Preparation of high-risk patients (diabetes, hypertension, patients on anticoagulant therapy, etc.) about anesthesia, tooth extraction and other surgical procedures in MFA

Question 1

Types of high risk patients

Answer 1

Myocardial Infarction
Hypertension/Orthostatic hypertension
Anticoagulants
Diabetes
Asthma
Epilepsy

Question 2

Treatment of patients with Myocardial Infarction

Answer 2

• Avoid if happened in last 6 months→ If necessary carried out in hospital
• Dental office treatment after 6 months

Question 3

Treatment of patients with Hypertension

Answer 3

• Bp of 160-190/95-110 requires premedication→ no treatment over this
• Monitoring of bp before and during anaesthesia
• Aspiration
• Avoid Noradrenaline
• Short and painless appointments as possible

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Question 4

Treatment of Orthostatic hypertension

Answer 4

• Evaluate medical history
• Support patient as get out of chair
• Monitoring of Bp
• Avoidance of sudden change in chair position

Question 5

Types of Anticoagulants

Answer 5

-Coumarin and Heparin

Question 6

Treatment of patient on Anticoagulants-Coumarin drugs

Answer 6

• Consulting with doctor to control bleeding time→ Reduction in dose
• Reduction of dose at least two days before
• Prothrombin time should be 17-19s for procedure(11-12 normal)
• Prothrombin time increased over following two days

Question 7

Treatment of patient on Anticoagulants-Heparin

Answer 7

• Discontinued up to 4 hours before procedure
• If no profuse bleeding→ can be administered again on procedure day
• Low molecular weight heparin(Clexane) for DVT→ No dosage adjustment needed

Question 8

Treatment of patient on Anticoagulants-Aspirin

Answer 8

-Discontinued 2-5 days before procudure→ Continued 24 hours later

Question 9

Treatment of patient with Diabetes Mellitus

Answer 9

-Supply of Insulin, sugar or glucose in surgery

Screening test→ Glucometer

Time of surgery→ Morning 1-1.5h after breakfast to avoid hypoglycaemic shock and patient stress free/rested

• Diet shouldn’t be changed before or after procedure→ Hypoglycaemia
• Medication→ Mild analgesics→ Tylenol and avoidance of Corticosteroids (Glycogenolytic) and aspirin(hypoglycaemic)

Question 10

Treatment of patient with Asthma

Answer 10

• Detailed history→ Condition/frequency/type of attacks
• Sedative medication for stress management
• Pain control
• Short appointments

Question 11

Management of patients with Epilepsy

Answer 11

• Stress reduction→ Anxiolytic medication
• Always aspitate
• Short appointments
• Additional anticonvulsive drugs→ Consult w/ doctor