2. Dr Masood Entezariasl Anesthesia for dental surgery

3. Shared airway • 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

4. 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

5. 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

6. Dental anesthesia • 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

8. 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)

9. If sedation is used , the patient must be able to talk to the anesthetist or dental surgeon • Intravenous benzodiazepines are used frequently to provide sedation • Occasionally Entonex (50% N₂O:50% O₂) is inhaled • There are many important considerations for general anesthesia in dental surgery

11. 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

12. 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

13. 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

14. Emergency dental anesthesia • 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 anatomycompounds the problem • Fiber optic laryngoscopy and intubation , or an inhalation induction followed by blind nasal intubation , is often necessary in these patients

15. 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