Local Anesthesia Patient Evaluation Flashcards
Why does a pre-anesthetic evaluation of each patient need to be done?
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
What classification system can be used to asses the state of a patient and their ability to tolerate anesthesia and treatment?
What factors do we need to check in a patients medical history to determine usage of anesthesia?
Review of systems
Prior experience with anesthesia
Current medications and supplements
What do we look at in a review of systems?
Cardiovascular conditions: BP, stroke etc
Endocrine disorders: diabetes, thyroid, adrenal
Liver diseases: cirrhosis, hepatitis, decreased liver function
Bacteremia risk: prosthetic valves, infective endocarditis
What needs to be limited in cases of patients with cardiovascular conditions? What are some of these conditions?
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
Hyperthyroidism- cardiac dysfunction- sensitivity to vasoconstrictors- must be euthyroid for elective treatment
Adrenal Insufficiency- Intolerance to procedural stress. limit treatment time and complexity
Liver Disease and anesthetics
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
Bacteremia and anesthetics
Local anesthetic injections can cause transient bacteremia. Even these small amount can put some patients at risk
Not a contraindication to treatment. Consult patients physician if it is not well controlled
Contraindications for anesthesia in patients with seizure disorders
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
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
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