Dr Masood Entezariasl

 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 sedation  Occasionally Entonex (50 % N₂O:50 % O₂) is inhaled  There 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