Dr Masood Entezariasl

The problems of anesthetizing for surgical procedures in and near the airway are common to both dental and ENT surgery

A patent, secure airway is essential for anesthetic practice

The tracheal tube and laryngeal mask airway should not protrude into the surgical field

Access to the airway is lost once the patient is draped and surgery started

The anesthetic circuit is often lung (and occasionally bulky) as the anesthetic machine is placed at the feet of the patient

Tow major problems may arise: * the weight of the circuit can

pull out or kink the endoteracheal tube

* the surgeon may obstruct the tracheal tube when operating

If the airway is lost , surgery must be stopped and appropriate adjustment made

Venous access is restricted and extension tubing on an intravenous cannula is essential

Dental anesthesia is conducted either in hospital, or in fully equipped premises, usually as day-stay surgery

Dental operations can take only a few seconds, but you must provide suitable anesthesia in an appropriate , safe environment

There are many possible anesthetic techniques for dental surgery

Anesthetic techniques for dental surgery Local anesthesia Local anesthesia and sedation sedation - intravenous - inhalation General anesthesia General anesthesia and Local anesthesia

The teeth are supplied by branches of the trigeminal nerve and dental surgeons are adroit at blocking the superior and inferior alveolar nerves at specific sites

Dental surgeons use prilocaine with epinephrine(adrenalin) or fleypressin (a less toxic vasoconstrictor than epinephrine)

If sedation is used , the patient must be able to talk to the anesthetist or

dental surgeon Intravenous benzodiazepines are

used frequently to provide sedationOccasionally Entonex (50% N₂O:50%

O₂) is inhaledThere are many important

considerations for general anesthesia in dental surgery

surgeons prefer a dry mouth , as it makes surgery easier

An antcholinergic drug in the premedication also protects against a bradicardia that often occurs during surgery

An intravenous induction is used if there are no difficulties with the airway

Control of the airway is obtained with a nasotracheal tube, and throat packs are inserted before surgery for collect blood and debris

It is easy to inadvertently leave the throat packs in at the end of the surgery – obstruction of the airway occurs

Complications during and after dental surgery are common

Severe hemorrhage is fortunately rare after dental surgery , if there is any doubt about the adequacy of homeostasis then the patient must be kept in hospital under close observation

Arrhythmias are common(30% of patients) and can continue in the postoperative period

Edema can be minimized by the use of steroids before surgery

Extubation of the trachea can be undertaken under light or deep anesthesia

Under deep anesthesia the patient is less likely to develop laryngospasm, but is more likely to aspirate vomit, blood, or debris

Under light anesthesia the patient has adequate protective reflexes, is more prone to laryngospasm

Emergency dental anesthesia should not be underestimated

The principle problem in patients with a dental abscess or mandibular fractures is difficulty in opening the mouth and henes the difficulty with intubation

Distorted facial anatomy compounds the problem

Fiber optic laryngoscopy and intubation , or an inhalation induction followed by blind nasal intubation , is often necessary in these patients

Muscle relaxation must not be given until patency and control of the airway is secured

The urgency of the surgery should be discussed with the dental surgeon

Only rarely is it a life threatening emergency

If the airway is not safe postoperatively , the patient should be managed in an Intensive Care Unite