difficulty
expected duration
presence of infection
ease of access

Question 3

what variables should dentists consider wh0en giving anaesthetic? (operator)

Answer 3

operator skill
operator experience

Question 4

what variables should dentists consider when giving anaesthetic? (Clinic)

Answer 4

equipment
support
cost

Question 5

what factors should be considered for giving anaesthetics?

Answer 5

available
practical
safe
acceptable
affordable

Question 6

what is pain?

Answer 6

an unpleasant sensory and emotional experience with actual or potential tissue damage.

Question 7

what is pain influenced by?

Answer 7

it is subjective and influenced by:
biology
social
psychology

Question 8

why is pain management important?

Answer 8

oral cavity is one of the most sensitive areas

why people seek the sentsit

why people are scared of the dentist

Question 9

what is anxiety?

Answer 9

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

Question 10

what is anxiety influenced by?

Answer 10

it is subjective and influenced by:
biology
social
psychology

Question 11

what is compliance?

Answer 11

act of conforming, cooperating, agreeing and allowing.

maybe voluntary or involuntary
requires understanding and ability
may prevent the safe delivery of care

Question 12

are there complication of LA?

Answer 12

complications are rare, however, risks increase with medical comorbidity.

Question 13

What are the advantages of LA?

Answer 13

-effective for most dental procedures
-low risk
-patients can offer full cooperation
-cost effective

Question 14

What are the disadvantages of LA?

Answer 14

-pressure and movement are still felt
-may not work effectively
-no reduction in conscious awareness/anxiety-provoking
-occasional medical contraindication

Question 15

What are the advantages of intravenous sedation?

Answer 15

-reduced anxiety and awareness
-low risk
-less expensive than GA
-available in primary and secondary -care

Question 16

What are the disadvantages of intravenous sedation?

Answer 16

-some awareness still remains
-not suitable for all patients
-loss of patient cooperation
-specialist equipment and training required

Question 17

what are the advantages of inhalation sedation?

Answer 17

• well tolerated in children
• provides analgesia due to NO
• can avoid needles
• may offer an alternative to IV for difficult airway

Question 18

what are the disadvantages of inhalation sedation?

Answer 18

-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.

Question 19

what are the advantages of GA?

Answer 19

-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

Question 20

what are the disadvantages of GA?

Answer 20

-only delivered in secondary care by anaesthetics
-no patient cooperation
-it is expensive
-risk of mortality and morbidity

Question 21

what are the indications for GA?

Answer 21

1. repeated failed LA (ether-danios)
2. sedation not effective/appropriate (illicit drug use)
3. prolonged surgery (>40mins)
4. surgery that would be extremely unpleasant
5. Patient can not remain still eg: Parkinsons
6. extreme phobia or anxiety

Question 22

what are patients advised before GA?

Answer 22

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

Question 23

what is the risk assesement for GA?

Answer 23

American Association of Anesthesiology grading system.

there are 6 stages

Question 24

what is ASA 1?

Answer 24

healthy
non-smoker
minimal alcohol intake

Question 25

what is ASA 2?

Answer 25

current smoker
social alcohol drinker
obesity
controlled diabetes or hypertension
well-controlled mild Ashtma

Question 26

what is ASA3?

Answer 26

poorly controlled diabetes or hypertension
poor controlled asthma/COPD
morbid obesity
alcohol/drug dependency
dialysis/kidney disease
controlled cardiac disease

Question 27

who are not suitable for day surgery GA?

Answer 27

unstable systemic disease
limited mouth opening
no escort
obesity
surgery likely to last more than 2 hours

Question 28

does age limit the use of anaesthetics?

Answer 28

there is no upper age limit for GA/IVS

IVS: careful with elderly patients go low go slow

Question 29

what problems can obesity cause when undergoing anaesthesia?

Answer 29

-hypertension/diabetes is associated with obesity

difficulties with airway

difficult to ventilation

DVT risk increases

difficult to cannulate

Question 30

what problems can pregnancy cause when undergoing anaesthesia?

Answer 30

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

Question 31

what problems can COPD cause when undergoing anaesthesia?

Answer 31

COPD: irreversible airflow limitation associated with progessive lung inflammation.

must check:
if disease is managed

GA and IVS may be risky

Question 32

what problems can diabetes cause when undergoing anaesthesia?

Answer 32

risks:
loss of glucose control
hypoglycaemic emergency
associated medical comorbidity
obesity