LOCAL AND GENERAL ANAESTHESIA. Semmelweis University Paedodontic and Orthodontic Clinic

Transcription

1 LOCAL AND GENERAL ANAESTHESIA Semmelweis University Paedodontic and Orthodontic Clinic

2 Anaesthesia The aim is to carry out treatment without pain

3 Anaesthesia Local Anaesthesia Conscious sedation General anaesthesia

4 Methods: Temperature reduction Electronic dental anaesthesia (a minute electrical current to interfere with local nerve conduction. Electric stimulation closes the gate to pain transmission) Chemical agents (bondage of nerve endings is loose, reversible process)

5 Types: Infiltration injection Block injection Ganglion injection

6 Position of Mandibular Foramen Age <6 : below occlusal plane Age 6-12 years: at occlusal plane Age>12 : above occlusal plane

7 Complications Needle breakage Allergy Pain on injection Dermatological react. (urticaria, edema) Burning Bronchospasm (respiratory distress, Paresthesia wheezing, cyanosis, perspiration, tachycardia,) Trismus Hematoma 0,3 ml 1:1000 epinephrine IM, antihistamin,o 2, consultation

8 Carpule syringe syringe is non-disposable equipment it can be sterilized by autoclaving positive aspirating syringe cartridge can be placed directly into syringe disposable needle can be screwed

9 Jet syringe syringe without needle noisy does not produce reliable anaesthesia post-operative pain and bleeding

10 Intraligamentary injection high pressure syringe with ultra-short needle The anaesthetic is deposited via the periodontal ligament by the needle at degrees to the long axis of the tooth at the mesiobuccal aspect of the root lips and tounge are not anaesthetized

11 General principles Explain to patient what you are trying to do and why. Use topical anaesthesia lignocaine spray, oinments, flavoured benzocaine gel. Use fine-gauge disposable needle. Always have dental nurse to assist. Hold mucosa taut. Slow rate of injection. Warn about post-op numbness.

12 First choice of anaesthetic agent Amide type, intermediate action Lignocaine 2% (20 mg lign.ch.+0,01 mg epinehrine ch.) Ultracaine DS Forte 4% (40 mg articaine ch.+0,01 mg epinehrine ch.)

13 Second choice of anaesthetic agent Amide type, long-lasting action Bupivacaine 0,5% (5mg bupiv.ch.+ 0,01 mg epinehrine ch.)

14 Dosage Depends upon body weight L.: maximum dose 4,4 mg/kg U.: maximum dose 3,5 mg/kg(no under 4yrs) B.: maximum dose 1,3 mg/kg Under 12 yrs 1 ml Over 12 yrs 2 ml

15 Contraindications Uncooperative patients Patients with major bleeding diathesis Infection around the injection site Allergy

16 Conscious sedation There is an extension of local anaesthesia technique using drugs which produces, a state of depression of CNS enabling treatment to be carried out or local anaesthetic agent to be given. Communication is maintained during treatment.

17 (Mitchell and Mitchell Oxford Handbook) Conscious sedation Indications The anxious child The questioner: attempts to delay treatment. Firm but gentle handling is needed.explain everything The temper tantrum: ignore tantrum and try to complete treatment regardless General principles: Show interest in child as a person Do not deny patient s fear Explain why, how, when Reward good behaviour Get child involved in treatment holding saliva ejector)

18 Conscious sedation Relative analgesia is the most commonly used and safest form of sedation in dentistry. (Sytemic Agents: benzodiazepines, antihistaminics) The delivery of mixture of nitrous oxide and oxygen. Start by delivering 1OO % oxygen via nasal mask Then give 1O % nitrous oxide for 1min. Increase to 2O % and 3O % (max.35%). To give LA or to carry out treatment Oxygenate patient for 2 min. To sit in recovery room for 1O min.

19 Oral sedation Diazepam: 1mg/kg (5mg) night before 1 tabl. and 1,5 h pre treatment. Midazolam: O,5mg/kg (7,5mg) night before 1 tabl. 1h prior to treatment. Temazepam: O,3mg/kg (1Omg) 1h before treatment1-2 tabl. Absorption time, the risk of sedation occurring too early or too late. Sexual fantasies, resistance, paradoxical stimulation can be under the influence of these drugs.

20 General anaesthesia: a temporary, controllable and reversible reduction of the sensitivity of the central nervous system, and its ability to respond to stimulus. the sensitivity of different cells of CNS do not have the same inhibiting effect. Cortex loss of consciousness and memory truncal ggl. and cells of cerebellum will be blocked spinal cord and centers of medulla oblongata paralysis of the respiration and circulation

21 Indication of narcosis Anxiety O,1% Disability 99,9% Mental handicap (mild, severe and Down sy.) Physical handicap (cerebral palsy motor manifestation of cerebral damage, increased muscle tone) Sensory handicap (blindness, deafness)

22 Inhalational anaesthetics Nitrous oxide smell of sweetish gas strong analgesic weak narcotic respiration and circulation are not influenced non toxic with adequate oxygen side effect is rare It is not proper for deep narcosis

23 Halothane colourless pleasant smelling strong narcotic weak analgesic depress respiration circulation(rr,dysrythmias) good relaxant can be hepatotoxic on repeated administration Isoflurane Sevoflurane non pungent anaesthetic agent less side effects (less cardiac problems) rapid induction and recovery

24 Narcosis administration of oxygen+ nitrous oxide via mask parasympathetic blocking agent sedative drug primary narcotic agent muscle relaxant combination of gases

25 Narcosis administration of oxygen+ nitrous oxide via mask parasympathetic blocking agent Atropine sedative drug primary narcotic agent muscle relaxant combination of gases reduces salivation,secretion spasmolytic effect protects against vagal reflex stimulates respiration and CNS anti-emetic effect Dose: O,O2 mg/kg

26 Narcosis administration of oxygen+ nitrous oxide via mask parasympathetic blocking agent sedative drug Midazolam primary narcotic agent muscle relaxant combination of gases reduce the surgical stress effect reinforce of effect of narcosis decrease the incidence of unpleasant dreams eliminate p an. excitatory activity reduce spasmophilia anterograde amnesia Dose:O,2 O,4mg/kg Suspended by Flumazenil

27 Narcosis administration of oxygen+ nitrous oxide via mask parasympathetic blocking agent sedative drug primary narcotic agent muscle relaxant combination of gases Propofol smooth induction rapid recovery cardiovascular depressant depth of n.can be controlled rare side effect at sedative doses no effect on respiratory system Dose: 2,5 mg/kg

28 Narcosis administration of oxygen+ nitrous oxide via mask parasympathetic blocking agent sedative drug primary narcotic agent muscle relaxant combination of gases

29 Contraidication of out patient GA hyprtension brain pressure cardiovascular or respiratory disease severe liver or renal impairment uncotrolled anaemia, hypothyroidism, diabetes porphyria

30 neurological disorders (multiple scler.) cervical spine pathology (spond.) allergy respiratory catarrh vaccination infectious disease

31 Personal and material conditions: anaesthetist, anaesthetic assistant, trained pedodontist and dental nurse operating room recovery room anaesthesia apparatus cardiac monitoring blood pressure monitor pulse oximeter exhauster resuscitating instruments: Ambu balloon, laryngoscope, tubes, positive pressure O₂ delivery system, vein cannula, gag.

32 Emergency drugs Antihistamines (Epinephrine) Anticonvulsant (Diazepam) Narcotic antagonist (Naloxone) Steroid (Hydrocortisone) Antihypoglycemics (5O% Dextrose) Vasopressors (Ephedrine) Analgesic (Paracetamol) Advanced cardiac life support(atropine)

33 preliminary pediatric examination written consent establishment of treatment plan sequence of dental care empty stomach and bladder cannula entering vein sited and secured dental treatment with gag and evacuation Technical procedures:

34 Condition of discharge from the clinic: to give correct answer to his mental level and age ability to walk in a straight line no fever no nausea he can drink

35 Thank you for your kind attention