Hospital Dentistry Flashcards
Mortality of 22,000 dental GA cases? Risks?
0 deaths reported.
- Low risk of temporary anxiety related to GA:
fingernail biting, fear of dark, needing parental reassurance.
What are the risks of no treatment?
A false sense that there is no problem w/not getting the indicated dental tx.
- disease severity increases
- decreased quality of life
ASA I ASA II ASA III ASA IV ASA V ASA VI
ASA I- normal healthy
ASA II- mild systemic disease
ASA III- severe systemic, non-incapacitating
ASA IV- severe systemic, constant threat to life
ASA V- moribund
ASA VI- on support, awaiting organ removal
More discussion makes parents more afraid of GA T/F. What are some common assessments of risk complications?
More discussion makes parents LESS afraid of complications relating to GA and more knowledgeable. (post operative pain most common, also agitation, sleepiness and sore throat) Sore throat 1:3 Nausea/Vomiting 1:4 Awareness during GA 1:1000 Cardiac arrest 1: 10,000 Death 1:20,000 Severe damage to teeth 1:30k Brain damage 1:80k
What are some congenital syndromes associated with difficult airways? Physical conditions assoc w/difficult airways?
Congenital:
Trisomy 21, Pierre Robin sequence, Crouzon, Treacher Collins, Hx of repaire cleft palate, Osteogenesis imperfect (decreased cervical mobility) and juvenile rheumatoid arthritis (decreased cervical mobility).
Also, physical: obesity, CP, also Asthma/reactive airway, obstructive sleep apnea
What neuromuscular blocking agents are not recommended in children? What are usually used instead?
Succinylcholine not recommended. May cause fatal hyperkalemia.
- Vecuronium, rocuronium (intermediate acting)
- Mivacurium (short acting)
Malignant hyperthermia:
what type of disorder is it?
Inheritance patterN?
What triggers?
Skeletal muscle disorder- hypermetabolic state
AD
No clinical signs
Triggered by volatile anesthetic gases and succinylcholine
What are the signs of malignant hyperthermia?
Unexplained increase in CO2 unexplained tachycardia hyptertension skin mottling muscle rigidity hyperthermia hyperkalemia-induced arrythmias Disseminated intravascular coagulation
Sevoflurane: CV? Onset? benefits?
Less cardiovascular depression than halothane
Faster onset
Less airway irritability
What is the treatment for maligant hyperthemia?
Discontinue triggering agents
Hyperventilate w/100% oxygen
Dantrolene sodium 2.5mg/kgIV -antagnoist to pathophysiologica changes.
Inhibits calcium release from the sarcoplasmic reticulum
- Cooling blanket
Low follow up appt rate? What percent?
Future well care? What percent?
Follow up 55-60% for the 1st appt come back
Future well care 13-30% come back
Which children at the highest risk for repeat dental treatment under GA?
- 100% involvement of maxillary incisors at time of initial GA
- Contd bottle use at time of GA
- Poor coop in dental/medical setting
- Difficult personality as described by parents
