General anesthesia Flashcards
Define general anesthesia (2)
- Controlled unconsciousness
- loss of protective reflexes
Define unconsciousness (3)
amnesia, analgesia and hypnosis
Define protective reflexes (3)
- Capacity to keep airways permeable
- respond to stimuli and verbal orders
General anesthesia: Paracelsus? (2)
(XVI century)—ether
General anesthesia: Priestley?
(1172)—-nitrous oxide
1st general anesthesia? (5)
19th century
- Ethyl chloride, ethylene, propilene
- Chloroform
Effects of general anesthesia? (4)
- Analgesia
- Amnesia
- Reflex inhibition
- Absence of skeletal muscles tone
Drugs used for general anesthesia must be…(5)
- Of reversible action
- Of foreseeable action
- Of controlled action
- High therapeutic coefficient
- Have minimal secondary effects
Which ASAs can be treated with general anesthesia?
ASA I - healthy
ASA II - mild systemic disease
Which ASAs can not be treated with general anesthesia?
ASA III - severe systemic disease
and up should be treated at the hospital
The patient selection for general anesthesia must be based on 3 factors:
- Child’s capacity to collaborate
- Pathology that must be treated
- Age/weight
General anesthesia indications? (8)
- small child with a lot of pathology
- physically and mentally disabled
- patients with severe systemic diseases
- cerebral palsy, down syndrome, severe mentally disabled
- patients with phobia to the dentist
- ineffectiveness of the local anesthesia
- big orofacial traumas and oral surgry
- protection against psychological alterations
General anesthesia indications: small child with a lot of pathology? (2)
- Big destructions, baby bottle tooth decay
* Evaluate if we can wait
General anesthesia indications: Physically and mentally disabled? (3)
- Paraplegia, scoliosis, tetraplegia, spina bifida
- Some airways problems
- Some cases of blindness, deafness
General anesthesia indications: With severe systemic diseases (8)
- Kidney diseases
- Blood dyscrasias, severe coagulopathies
- Convulsive disorders
- Inmunodepressed and transplanted patients
- Oncologic patients
- Patients that have been hospitalized for a long time
- Severe infections
- With craneofacial alterations
General anesthesia indications: Cerebral palsy, Down syndrome, severe
mentally disabled
Those patients that are unable to maintain a minimum of voluntary immobility
General anesthesia indications: Patients with phobia to the dentist
Those that even with strong premedication or
inhaled sedation can´t control their behavior
General anesthesia indications: Ineffectiveness of the local anesthesia
Due to systemic or metabolic alterations
General anesthesia indications: Big orofacial traumas and oral surgery
Oral surgery procedures that other way would be
very unpleasant
General anesthesia indications: Protection against psychological alterations
Patients with psychosis, schizophrenia,…
General anesthesia counter indications (4)
- Family history of malignant hypertension
- Severe renal or hepatic failure that can´t be
controlled - Pulmonary edema
- Full stomach (no eating or drinking 6 hours before)
Advantages of general anesthesia?
It enables us to achieve a good quality in our treatments
Disadvantages of general anesthesia? (4)
- Hospitalization as a frequent cause of anxiety: Studies demonstrate that
children that have been hospitalized may present some kind of behavior
alteration after the hospitalization - Fear or phobia to the general anesthesia: Accidents in the past
- Treatment limitations: The treatments must be done in one session, great
reconstructions are not recommended, do less conservative treatments - Increase in the treatment cost
General anesthesia: Order of the treatment plan? (3)
- Pulp treatment
- Fillings
- Teeth extractions
General anesthesia: We avoid the normal order of the treatment plan in these cases: (3)
- Complex pulp treatments
- Crowns
- Space maintainers
What does the preoperative protocol for general anesthesia consist of? (5)
- Medical chart, intraoral exam, x-rays
- Informed consent of the pediatrician
- Instructions to parents
- Hospital admission
- Informed consent for the procedure
Preoperative protocol general anesthesia: informed consent of the pediatricion consists of ? (2)
• Lab tests: ECG, blood clotting tests, blood
count, urine, torax X-ray
• Report from the specialist if the patient has an
ASA classification higher than II
What are the 2 anesthesia guidelines?
- Patient guideline
2. Selection of the anesthesia
What are the 2 anesthesia guidelines/ decisions that need to be made?
- Patient guideline
2. Selection of the anesthesia
General anesthesia: Patient guideline? (2)
• To check the medical chart: Medical history, actual
pathology, medication
• Evaluate the ASA level of the patient
General anesthesia: Selection of the anesthesia technique? (3)
- With intubation or without it
- At the hospital or not
- Prescribe premedication if necessary
Operating room protocol? (4)
- Sterile environment
- Intravenous via in the patient’s arm
- Monitoring: Heart activity and oxygen saturation
- Perfect pharynx packing with a damp gauze
What are the 4 stages of anesthesia?
- Premedication (preanesthesia room)
- Induction
- Anesthesia/ventilation
- Maintenance/awakening
Where does the premedication stage of anesthesia occur and with who?
- Preanesthesia room
- The child is with their parents
What occurs during the premedication stage of anesthesia? (3)
- Goal: diminish anxiety levels
- Given intranasally: Midazolam (sedative), Atrpine (anticholinergic)
- Optionally: benzodiazepine can be given the night before
What occurs during the induction stage of anesthesia? (3)
• Intravenous via: It is the most used in children. It has an hypnotic (propofol) and an opiate (fentanyl)
• Inhalation: With an halogenated anesthesia
(sevoflurane)
• A muscle relaxant is given to facilitate the
nasotracheal intubation: Rocuronium (Esmerón)
Anesthesia induction: drug Intravenously? (2)
- Propofol (hypnotic)
- Fentanyl (opiate)
Anesthesia induction: inhaled drugs?
Sevoflurane (halogenated anesthesia)
Anesthesia induction: muscle relaxant drugs?
Esmeron (Rocuronium)
What drugs are administered during anesthesia/ventillation stage of anesthesia? (5)
Inhalation: Applied with a face mask
- Sevoflurane ***
- Desflurane (not in children. Very irritating)
Intravenous:
• Barbituates (pentathol)
• Benzodiazepines (midazolam)
• Hypnotics (propofol)
Anesthesia /ventillation stage: inhaled drugs? (2)
- Sevoflurane ***
* Desflurane (not in children. Very irritating)
Anesthesia /ventillation stage: intravenous drugs? (3)
- Barbituates (pentathol)
- Benzodiazepines (midazolam)
- Hypnotics (propofol)
During nesthesia /ventillation stage it is necessary to…? How do we do this? (3)
Maintain breathing with mechanic ventilation with insufflation of O2
- with nasotracheal intubation
- larynx intubation
During anesthesia it is necessary to monitor the patient using… (3)
- pulse oximeter
- oscilloscope
- sphygmomanometer
What is a pulse oximeter?
It determines the saturation of O2 of the hemoglobin in the arterial blood
What is a oscilloscope?
Complete monitorization of the
heart rate
What is a sphygmomanomter?
it determines the blood
pressure
Once the child is asleep and prepared, it is essential to
use: (3)
- Mouthblocks
- Posterior packing (gauze, larynx mask)
- Complete dental equipment
What drugs are used during the maintenance phase? (4)
• Strong analgesic (fentanile)
• Muscle relaxant (rocuronium)
• Intravenous hypnotic (Propofol) or inhaled anesthesic
(sevoflurane)
What happens during the awakening phase?
Reverse of the anesthesia, elimination of the anesthesia gases (10 minutes)
How long is the awakening stage?
10 mins
When is the patient dischraged after general anesthesia?
that same day or the day after
