Complication in Dental Chair
Comments
Content
DENTAL ANESTHESIA
COMPLICATIONS IN THE DENTAL
CHAIR
Dr. SAAD A. SHETA
Assistant Professor, Anesthesia
Dental College
KSU
Dental Anesthesia
Out-Patient anesthesia (Dental Chair Anesthesia)
Day-Case anesthesia
In-Patient anesthesia
Complete Dental rehabilitation
Complicated oral surgery procedures
Major Maxillofacial surgeries
In addition, Sedation Techniques
Out-Patient Dental Anesthesia
Dental Chair Anesthesia
Out-Patient dental extraction
Children (4-10 years): high incidence of URTI
Steadily decreased
Out-patient Dental Anesthesia
Patient Selection (&Indications)
ASA grade I&II
Disability (mental& physical)
coexisting disease
current medications
Review:
Fearful adults
rather sedation
Procedure
short
not so extensive
Out-Patient Dental Anesthesia
Contraindications
Serious cardiopulmonary diseases
COPD
Diabetes or other endocrinological diseases
Neuromuscular disorders
Coagulopathies & Hemoglobinopathies
Marked oro-facial swelling (edema& trismus)
Potential difficult airways
Marked congenital heart defects
Extreme obesity
Drugs: MAOIs , Anticoagulant
Not fasting
Out-Patient Dental Anesthesia
Equipment (Up to the standards of in-patient GA)
Dental Chair
Anesthetic equipment
Monitoring
Resuscitation equipment
Dental Chair
Adjustable:
horizontal (supine)
Head down
Manual release
Adjustable head rest
Hospital out-patient:operating table
Anesthesia Equipment
Continuous flow anesthesia machine
Quantiflex (Relative Analgesia)
Mouth
props, packs,
airway, rubber dam
Separate suction unit
Scavenging system
gags,
nasopharyngeal
Quantiflex Machine
Nasal Mask
Rubber Dam
Monitoring
Pulse
ECG
NIBP
Pulse Oximetry
Capnography
Resuscitation Equipment
Full range of tracheal tubes& accessories
Two working laryngoscope
IV agents: Succinylcholine& atropine
Emergency drugs
Defibrillator
Training: B&ALS
Out-Patient Dental Anesthesia
Induction
Inhalational (mask) induction
N2O/O2 (>30%)
+
Halothane (3%)
Enflurane (>3%)
Isoflurane
Sevoflurane
common, smooth
less potent
Respiratory irritation
New, smooth, less potent
Out-Patient Dental Anesthesia
Induction
Intravenous Induction
Advantages
Avoidance of face mask
Less salivation
Less atmospheric pollution
Disadvantages
Drugs
Methohexitone
Propofol
CV depression
Low incidence of nausea &vomiting
Good recovery
Pain on injection,
involuntary movements,
hiccups &
respiratory depression
Out-Patient Dental Anesthesia
Maintenance
Inhalational agents/N2O
Nasal mask, mouth gag, pack
Maintain airway
Posture
(Supine Position)
Less hypotension
less bradycardia
However
high risk of aspiration
Airway obstruction&
Decrease ERV
Out-Patient Dental Anesthesia
Recovery
Left lateral position
100% O2
Suction Observation & monitoring
Discharge criteria
Instructions
Analgesia (NSAIDs)
Out-Patient Dental Anesthesia
Complications
Respiratory Complications
Airway Obstruction (Tongue, Adenoid, Pack,debris…}
Respiratory arrest
Laryngeal spasm
Pulmonary aspiration
Out-Patient Dental Anesthesia
Complications
Cardiovascular Complications
Hypotension
Induction of anesthesia
Carotid sinus compression
Bradycardia
Tooth extraction
Halothane(nodal rhythm)
Out-Patient Dental Anesthesia
Complications
Dysrhythmias (Tachy-arrhythmias)
Aetiology
(Tooth extraction)
- High preoperative catecholamines
- Light anesthesia
- Airway obstruction & hypoxia
- Halothane & local anesthesia
- Local anesthesia with vasopressor
Significance
- Controversial
- Significant with unexpected cardiac
myocarditis)
disease(viral
Out-Patient Dental Anesthesia
Complications
Allergic Reaction
Incidence
- Very rare
- More commonly (vaso-vagal,Toxic
reaction, epinephrine)
Aetiology
- Ig E-mediated reaction
- Easter-linked: p-amino benzoic acid
- Amide-linked: preservatives (Paraben)
Out-Patient Dental Anesthesia
Complications
Allergic Reaction
Manifestations
- Hypotension, tachycardia, arrhythmias
- Bronchospasm,cough, dyspnea, pulmonary
oedema, laryngeal oedema, hypoxia
- Urticaria, facial oedema, pruritus
Out-Patient Dental Anesthesia
Complications
Allergic Reaction
Management
- Discontinue drug
- 100% O2
- Epinephrine (0.01-0.5 mg IV or IM)
- Intubation
- IV fluids (LRS 1-2 liters)
- Diphenhydramine
- Hydrocortisone (up to 200mg IV)
Out-Patient Dental Anesthesia
Complications
Fainting
Causes
Previous factors (CV, allergic,..)
Emotional factors (more common)
Aetiology
limbic cortex-hypothalamus-reflex vasodilatation
Increase parasympathetic activity-bradycardia
Management
Head down-leg elevated
100% O2
Cessation of anesthesia
Out-Patient Dental Anesthesia
Complications
Miscellaneous
Nasal trauma, epistaxis
Diffusion hypoxia
Continued bleeding
Postoperative
Sore throat
Nausea & vomiting
Pain & swelling
THANK YOU
Sponsor Documents