Post on 17-Dec-2015
transcript
The problems of anesthetizing for surgical procedures in and near the airway are common to both dental and ENT surgery
A patent, secure airway is essential for anesthetic practice
The tracheal tube and laryngeal mask airway should not protrude into the surgical field
Access to the airway is lost once the patient is draped and surgery started
The anesthetic circuit is often lung (and occasionally bulky) as the anesthetic machine is placed at the feet of the patient
Tow major problems may arise: * the weight of the circuit can
pull out or kink the endoteracheal tube
* the surgeon may obstruct the tracheal tube when operating
If the airway is lost , surgery must be stopped and appropriate adjustment made
Venous access is restricted and extension tubing on an intravenous cannula is essential
Dental anesthesia is conducted either in hospital, or in fully equipped premises, usually as day-stay surgery
Dental operations can take only a few seconds, but you must provide suitable anesthesia in an appropriate , safe environment
There are many possible anesthetic techniques for dental surgery
Anesthetic techniques for dental surgery Local anesthesia Local anesthesia and sedation sedation - intravenous - inhalation General anesthesia General anesthesia and Local anesthesia
The teeth are supplied by branches of the trigeminal nerve and dental surgeons are adroit at blocking the superior and inferior alveolar nerves at specific sites
Dental surgeons use prilocaine with epinephrine(adrenalin) or fleypressin (a less toxic vasoconstrictor than epinephrine)
If sedation is used , the patient must be able to talk to the anesthetist or
dental surgeon Intravenous benzodiazepines are
used frequently to provide sedationOccasionally Entonex (50% N₂O:50%
O₂) is inhaledThere are many important
considerations for general anesthesia in dental surgery
surgeons prefer a dry mouth , as it makes surgery easier
An antcholinergic drug in the premedication also protects against a bradicardia that often occurs during surgery
An intravenous induction is used if there are no difficulties with the airway
Control of the airway is obtained with a nasotracheal tube, and throat packs are inserted before surgery for collect blood and debris
It is easy to inadvertently leave the throat packs in at the end of the surgery – obstruction of the airway occurs
Complications during and after dental surgery are common
Severe hemorrhage is fortunately rare after dental surgery , if there is any doubt about the adequacy of homeostasis then the patient must be kept in hospital under close observation
Arrhythmias are common(30% of patients) and can continue in the postoperative period
Edema can be minimized by the use of steroids before surgery
Extubation of the trachea can be undertaken under light or deep anesthesia
Under deep anesthesia the patient is less likely to develop laryngospasm, but is more likely to aspirate vomit, blood, or debris
Under light anesthesia the patient has adequate protective reflexes, is more prone to laryngospasm
Emergency dental anesthesia should not be underestimated
The principle problem in patients with a dental abscess or mandibular fractures is difficulty in opening the mouth and henes the difficulty with intubation
Distorted facial anatomy compounds the problem
Fiber optic laryngoscopy and intubation , or an inhalation induction followed by blind nasal intubation , is often necessary in these patients
Muscle relaxation must not be given until patency and control of the airway is secured
The urgency of the surgery should be discussed with the dental surgeon
Only rarely is it a life threatening emergency
If the airway is not safe postoperatively , the patient should be managed in an Intensive Care Unite