DENTAL ANESTHESIA

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)

coexisting disease
current medications
Review:

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,
airway, rubber dam

Separate suction unit

Scavenging system

gags,

nasopharyngeal

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

N2O/O2 (>30%)

+
Halothane (3%)
Enflurane (>3%)
Isoflurane
Sevoflurane

common, smooth
less potent
Respiratory irritation
New, smooth, less potent

Out-Patient Dental Anesthesia

Induction
Intravenous Induction
Advantages
Avoidance of face mask
Less salivation
Less atmospheric pollution

Disadvantages
Drugs
Methohexitone

Propofol

CV depression

Low incidence of nausea &vomiting

Good recovery
Pain on injection,
involuntary movements,
hiccups &
respiratory depression

Out-Patient Dental Anesthesia

Maintenance
Inhalational agents/N2O
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
myocarditis)

disease(viral

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% O2
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