Description of complication in dental department

Complication in dental department

1. DENTAL ANESTHESIA
COMPLICATIONS IN THE DENTAL
CHAIR

3. Dental Anesthesia
Out-Patientanesthesia(DentalChairAnesthesia)
Day-Caseanesthesia
In-Patientanesthesia
CompleteDentalrehabilitation
Complicatedoralsurgeryprocedures
MajorMaxillofacialsurgeries
Inaddition,SedationTechniques

4. Out-Patient Dental Anesthesia
Dental Chair Anesthesia
Out-Patient dental extraction
Children (4-10 years): high incidence of URTI
Steadily decreased

5. Out-patient Dental Anesthesia
Patient Selection (&Indications)
ASA grade I&II
Disability (mental& physical)
Review: coexisting disease
current medications
Fearful adults rather sedation
Procedure short
not so extensive

6. 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

7. Out-Patient Dental Anesthesia
Equipment (Up to the standards of in-patient GA)
Dental Chair
Anesthetic equipment
Monitoring
Resuscitation equipment

8. Dental Chair
Adjustable: horizontal (supine)
Head down
Manual release
Adjustable head rest
Hospital out-patient:operating table

9. Anesthesia Equipment
Continuousflowanesthesiamachine
Quantiflex(RelativeAnalgesia)
Mouthprops,packs,gags,nasopharyngeal
airway,rubberdam
Separatesuctionunit
Scavengingsystem

10. Quantiflex Machine Nasal Mask
Rubber Dam

11. Monitoring
Pulse
ECG
NIBP
Pulse Oximetry
Capnography

12. Resuscitation Equipment
Full range of tracheal tubes& accessories
Two working laryngoscope
IV agents: Succinylcholine& atropine
Emergency drugs
Defibrillator
Training: B&ALS

13. Out-Patient Dental Anesthesia
Induction
Inhalational (mask) induction
N
2O/O
2(>30%)
+
Halothane (3%) common, smooth
Enflurane(>3%) less potent
Isoflurane Respiratory irritation
Sevoflurane New, smooth, less potent

14. Out-Patient Dental Anesthesia
Induction
Intravenous Induction
Advantages Avoidance of face mask
Less salivation
Less atmospheric pollution
Disadvantages CV depression
Drugs
Methohexitone Low incidence of nausea &vomiting
Good recovery
Pain on injection,
involuntary movements,
hiccups &
respiratory depression
Propofol

15. Out-Patient Dental Anesthesia
Maintenance
Inhalational agents/N
2O
Nasal mask, mouth gag, pack
Maintain airway
Posture (Supine Position)
Less hypotension
less bradycardia
However
high risk of aspiration
Airway obstruction&
Decrease ERV

16. Out-Patient Dental Anesthesia
Recovery
Left lateral position
100% O2
Suction Observation & monitoring
Discharge criteria
Instructions
Analgesia (NSAIDs)

17. Out-Patient Dental Anesthesia
Complications
Respiratory Complications
Airway Obstruction (Tongue, Adenoid, Pack,debris…}
Respiratory arrest
Laryngeal spasm
Pulmonary aspiration

18. Out-Patient Dental Anesthesia
Complications
Cardiovascular Complications
Hypotension
Induction of anesthesia
Carotid sinus compression
Bradycardia
Tooth extraction
Halothane(nodal rhythm)

19. Out-Patient Dental Anesthesia
Complications
Dysrhythmias (Tachy-arrhythmias)
Aetiology (Tooth extraction)
-Highpreoperativecatecholamines
-Lightanesthesia
-Airwayobstruction&hypoxia
-Halothane&localanesthesia
-Localanesthesiawithvasopressor
Significance
-Controversial
-Significantwithunexpectedcardiac
disease(viralmyocarditis)

20. 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)

21. Out-Patient Dental Anesthesia
Complications
Allergic Reaction
Manifestations
-Hypotension, tachycardia, arrhythmias
-Bronchospasm,cough, dyspnea, pulmonary
oedema, laryngeal oedema, hypoxia
-Urticaria, facial oedema, pruritus

22. 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)

23. 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% O
2
Cessation of anesthesia

24. Out-Patient Dental Anesthesia
Complications
Miscellaneous
Nasal trauma, epistaxis
Diffusion hypoxia
Continued bleeding
Postoperative
Sore throat
Nausea & vomiting
Pain & swelling

25. THANK YOU