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5th yr- AMS > General anaesthesia in Dentistry > Flashcards

General anaesthesia in Dentistry Flashcards

1
Q

What must the dentist who is thinking of referring a patent for GA obtain

A

consent

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2
Q

What must the dentist who is thinking of referring a patent for GA inform the patient on prior to referral

A
  1. Explain all the available option
  2. Explain the risks and benefits of each option
  3. Emphasise it is the patients choice
  4. Document the discussion and the patients preference
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3
Q

What options regarding anaesthesia do we have

A
  1. Local anaesthesia
  2. Conscious sedation
  3. General anaesthesia
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4
Q

Name the different conscious sedation options

A
  1. Inhalation sedation
  2. Iv sedation
  3. Advanced sedation techniques
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5
Q

Define conscious sedation

A

A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out but during which verbal contact with the patient is maintained throughout the period of sedation

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6
Q

Which drugs are used in inhalation sedation

A

Oxygen and nitrous oxide

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7
Q

Which drugs are used in intravenous sedation

A

Midazolam

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8
Q

Which drugs are used in advanced sedation

A

Use of different drugs such as ketamine, propofol and fentanyl
These drugs can be used in combination and /or combined routes of administration

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9
Q

Talk through the process of conscious sedation

A
  1. Informed consent
  2. Written information
  3. Fasting (patient and clinical dependant)
  4. Monitoring
  5. Procedure
  6. Discharge
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10
Q

What do we monitor when doing conscious sedation

A

Pulse oximetry
Blood pressure

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11
Q

List some of the basic discharge criteria we have in place following conscious sedation

A
  1. Patient should be fully awake
  2. Patient not in pain
  3. Doesn’t feel sick
  4. Should be a responsible adult present
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12
Q

List some reasons that may indicate general anaesthesia over conscious sedation

A
  1. Young children
  2. Patients with learning disabilities
  3. Patients with severe anxiety
  4. Patients unable to lie still due to movement disorders
  5. Major surgery
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13
Q

Define general anaesthesia

A

A state of controlled consciousness

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14
Q

How do we describe GA to patient s

A

Medicines are used to send you to sleep so that you are unaware of the surgery and can not move or feel pain during the procedure

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15
Q

Name the 3 pillars of anaesthesia

A
  1. Amnesia
  2. Analgesia
  3. Muscle relaxation
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16
Q

How do we achieve amnesia during GA

A

Through medication such as:
1. IV Agents eg propofol
2. Inhalation agents eg sevoflurane
3. Less commonly used is benzodiazepines eg midazolam

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17
Q

Describe propofol

A

White milky liquid

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18
Q

How can we achieve analgesia under GA

A
  1. Paracetamol
  2. NSAIDS
  3. Opioids
  4. Nitrous oxide
  5. local anaesthetics
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19
Q

In whom are NSAIDs contraindicated

A

Patients with:
1. Kidney problems
2. Gastric ulcers
3. Gastritis
4. Asthma

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20
Q

Give examples of opioids

A
  1. Codeine
  2. Tramadol
  3. Morphine
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21
Q

Do we tend to give anything for muscle relaxation for dental torment under GA

A

No as the amnesia and analgesia usually helps with muscle relaxation

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22
Q

What can we give to relax the muscles during GA

A
  1. Depolarising agents eg suzamethonium
  2. Non depolarising agents eg rocuronium, atracurium
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23
Q

Before the patient goes to sleep under GA what do we check

A
  1. ECG
  2. Non invasive blood pressure
  3. Pulse oximetry
24
Q

What do we need to monitor throughout the GA

A
  1. Carbon dioxide levels in breathing
  2. Oxygen levels
  3. Level of anaesthetic gases patient is receiving
25
Q

What is a key part of anaesthesia and why

A

Airway management as all fall forms anaesthesia depress the airway

26
Q

how do we manage the airway under GA

A
  1. Mask and airways
    OR
  2. Laryngeal masks (most common)
    OR
  3. Endotracheal tubes which can be oral or nasal
27
Q

What role does the anaesthetist have

A
  1. Assess patient
  2. Plan anaesthetic
  3. Manage airway
  4. Monitor organ systems
  5. Balance anaesthesia
  6. Post op pain relief
  7. Resuscitate if needed
28
Q

What are the risks of general anaesthetic dependent on

A

the patients ASA grade

29
Q

What is the ASA grade split into

A

Scale from I-IV

30
Q

Describe an ASA I patient

A

Normal healthy individual

31
Q

Describe an ASA II patient

A

Mild systemic disease that does not limit activity

32
Q

Describe an ASA III patient

A

Severe systemic disease that does limit activity

33
Q

Describe an ASA IV patient

A

Severe systemic disease that is a contact threat to life

34
Q

Describe an ASA V patient

A

Moribund patient not expected to survive without the surgery

35
Q

What is the mortality risk fro a patient that is grade I on the ASA classification

A

0.06%

36
Q

What is the mortality risk fro a patient that is grade II on the ASA classification

A

0.4%

37
Q

What is the mortality risk fro a patient that is grade III on the ASA classification

A

4.5%

38
Q

What is the mortality risk fro a patient that is grade IV on the ASA classification

A

23%

39
Q

What is the mortality risk fro a patient that is grade V on the ASA classification

A

51%

40
Q

List the very common risks of GA

A
  1. Sickness
  2. Shivering
  3. Thirst
  4. Sore throat
  5. bruising
  6. Temporary memory loss (mainly in over 60s)
41
Q

List the common risks of GA

A
  1. Pain at the injection site
  2. minor lip or tongue injury
42
Q

List the uncommon risks of GA

A

Minor nerve injury

43
Q

What do we mean by very common risks

A

1 in 10 may suffer from these risks

44
Q

What do we mean by common risks

A

Between 1 in 10 and 1 in 100 may suffer from these risks

45
Q

What do we mean by uncommon risks

A

Between 1 in 100 and 1 in 1000 may suffer from these risks

46
Q

What do we mean by rare risks

A

Between 1 in 1000 and 1 in 10,000 may suffer from these risks

47
Q

What do we mean by very rare risks

A

1 in 10,000 to 1 in 100,000 or more may suffer from these risks

48
Q

List the rare risks of GA

A
  1. 1 in 1000 may suffer from permanent peripheral nerve damage
  2. 1 in 2,800 may suffer from cereal abrasion
  3. 1 in 4500 may suffer from damage to teeth requiring treatment
  4. 1 in 10,000 may suffer from anaphylaxis
49
Q

List the very rare risks of GA

A
  1. 1 in 20,000 may gain awareness during anaesthetic
  2. 1 in 100,000 may lose their vision
  3. 1 in 100,000 may die as a rustle of anaesthesia
50
Q

Can we conduct general anaesthesia in primary practice

A

no must be conducted in hospital

51
Q

What happens pre op to GA

A
  1. Pt called by a nurse for assessment
  2. Pts will be asked to continue current medications with some exceptions
  3. Pts asked to fast from food for 6 hours and clear fluids for 2 hours
52
Q

Why do we ask patients to fast before a general anaesthesia

A

As the patient protective mechanisms such as cough and sphincter control are suppressed during GA so if they have a full stomach they can regurgitate the food into the lungs

53
Q

On the day of the GA what happens

A
  1. Pt attends dental hospital and is checked in by nurse
  2. An anaesthetist will assess and decide the best from of anaesthetic and a dentist will take consent for the procedure
  3. Pt changes into theatre gown and is attached to monitoring
  4. Anaesthetist will insert IV canna into back of hand
  5. Anaesthetic goes in through the cannula and works in a few seconds
  6. Pt can choose to go to sleep breathing an anaesthetic gas
54
Q

What happens at the end of the GA

A

Patient will wake up in the recovery room with a nurse

55
Q

What happens post op following GA

A
  1. Pain relief is explained in detail by nurses before discharge
  2. Nausea and vommiting should have settled by discharge
  3. Sore throat explained and should settle in 24 hours
  4. Head ache should remove with painkillers
  5. Pt informed of reasons to call the hospital
  6. PT should have a responsible adult stating with them for at least 24 hours
56
Q

List some reasons the pt should call the hospital following GA

A
  1. Vomiting persisting beyond 24 hours
    2.If pt is unable to eat/ drink
  2. Bleeding
  3. Signs of infection

5th yr- AMS (11 decks)

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