COMPLICATIONS IN THE DENTAL

CHAIR
Dr. SAAD A. SHETA
Assistant Professor, Anesthesia
Dental College
KSU
Dental Anesthesia
Out-Patient anesthesia (Dental Chair Anesthesia)

Day-Case anesthesia

In-Patient anesthesia

Complete Dental rehabilitation
Complicated oral surgery procedures
Major Maxillofacial surgeries

In addition, Sedation Techniques
Out-Patient Dental Anesthesia

Dental Chair Anesthesia

Out-Patient dental extraction

Children (4-10 years): high incidence of URTI

Steadily decreased


Out-patient Dental Anesthesia
Patient Selection (&Indications)

ASA grade I&II

Disability (mental& physical)
Review: coexisting disease
current medications

Fearful adults rather sedation

Procedure short
not so extensive

Out-Patient Dental Anesthesia
Contraindications
Serious cardiopulmonary diseases
COPD
Diabetes or other endocrinological diseases
Neuromuscular disorders
Coagulopathies & Hemoglobinopathies
Marked oro-facial swelling (edema& trismus)
Potential difficult airways
Marked congenital heart defects
Extreme obesity
Drugs: MAOIs , Anticoagulant
Not fasting


Out-Patient Dental Anesthesia
Equipment (Up to the standards of in-patient GA)

Dental Chair

Anesthetic equipment

Monitoring

Resuscitation equipment

Dental Chair
Adjustable: horizontal (supine)
Head down

Manual release

Adjustable head rest

Hospital out-patient:operating table
Anesthesia Equipment
Continuous flow anesthesia machine

Quantiflex (Relative Analgesia)

Mouth props, packs, gags, nasopharyngeal
airway, rubber dam

Separate suction unit

Scavenging system
Quantiflex Machine
Nasal Mask





Rubber Dam
Monitoring

Pulse
ECG
NIBP
Pulse Oximetry
Capnography

Resuscitation Equipment
Full range of tracheal tubes& accessories
Two working laryngoscope
IV agents: Succinylcholine& atropine
Emergency drugs
Defibrillator
Training: B&ALS
Out-Patient Dental Anesthesia
Induction
Inhalational (mask) induction

N
2
O/O
2
(>30%)
+
Halothane (3%) common, smooth
Enflurane (>3%) less potent
Isoflurane Respiratory irritation
Sevoflurane New, smooth, less potent

Out-Patient Dental Anesthesia
Induction
Intravenous Induction
Advantages Avoidance of face mask
Less salivation
Less atmospheric pollution

Disadvantages CV depression

Drugs
Methohexitone Low incidence of nausea &vomiting
Good recovery
Pain on injection,
involuntary movements,
hiccups &
respiratory depression
Propofol

Out-Patient Dental Anesthesia
Maintenance
Inhalational agents/N
2
O
Nasal mask, mouth gag, pack
Maintain airway

Posture (Supine Position)
Less hypotension
less bradycardia
However
high risk of aspiration
Airway obstruction&
Decrease ERV

Out-Patient Dental Anesthesia
Recovery

Left lateral position
100% O2
Suction Observation & monitoring
Discharge criteria
Instructions
Analgesia (NSAIDs)


Out-Patient Dental Anesthesia
Complications
Respiratory Complications

Airway Obstruction (Tongue, Adenoid, Pack,debris}

Respiratory arrest

Laryngeal spasm

Pulmonary aspiration



Out-Patient Dental Anesthesia
Complications

Cardiovascular Complications

Hypotension
Induction of anesthesia
Carotid sinus compression

Bradycardia
Tooth extraction
Halothane(nodal rhythm)

Out-Patient Dental Anesthesia
Complications

Dysrhythmias (Tachy-arrhythmias)

Aetiology (Tooth extraction)
- High preoperative catecholamines
- Light anesthesia
- Airway obstruction & hypoxia
- Halothane & local anesthesia
- Local anesthesia with vasopressor
Significance
- Controversial
- Significant with unexpected cardiac
disease(viral myocarditis)


Out-Patient Dental Anesthesia
Complications

Allergic Reaction

Incidence - Very rare
- More commonly (vaso-vagal,Toxic
reaction, epinephrine)
Aetiology
- Ig E-mediated reaction
- Easter-linked: p-amino benzoic acid
- Amide-linked: preservatives (Paraben)


Out-Patient Dental Anesthesia
Complications
Allergic Reaction

Manifestations

- Hypotension, tachycardia, arrhythmias

- Bronchospasm,cough, dyspnea, pulmonary
oedema, laryngeal oedema, hypoxia

- Urticaria, facial oedema, pruritus


Out-Patient Dental Anesthesia
Complications
Allergic Reaction

Management

- Discontinue drug
- 100% O2
- Epinephrine (0.01-0.5 mg IV or IM)
- Intubation
- IV fluids (LRS 1-2 liters)
- Diphenhydramine
- Hydrocortisone (up to 200mg IV)

Out-Patient Dental Anesthesia
Complications

Fainting

Causes Previous factors (CV, allergic,..)

Emotional factors (more common)
Aetiology
limbic cortex-hypothalamus-reflex vasodilatation
Increase parasympathetic activity-bradycardia
Management
Head down-leg elevated
100% O
2
Cessation of anesthesia

Out-Patient Dental Anesthesia
Complications

Miscellaneous

Nasal trauma, epistaxis
Diffusion hypoxia
Continued bleeding
Postoperative
Sore throat
Nausea & vomiting
Pain & swelling

THANK YOU