DENTAL ANAESTHESIA

Sherif El-Hadi MD
Neuroanaesthesia Unit
Faculty of medicine
Analgesia Anaesthesia in Dentistry
1. Local Analgesia
2. Local Analgesia + Sedation
3. Local Analgesia + General Anaesthesia
4. General Anaesthesia
Why GA??
• Cooperation absent
▫ Child
▫ Mentally retarded
• LA cannot be given
▫ Allergy
▫ Local Infection
• Anxiety
Dental Phobia
Referred to hospital:
• Serious diseases e.g. cardiopulmonary, diabetes,
neuromuscular.
• Patients taking significant amount of drugs
including anticoagulants.
• Hematological diseases e.g. haemophilia.
• Major oral infection (swelling) or trauma (airway
obstruction).
• Children with congenital cardiac defects.
• Extreme obesity.
Preoperative Assessment
• Age, weight
• Anaesthetic before, any problems?
• Trouble with your heart (e.g. chest pain)?
• Do you have any problems with your lungs (dyspnea.
cough ?(
• Have you had a cold recently or have you now?
• Do you find that you bleed or bruise easily?
• Are you taking any medicines (e.g. aspirin .. .etc) ?
• Do you suffer from any allergies?
• Do you faint easil
Preparations before induction of GA
Patients:
• Eight hours no food.
• Bladder should be empty.
• Examine nose (patency), mouth (loose teeth),
remove dentures.
• Tight clothing loosened.
• Patient must be accompanied by a responsible
adult.
• Oral anxiolytic .
• PPI (Parental Presence during Induction)
Apparatus
• Standard anaesthesia machine.
• O2 source.
• Suction.
• Full intubation set.
• Full resuscitation equipment.
• Fluids, crystalloids, colloids, IV cannulae.
• Intravenous anaesthetics, atropine, succinylcholine.
• Emergency drugs e.g. epinephrine, xylocaine ...etc.
• Monitors: ECG, BP, pulse oximetry.
• Defibrillator.
Mouth props, packs and airways:
• The mouth prop to keep mouth open during
anaesthesia.
• Mouth pack is essential
▫ Blood and saliva to prevent aspiration
▫ Swallowed blood causes PO vomiting
• Avoid pushing the tongue backward causing
airway obstruction.
• Soft nasopharyngeal airway
Posture
• Sitting: can cause hypotension (vasodilatation and
bradycardia), fainting (or even cardiac arrest.
• Supine: can cause airway obstruction, pharyngeal
soiling with blood and aspiration of gastric contents.
• Semi-supine (i.e. supine with some degree of head
up): Commonest position because:
Best balance of respiratory and haemodynamic conditions.
Blood and debris in the floor of the mouth.
The airway easily maintained by the anaesthetist.
• Ability to tilt the dental chair to supine
position is essential
Induction of GA:
Either by:
• Inhalational (children) or
• IV technique (old children, adults).
Inhalational induction
▫ Usually started using N2O/O2 for few breaths then
a volatile agent is added.
▫ Halothane: most commonly used, pleasant smell,
smooth, rapid induction, cheapest agent.
▫ Sevoflurane: recent agent, very pleasant smell,
more smooth, rapid induction and recovery than
halothane, very expensive.
▫ Isoflurane: is not suitable in children, pungent
smell, irritant to airways, causing coughing,
laryngospasm and hypoxia.
Intravenous induction
Preferred method of many dental anaesthetists.
Rapid smooth induction, no face mask, less salivation.
Disadvantages: hypotension, respiratory depression
or apnea, adults may faint at the sight of a needle.
Thiopentone
Propofol: very smooth induction, no hangover effect.
Dose 2-2.5 mg/kg (adult), 3 mg/kg (children).
Pain on injection (xylocaine is added),
Greater degree of cardiorespiraty depression
Ketamine: Strong analgesia., hallucinations
Monitoring
• Observing colour of lips, mucosal surfaces.
• Watching the movements of reservoir bag.
• Feeling the carotid pulse
• Equipment:
▫ ECG.
▫ Arterial blood pressure.
▫ Oxygen saturation (pulse oximetry).
Recovery
• Lateral position.
• Oxygen mask until patient open eyes.
• Suction must be ready.
• Monitoring of airway and breathing.
• Period of stay in the recovery room is at least 30
min.
• Responsible adult should accompany patient
home
• Patient should be able to walk unsupported.
• No drive or for the rest of the day.
Thank You