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Dental Analgesia and Anaesthesia (view source)
Revision as of 15:56, 25 April 2014
, 15:56, 25 April 2014→Specific Anaesthetic Considerations Regarding the Dental/Oral Patient
==Specific Anaesthetic Considerations Regarding the Dental/Oral Patient==
==Specific Anaesthetic Considerations Regarding the Dental/Oral Patient==
[[File:Throat pack tied.jpg|200px|right|thumb|Tying the throat pack to the endotracheal tube]]
[[File:Circulating hot air.jpg|thumb|200px|right|Circulating hot air used to warm the patient]]
====Geriatric Patients:====
====Geriatric Patients:====
Owing to the relationship between age and the progression of periodontal and dental diseases, as well as the risk of oral neoplasia, geriatric patients often require dental and oral surgery procedures. There is often concurrent disease in these patients.
Owing to the relationship between age and the progression of periodontal and dental diseases, as well as the risk of oral neoplasia, geriatric patients often require dental and oral surgery procedures. There is often concurrent disease in these patients.
====Airway Management:====
====Airway Management:====
Cuffed ETTs will prevent gross debris from entering the airway, but will not prevent all liquid tracking down the trachea. Pack the oropharynx. The packing will become saturated and needs to be changed or squeezed out frequently to avoid oversaturation and water seepage into the airway. Lingual blood flow may become compromised if the pharynx is packed too tightly. Tie the throat pack to the ETT so that it is not accidentally left in situ at the end of the procedure. (pic1) Care should be taken when inflating the ETT cuff, especially in cats, as over inflation is reported to cause tracheal rupture. Always turn the patient so that fluid does not run back into the mouth. The anaesthetic circuit should always be disconnected when turning to prevent movement of the ETT.
Cuffed endotracheal tubes (ETTs) will prevent gross debris from entering the airway, but will not prevent all liquid tracking down the trachea. Pack the oropharynx. The packing will become saturated and needs to be changed or squeezed out frequently to avoid oversaturation and water seepage into the airway. Lingual blood flow may become compromised if the pharynx is packed too tightly. Tie the throat pack to the ETT so that it is not accidentally left in situ at the end of the procedure. Care should be taken when inflating the ETT cuff, especially in cats, as over inflation is reported to cause tracheal rupture. Always turn the patient so that fluid does not run back into the mouth. The anaesthetic circuit should always be disconnected when turning to prevent movement of the ETT.
====Hypothermia:====
====Hypothermia:====
Heat loss starts at time of pre-anaesthetic medication, as the ability to compensate for heat loss is reduced. Temperature management is essential in all patients, but special attention should be paid to small, young, geriatric, thin or metabolically compromised animals. Heat loss is potentially high in dental and oral surgery patients as the mouth is always open and irrigation water used to cool instruments will also cool the patient. Care should be taken if the patient gets wet or hypotensive. Electric heat pads should be avoided if possible, and alternatives such as circulating warm water or hot air should be used. (Pic2)
Heat loss starts at time of pre-anaesthetic medication, as the ability to compensate for heat loss is reduced. Temperature management is essential in all patients, but special attention should be paid to small, young, geriatric, thin or metabolically compromised animals. Heat loss is potentially high in dental and oral surgery patients as the mouth is always open and irrigation water used to cool instruments will also cool the patient. Care should be taken if the patient gets wet or hypotensive. Electric heat pads should be avoided if possible, and alternatives such as circulating warm water or hot air should be used.
====Mouth Gags and Cats====
====Mouth Gags and Cats====
Spring-held mouth gags can cause cerebral ischaemia and blindness in cats, and their use should be avoided. This risk may be compounded by hypotension and hypoxaemia. Gags can cause damage to the teeth, especially if the plane of anaesthesia is light and the animal begins to chew.
Spring-held mouth gags can cause cerebral ischaemia and blindness in cats, and their use should be avoided. This risk may be compounded by hypotension and hypoxaemia. Gags can cause damage to the teeth, especially if the plane of anaesthesia is light and the animal begins to chew.
==Loco-Regional Anaesthesia (pic3)==
==Loco-Regional Anaesthesia (pic3)==