Anesthetic assessment

Question 1

What are the 5 things that affect what anaesthetic to use?

Answer 1

• The procedure
• The patient
• The facilities
• The operator
• Cost

Question 2

What patient factors influence what anaesthetic to use?

Answer 2

• Anxiety
• Medical issues
• Compliance issues

Question 3

How does the procedure affect the anaesthetic needed?

Answer 3

• Duration
• Complexity
• How easy it is to gain acess?

Question 4

How does the operator affect anaesthetic used?

Answer 4

• Skill and experience

Question 5

How does the environment affect anaesthetic used?

Answer 5

• Equipment available
• Support (assistance)
• Cost

Question 6

When we finally chose the anaesthetic we need to consider another 5 things which are?

Answer 6

• Available
• Practical
• Safe
• Acceptable
• Affordable

Question 7

What is pain?

Why is this important in the oral cavity?

Answer 7

Pain is the unpleasant sensory and emotional experience with actual or potential tissue damage.

The oral cavity is highly innervated so pain is important to manage.

Question 8

How does anxiety affect anaethetic?

Answer 8

Anxiety is the feeling of unease provoked under threat.

Phobia to dentistry is common and we need to manage this effectively.

Question 9

How does compliance affect anaesthetic?

Answer 9

This is the act of conforming, cooperating, agreeing and allowing enabling us to carry out treatment.

Compliance requires understanding and ability and noncompliance may prevent safe delivery of care.

Question 10

What is the anaesthetic ladder?

Answer 10

LA
IVS
GA

Increase in risk, cost, support as we go up the ladder.

Question 11

What are the advantages and disadvantages of LA?

Answer 11

+ Low risk
+ Effective for dental procedures
+ Patient can offer full co-operation
+ Cost effective

• Pressure is still felt
• May not work effectively if patient has an infection
• No reduction in anxiety
• Occasional medical contraindication e.g. allergy

Question 12

What are the advantages and disadvantages of IV sedation?

Answer 12

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

• some awareness remains
• not suitable for all patients
• less patient co-operation
• specialist equipment and training needed

Question 13

What are the advantages and disadvantages of inhalation sedation?

Answer 13

+ well tolerated by children
+ provides analgesia due to nitrogen oxide
+ can avoid needles
+ alternative to IV for difficult airway problems

• some awareness remains
• patient needs to be able to breathe through nose
• nasal mask can get in way of procedure
• specialist equipment and training needed
• disposal of expired gases needs to be done carefully

Question 14

What are the advantages and disadvantages of GA?

Answer 14

+ no patient awareness
+ no patient interference
+ no muscular activity so easier access
+ enables treatment in those with severe anxiety

• more risk
• costs more
• no patient co-operation
• only given in secondary care by anaesthetists

Question 15

What are the indications for GA?

Answer 15

1) Repeated failed LA
2) If other methods arent effective due to drug use e.c.t
3) Surgery that would be extremely unpleasant and long
4) Patient cannot remain still e.g. parkinsons
5) Extreme anxiety/phobia

Question 16

What do we need to be aware of when using GA?

Answer 16

• Risk of regurgitation of gastric contents as patient lays flat
• Aspiration down the right side of the lung

Question 17

How do we reduce the risk of a patient aspiring gastric contents during a GA procedure?

Answer 17

Not to eat any solid food for 6 hours and no liquids 2 hours before.

Question 18

What classification can we use to GA risk assessment?

Answer 18

ASA

1 = normal and healthy e.g. non smoking and minimal alcohol

2 = mild systemic disease
e.g. current smoker, controlled diabetes, obesity BMI 30-40, well controlled asthma

3 = severe systemic disease
e.g. poorly controlled diabetes, poorly controlled asthma, alcohol dependency, kidney disease

4 = severe systemic disease that is constant threat to life

Question 19

What people are not suitable for day surgery GA?

Answer 19

• ASA 4
• Limited mouth opening (tube cant get into mouth for patient to breathe)
• No escort
• Obesity
• Surgery likely to last more than 2 hours (longer GA means more recovery)

Question 20

Does age affect GA indication?

Answer 20

There is no upper age limit for GA.

ASA is a more useful classification.

Question 21

What are the 4 main contraindications for GA?

Answer 21

1) Obesity = bmi > 40
- Results in hypertension, difficulty with airway management, difficult to cannulate

2) Pregnancy - Risk to foetal development in early development.
In later stages = risk to mother and to foetus due to pressure placed on the inferior vena cava during the operator.

3) COPD - irreversible air flow obstruction with progressive lung inflammation.
How is the disease managed? - hospital admissions? - recent GA experience?

4) Diabetes - loss of glucose control when under sedation.
This can lead to a hypoglycaemic emergency.