Dr S Parthasarathy MD DA DNB Dip DiabMD DCA Dip software based statistics PhD physiology Anesthesia started with dentistry Horace wells administered himself nitrous oxide his colleague extracted his tooth in 1844 ID: 1006515
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1. Anesthesia for dental procedures Dr. S. Parthasarathy MD, DA, DNB, Dip Diab.MD ,DCA, Dip software based statistics,PhD (physiology)
2. Anesthesia started with dentistry Horace wells administered himself nitrous oxide – his colleague extracted his tooth in 1844In 1846, morton did it again !!
3. Usually not called for !! Children Mentally retarded adults Dental phobia Acute pus Radiotherapy previous –( LA Vs GA)Allergy to local anestheticsMajor surgeries (difficult dental extractions or for dental releasing surgeries)
4. Contraindications !! Serious medical disease ?? Can we do as an outpatient ?? Eg. CHF, anticoagulants, Swelling of the neck Anesthetist – inexperienced
5. Three types of anesthesia Dental chair anaesthesia, Day care anaesthesia In-patient anaesthesia.
6. Problems in dental chair Venous return decrease ? Venous embolism Unprotected airwayAspiration of blood or mucus Adrenaline in local anaesthetic can cause arrhythmias in presence of halothaneHigher incidence of arrhythmias due to stimulation of 5 th cranial nerve
7. Problems in dental chair Nasal bleeding if nasal airway is used to deliver the anaestheticFainting due to cerebral hypoxiaDifficulty in initiating CPCR once cardiac arrest occursForeign body obstruction of the airway by needles or dentures, necessitating removal by bronchoscopyBABA FACE - pnemonic
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10. Preoperative work up √ Equipments √ Nasal airway
11. ECO mask – goldman mask Intermittent machines , haloxair ??
12. Haloxair unit
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15. Newer set ups
16. SAFE short acting fast emergence Bowel bladder evacuation Inj. Atropine Sevoflurane induction – previously halothane Nitrous oxygen 65 – 35 + sevo –50% fio2- betterAction in a few seconds Recover !! SAFE agents !!
17. Older children Propofol is definite Thio and keta ?? are other options Suction – two machines Transparent neonatal mask IV sedation with MAC – OK !? Drooping of upper eye lid over pupil – patient is under !!- verrill sign
18. Position on induction !! Maximal time
19. Airways Nasal masks Nasal airways - mouth packs !!Mouth gag on the opposite side The surgeon finishes the procedure in a few seconds Allow to breathe through nose If adenoids , nasal airway is a must Intubate ?? Mckesson prop Devonshire
20. Usually nasotracheal Difficult access as in impacted tooth, macroglossia, short neckExcessive uncontrolled bleedingmaxillofacial or major dental surgeryMentally handicappedObstruction of nasal passages, large adenoids where nasal mask is not effectiveInpatients ?
21. Semi sitting position problems ??
22. Intraoperative problem There is a possibility of surgical emphysema or mediastinal emphysema following use of air turbine dental drills.Stop nitrous oxide. Diagnose a rare pneumothorax, IPPV - ?ICD - !
23. Intraoperative problemsArrhythmias – adrenaline, halo , V th nerve Aspiration Laryngospasm Mouth breathing Fainting – oxygen, Iv fluids, stop manipulation Single click switch back to supine position Labile patients !!
24. Arrest Collapse Anaphylaxis Think of dental chair
25. Use of the LMA for Dental AnaesthesiaYoung (1991) has discussed the experience of using the regular nonreinforced LMA for dental work, usually for extractions and fillings in children. Use of the LMA is said to be easier for the anesthetist than a nasal mask.Throat pack – ok Airway problems – more common – surgeons move all bones !! – manipulate and adjust mild – it becomes acceptable Reinforced LMA – good- less interference with dentist
26. Recovery Tooth sockets may continue to bleed. Complete awake Reflexes Left lateral Suction 30 minutes atleast oxygen Nil oral for 3-4 hours Packs remove
27. EJOA – precision delivery of local anesthetic
28. Nerve blocks Posterior Superior Alveolar Nerve BlockMiddle superior alveolar nerve blockAnterior superior alveolar nerve blockInferior alveolar nerve block
29. Middle superior alveolar nerve block Mucobuccal fold above second premolar5 mm depth – 1 ml
30. posterior superior alveolar nerve block height of the mucobuccal fold above and distal to distobuccal root of the last molar present in the archUpward (superiorly at a 45 degree angle to the occlusal plane).Inward (medially toward the midline at a 45 degree angle to the occlusal plane).Backward (posteriorly at a 45 degree angle to the long axis of the molar) to a depth of 10-14mm.
31. Canine eminence ( infra orbital nerve block ) Anterior superior alveolar nerve block
32. Inferior alveolar nerve blockanesthetic solution at the retromolar triangle which is a triangular area located near to the distal side of the lower third molar.
33. Hypnosis Acupuncture Had roles but now ??
34. Post operative pain Extraction of baby teeth is not especially painful. The main problem is the psychological trauma of waking up uncomfortable in a strange place.Para or syr. Ibuprofen sufficient
35. Poswilla report 1990 IV sedation single drug with nitrous (LA) – patient talking Operator and anesthetist – different All monitors including defibrillator Experienced
36. Summary Three types Dental chair dangers Indications ContraindicationsLA alone , IVS with MAC, Nasal airway – 50 % O2 LMA Intubate SAFE agents Recovery Nerve blocks Poswilla report
37. Thank you all There is no minor anesthetic technique Same vigilance