Preparation of high-risk patients (diabetes, hypertension, patients on anticoagulant therapy, etc.) about anesthesia, tooth extraction and other surgical procedures in MFA Flashcards
Types of high risk patients
Myocardial Infarction
Hypertension/Orthostatic hypertension
Anticoagulants
Diabetes
Asthma
Epilepsy
Treatment of patients with Myocardial Infarction
- Avoid if happened in last 6 months→ If necessary carried out in hospital
- Dental office treatment after 6 months
Treatment of patients with Hypertension
- 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
-
Treatment of Orthostatic hypertension
- Evaluate medical history
- Support patient as get out of chair
- Monitoring of Bp
- Avoidance of sudden change in chair position
Types of Anticoagulants
-Coumarin and Heparin
Treatment of patient on Anticoagulants-Coumarin drugs
- 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
Treatment of patient on Anticoagulants-Heparin
- 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
Treatment of patient on Anticoagulants-Aspirin
-Discontinued 2-5 days before procudure→ Continued 24 hours later
Treatment of patient with Diabetes Mellitus
-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)
Treatment of patient with Asthma
- Detailed history→ Condition/frequency/type of attacks
- Sedative medication for stress management
- Pain control
- Short appointments
Management of patients with Epilepsy
- Stress reduction→ Anxiolytic medication
- Always aspitate
- Short appointments
- Additional anticonvulsive drugs→ Consult w/ doctor