1. DENTAL ANESTHESIA COMPLICATIONS IN THE DENTAL CHAIR

3. 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

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 Continuous flow anesthesia machine
Quantiflex (Relative Analgesia)
Mouth props, packs, gags, nasopharyngeal airway, rubber dam
Separate suction unit
Scavenging system

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
N2O/O2 (>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/N2O
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)
- High preoperative catecholamines
- Light anesthesia
- Airway obstruction & hypoxia
- Halothane & local anesthesia
- Local anesthesia with vasopressor
Significance
- Controversial
- Significant with unexpected cardiac disease(viral myocarditis)

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 ( 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% O2
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