complication in dental chair

8/11/2019 Complication in Dental Chair

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DENTAL ANESTHESIA

COMPLICATIONS IN THE DENTAL

CHAIR

Dr SAAD A SHETA

Assistant Professor, Anesthesia

Dental College

KSU


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Dental Anesthesia

Out-Patient anesthesia (Dental Chair Anesthesia)

Day-Case anesthesia

In-Patient anesthesia

Complete Dental rehabilitation

Complicated oral surgery proceduresMajor Maxillofacial surgeries

In addition, Sedation Techniques


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Out-Patient Dental Anesthesia

Dental Chair Anesthesia

Out-Patient dental extraction

Children (4-10 years): high incidence of URTI

Steadily decreased


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Out-patient Dental Anesthesia

Patient Select ion (& Ind icat ions)

ASA grade I&II

Disability (mental& physical)

Review: coexisting disease

current medications

Fearful adults rather sedation

Procedure short

not so extensive


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Contra indicat ions

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


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Out-Patient Dental AnesthesiaEquipment (Up to the standards of in -pat ient GA)

Dental Chair

Anesthetic equipment

Monitoring

Resuscitation equipment


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Dental Chair

Adjustable: horizontal (supine)

Head down

Manual release

Adjustable head rest

Hospital out-patient:operating table


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Anesthesia Equipment

Continuous flow anesthesia machine

Quantiflex (Relative Analgesia)

Mouth props, packs, gags, nasopharyngealairway, rubber dam

Separate suction unit

Scavenging system


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Quantiflex Machine Nasal Mask

Rubber Dam


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Monitoring

Pulse

ECG NIBP

Pulse Oximetry

Capnography


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Resuscitation Equipment

Full range of tracheal tubes& accessories

Two working laryngoscope

IV agents: Succinylcholine& atropine

Emergency drugs

Defibrillator

Training: B&ALS


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Out-Patient Dental AnesthesiaInduct ion

Inhalational (mask) induction

N2O/O2(>30%)

+Halothane (3%) common, smooth

Enflurane (>3%) less potent

Isoflurane Respiratory irritation

Sevoflurane New, smooth, less potent


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Out-Patient Dental AnesthesiaInduct ion

Intravenous InductionAdvantages Avoidance of face mask

Less salivation

Less atmospheric pollution

Disadvantages CV depression

Drugs

Methohexitone Low incidence of nausea &vomitingGood recovery

Pain on injection,

involuntary movements,

hiccups &

respiratory depression

Propofol


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Out-Patient Dental AnesthesiaMaintenance

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


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Out-Patient Dental AnesthesiaRecovery

Left lateral position

100% O2 Suction Observation & monitoring

Discharge criteria

Instructions

Analgesia (NSAIDs)


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Out-Patient Dental AnesthesiaCompl icat ions

Respiratory Complications

Airway Obstruction (Tongue, Adenoid, Pack,debris}

Respiratory arrest

Laryngeal spasm

Pulmonary aspiration


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Compl icat ions

Cardiovascular Complications

HypotensionInduction of anesthesia

Carotid sinus compression

BradycardiaTooth extraction

Halothane(nodal rhythm)


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Compl icat ions Dysrhythmias (Tachy-arrhythmias)

Aet io logy (Tooth extract ion)

- High preoperative catecholamines

- Light anesthesia

- Airway obstruction & hypoxia

- Halothane & local anesthesia

- Local anesthesia with vasopressor

Signif icance

- Controversial

- Significant with unexpected cardiacdisease(viral myocarditis)


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Compl icat ions

Allergic Reaction

Incidence -Very rare

-More commonly (vaso-vagal,Toxicreaction, epinephrine)

Aet io logy

- Ig E-mediated reaction

-Easter-linked:p-amino benzoic acid

- Amide-linked: preservatives(Paraben)


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Compl icat ions

Allergic Reaction

Manifestat ions

- Hypotension, tachycardia, arrhythmias

-Bronchospasm,cough, dyspnea, pulmonaryoedema, laryngeal oedema, hypoxia

- Urticaria, facial oedema, pruritus


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Compl icat ions

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)


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Compl icat ions

Fainting

Causes Previous factors (CV, allergic,..)

Emotional factors (more common)

Aetiologyl imb ic co rtex-hyp othalamus -ref lex vasodi latat ion

Increase parasympathet ic act iv i ty-bradycardia

Management

Head down-leg elevated

100% O2

Cessation of anesthesia


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Compl icat ions

Miscellaneous

Nasal trauma, epistaxis Diffusion hypoxia

Continued bleeding

Postoperative

Sore throat

Nausea & vomiting

Pain & swelling


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THANK YOU

complication in dental chair

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