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AMS > GA in Dentistry > Flashcards

GA in Dentistry Flashcards

1
Q

what is the process of consent for GA?

A
  • its the responsibility of the dentist to gain informed consent
  • all options explained including risks and benefits
  • discussion should be documented
  • treat or refer
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2
Q

what are the different options for anaesthesia?

A
  • LA
  • conscious sedation - inhaled/ IV/
    advanced sedation techniques
  • GA
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3
Q

what is conscious sedation?

A

technique using drugs to produce a state of depression of CNS allowing treatment to be carried out
- communication is maintained with pt throughout
- can be provided by suitably trained dental practitioners in primary care setting

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4
Q

what are the concious sedation techniques

A
  • inhaled sedation
  • IV sedation
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5
Q

what happens in inhaled sedation

A
  • dose of oxygen and nitrous oxide is given
  • pt feels relaxed and accepts treatment
  • given through a nose piece
  • takes a few minutes to work
  • used for children and adults
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6
Q

what happens in IV sedation

A

midazolam given using titrated dose
- used only for adults

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7
Q

what happens in advanced sedation techniques

A
  • include use of different drugs (ketamine, propofol, fentalyn) a combination of drugs or combination of routes
  • only use if pt isnt suited to sedation using standard technique
  • requires a higher level of training
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8
Q

what is the process of GA

A
  • informed consent
  • written information (pre/post op instructions)
  • fasting (different opinions suggest may not be necessary)
  • monitoring (pulse oximetry, BP and ECG)
  • procedure (IV/ Inhaled)
  • discharge criteria (need for responsible adult for 24hrs after)
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9
Q

what are the standards for conscious sedation in dental care

A
  • needs suitably trained sedationist
  • sedationist and other members should be aware of emergency protocols, management of sedation and complications
  • should have all necesary drugs and equipment to manage emergencies whilst delivering consious sedation
  • regular audit and inspection to ensure standards are maintained
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10
Q

advantages of GA

A
  • used for young children (non cooperative)
  • learning difficulty
  • severe anxiety
  • pts unable to lie still
  • major surgery
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11
Q

bad reasons for using GA

A
  • easily available
  • quicker
  • to get rid of pt
  • money
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12
Q

what is GA

A

state of uncontrolled unconsciousness
- during GA, medicines are used to send the pt to sleep so they are unaware of surgery and dont move or feel pain while surgery carried out

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13
Q

what are the 3 pillars of GA

A

amnesia
analgesia
muscle relaxation

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14
Q

what drug is used for amnesia

A

IV agents (propofol)
inhalation agents (sevolflurane)
benzodiapemines (midzolam)

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15
Q

what drugs are used to achieve analgesia

A

paracetamol
ibuuprofen (except asthma, liver/kidney problems and gastric ulcers)
opoids (codeine)
LA

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16
Q

How is muscle relaxation achieved

A

depolarizing agents
non-depolarizing agents

17
Q

what is used to monitor the pt during GA

A

ECG
BP
pulse oximeter
oxygen and carbon dioxide levels

18
Q

how is anesthesia induced

A

inhalation using mask (better for children)
IV through the veins

19
Q

why is airway management important during GA

A

tongue rolls back and obstructs airway

20
Q

how is airway managed

A
  • mask
  • laryngeal mask airways (using dental procedure)
  • endotracheal tubes (oral or nasal)
21
Q

what is essential for endotracheal tubes

A

pts muscles completely relaxed as the tube goes through the trachea

22
Q

what is the role of the anesthetist

A
  • assess pt
  • plan anesthetic
  • manage airway
  • monitor organ systems
  • balance anesthesia
  • post op pain relief
  • resuscitate if needed
23
Q

what are the very common risks of GA -1 in 10 ppl

A

sickness
shivering
bruising
sore throat
thirst
memory loss temporary

24
Q

what are the common risks of GA -1 in 100 ppl

A

pain at injection site
minor lip or tongue injury

25
Q

what are the uncommon risks of GA -1 in 1000 ppl

A

minor nerve injury

26
Q

what are the rare risks of GA -1 in 10000 ppl

A

permenant nerve damage
corneal abrasion
damage to teeth
anaphalaxis

27
Q

what are the very rare risks of GA -1 in 100000 pp

A

loss of vision
death
awareness during GA

28
Q

what does risk of GA depend on

A

pts pre op fitness

29
Q

What is the risk of GA ASA grading

A
  • healthy pt = grade 1 (0.06% mortality)
  • mild disease = grade 2 (0.4% mortality
  • sever systemic disease = grade 3 (4.5% mortality
  • systemic disease threat to life = grade 4 (23% mortality
  • not expected to survive 24hrs with or without surgery = grade 5 (51% mortality
30
Q

process of dental GA

A
  • all GA conducted in hospital
  • mostly day cases (pt in and out same day)
  • pre and post op info given in hospital
  • will be called by a nurse for assessment
  • continue all medications
  • fasting (empty stomach to prevent regurgitation) - 6 hours for food and 2 hours for liquids
  • attend hospital at given time
  • nurse will check in
  • aneasthetist will assess and decide anesthetic
  • dentist will examine and take consent
  • change into theatre gown
  • attach monitor
  • aneasthetist will insert IV cannula
  • pt will wake up in recovery room
31
Q

what happens post op to GA

A
  • pain relief explained
  • nausea and vomiting setteled before discharge (anti sickness drugs)
  • sore throat should settle in 24hrs
  • headaches = painkillers
  • explain when to contact hospital
  • pt usually leaves hospital in 1 hour
  • pt must have responsible adult for 24hrs post op
32
Q

what are problems associated with a 3 yr old needing 2 incisors extracting

A

refusal
fasting
coughs and cold

33
Q

what anesthesia will be used for a 3 yr old needing 2 incisors extracting

A

analgesia- pre op paracetamol or ibuprofen
monitor pulse oximeter
GA - inhalation oxygen or nitrous
airway monitor using mask

34
Q

what anesthesia will be used for a 7 yr old needing 8 primary molars extracting

A
  • GA- inhalation or IV
  • monitor
  • numbing cream for cannula
  • airway LMA- laryngeal mask
35
Q

what anesthesia will be used for a 22 yr old needing 4 impacted 3rd molars extracting

A
  • GA - IV propofol
  • analgesia pre op paracetamol/ibuprofen
  • monitor
  • will need paralysis
  • airway- use endotracheal tube through nasal approach
36
Q

what are problems associated with a 22 yr old needing 4 impacted wisdom teeth extracting

A
  • anxiety
  • nosebleed
  • post op pain
  • sore throat
37
Q

what are problems associated with a 7 yr old needing 8 primary molars extracting

A

refusal
nausea and vomiting

38
Q

what are the GA and sedation for dental procedures guidelines

A
  • GA only carried out if deemed most clinically appropriate
  • GA only administered in a hospital setting as defined by department of health report and conscious sedation in primary dental care
  • GA only given by someone who is specialist register of GMC as an anesthetist

AMS (10 decks)

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