Preparation of high-risk patients (diabetes, hypertension, patients on anticoagulant therapy, etc.) about anesthesia, tooth extraction and other surgical procedures in MFA Flashcards

1
Q

Types of high risk patients

A

Myocardial Infarction
Hypertension/Orthostatic hypertension
Anticoagulants
Diabetes
Asthma
Epilepsy

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2
Q

Treatment of patients with Myocardial Infarction

A
  • Avoid if happened in last 6 months→ If necessary carried out in hospital
  • Dental office treatment after 6 months
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3
Q

Treatment of patients with Hypertension

A
  • Bp of 160-190/95-110 requires premedication→ no treatment over this
  • Monitoring of bp before and during anaesthesia
  • Aspiration
  • Avoid Noradrenaline
  • Short and painless appointments as possible

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4
Q

Treatment of Orthostatic hypertension

A
  • Evaluate medical history
  • Support patient as get out of chair
  • Monitoring of Bp
  • Avoidance of sudden change in chair position
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5
Q

Types of Anticoagulants

A

-Coumarin and Heparin

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6
Q

Treatment of patient on Anticoagulants-Coumarin drugs

A
  • Consulting with doctor to control bleeding time→ Reduction in dose
  • Reduction of dose at least two days before
  • Prothrombin time should be 17-19s for procedure(11-12 normal)
  • Prothrombin time increased over following two days
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7
Q

Treatment of patient on Anticoagulants-Heparin

A
  • Discontinued up to 4 hours before procedure
  • If no profuse bleeding→ can be administered again on procedure day
  • Low molecular weight heparin(Clexane) for DVT→ No dosage adjustment needed
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8
Q

Treatment of patient on Anticoagulants-Aspirin

A

-Discontinued 2-5 days before procudure→ Continued 24 hours later

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9
Q

Treatment of patient with Diabetes Mellitus

A

-Supply of Insulin, sugar or glucose in surgery

Screening test→ Glucometer

Time of surgery→ Morning 1-1.5h after breakfast to avoid hypoglycaemic shock and patient stress free/rested

  • Diet shouldn’t be changed before or after procedure→ Hypoglycaemia
  • Medication→ Mild analgesics→ Tylenol and avoidance of Corticosteroids (Glycogenolytic) and aspirin(hypoglycaemic)
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10
Q

Treatment of patient with Asthma

A
  • Detailed history→ Condition/frequency/type of attacks
  • Sedative medication for stress management
  • Pain control
  • Short appointments
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11
Q

Management of patients with Epilepsy

A
  • Stress reduction→ Anxiolytic medication
  • Always aspitate
  • Short appointments
  • Additional anticonvulsive drugs→ Consult w/ doctor
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