GA in Dentistry Flashcards
(38 cards)
what is the process of consent for GA?
- its the responsibility of the dentist to gain informed consent
- all options explained including risks and benefits
- discussion should be documented
- treat or refer
what are the different options for anaesthesia?
- LA
- conscious sedation - inhaled/ IV/
advanced sedation techniques - GA
what is conscious sedation?
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
what are the concious sedation techniques
- inhaled sedation
- IV sedation
what happens in inhaled sedation
- 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
what happens in IV sedation
midazolam given using titrated dose
- used only for adults
what happens in advanced sedation techniques
- 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
what is the process of GA
- 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)
what are the standards for conscious sedation in dental care
- 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
advantages of GA
- used for young children (non cooperative)
- learning difficulty
- severe anxiety
- pts unable to lie still
- major surgery
bad reasons for using GA
- easily available
- quicker
- to get rid of pt
- money
what is GA
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
what are the 3 pillars of GA
amnesia
analgesia
muscle relaxation
what drug is used for amnesia
IV agents (propofol)
inhalation agents (sevolflurane)
benzodiapemines (midzolam)
what drugs are used to achieve analgesia
paracetamol
ibuuprofen (except asthma, liver/kidney problems and gastric ulcers)
opoids (codeine)
LA
How is muscle relaxation achieved
depolarizing agents
non-depolarizing agents
what is used to monitor the pt during GA
ECG
BP
pulse oximeter
oxygen and carbon dioxide levels
how is anesthesia induced
inhalation using mask (better for children)
IV through the veins
why is airway management important during GA
tongue rolls back and obstructs airway
how is airway managed
- mask
- laryngeal mask airways (using dental procedure)
- endotracheal tubes (oral or nasal)
what is essential for endotracheal tubes
pts muscles completely relaxed as the tube goes through the trachea
what is the role of the anesthetist
- assess pt
- plan anesthetic
- manage airway
- monitor organ systems
- balance anesthesia
- post op pain relief
- resuscitate if needed
what are the very common risks of GA -1 in 10 ppl
sickness
shivering
bruising
sore throat
thirst
memory loss temporary
what are the common risks of GA -1 in 100 ppl
pain at injection site
minor lip or tongue injury
