DENTAL ANESTHESIA
COMPLICATIONS IN THE DENTAL
CHAIR
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,
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
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% 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