Local Anesthesia Patient Evaluation

Question 1

Why does a pre-anesthetic evaluation of each patient need to be done?

Answer 1

To identify the rare patient who needs to have modification of technique, dosage or agent, or to identify if the patient should not receive anesthesia

Question 2

What classification system can be used to asses the state of a patient and their ability to tolerate anesthesia and treatment?

Answer 2

ASA classification

Question 3

What factors do we need to check in a patients medical history to determine usage of anesthesia?

Answer 3

Review of systems
Allergies
Prior experience with anesthesia
Current medications and supplements

Question 4

What do we look at in a review of systems?

Answer 4

Cardiovascular conditions: BP, stroke etc
Endocrine disorders: diabetes, thyroid, adrenal
Liver diseases: cirrhosis, hepatitis, decreased liver function
Bacteremia risk: prosthetic valves, infective endocarditis
HIV/AIDS
Pregnancy
Neurological disorders

Question 5

What needs to be limited in cases of patients with cardiovascular conditions? What are some of these conditions?

Answer 5

Use of vasoconstrictors like epinephrine

Heart attack, stroke, poorly controlled BP– no treatment within 6 mos of heart attack or stroke

0.04 mg epi or 2 cartridges 1:100,000 epi

Question 6

Endocrine Disorders

Answer 6

Hyperthyroidism- cardiac dysfunction- sensitivity to vasoconstrictors- must be euthyroid for elective treatment

Adrenal Insufficiency- Intolerance to procedural stress. limit treatment time and complexity

Question 7

Liver Disease and anesthetics

Answer 7

Amides are primarily metabolized in the liver. Interruptions in metabolism could result in buildup to toxic levels in systemic circulation

HOWEVER- even hepatitis and cirrhosis patients can usually tolerate dosage rates at level for dental procedures

Question 8

Bacteremia and anesthetics

Answer 8

Local anesthetic injections can cause transient bacteremia. Even these small amount can put some patients at risk

Question 9

HIV/AIDS

Answer 9

Not a contraindication to treatment. Consult patients physician if it is not well controlled

Question 10

Contraindications for anesthesia in patients with seizure disorders

Answer 10

Routine treatment not a contraindication. However, Stress, hypoglycemia and hyperventilation can cause seizures

Patients should be asked about most recent seizure and frequency of them

Question 11

Pregnancy

Answer 11

Slight contraindication during 1st and 3rd trimesters– consult physician on formulations and concentrations of epi

Perio can be a risk factor for low birth weight

Question 12

Allergies

Answer 12

Allergies to amides is rare. What most patients report as allergies are just adverse reactions, misinformation or misdiagnosis. Most are anxiety responses that can be managed

Most allergies are related to ester anesthetics. Patients with sulfite allergies should be administered plain anesthetics