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DENTAL ANESTHESIA
COMPLICATIONS IN THE DENTAL
CHAIR
SAAD A. SHETA
Associate Professor
Consultant 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
Complications in the Dental Chair
 Out-Patient Anesthesia
 Sedation Techniques
Main Anesthetic Concerns
Rapid Recovery &Minimal Postoperative Morbidity
The anesthesia service will be provided to the patient and he/she allowed
home in the same day of surgery
Remote locations
Procedures are commonly performed in a facility away from the proper
hospital setting
Pre-requirements:
(Essentials to reduce the risk)
Proper training and familiarity with the
technique (including support personals)
Patients selection
Clear instructions
Monitoring
Documentation
Emergency Back-up
Out-Patient Dental Anesthesia
“Dental Chair Anesthesia”
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
 Procedure
rather sedation
short
not so extensive
Out-Patient Dental Anesthesia
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Contraindications
Serious cardiopulmonary diseases, COPD
Diabetes or other endocrinological diseases
Neuromuscular disorders
Coagulopathies & Hemoglobinopathies
Marked oro-facial swelling (edema& trismus)
Potential difficult airways
Extreme obesity
Drugs: MAOIs , Anticoagulant
Not fasting
Out-Patient Dental Anesthesia
Equipments
Dental Chair
Anesthetic Equipments
Monitoring
Resuscitation Equipments
“ Up to the standards of In-Patient GA ”
Dental Chair
 Adjustable:
( horizontal /Head down)
 Manual release
 Adjustable head rest
 Hospital out-patient:
operating table
Anesthesia Equipments
 Continuous flow anesthesia machine
 Quantiflex (Relative Analgesia)
 Mouth props, packs, gags, nasopharyngeal airway,
rubber dam
 Separate suction unit
 Scavenging system
Equipment
 Continuous flow design with flow meters
 Safe delivery of O2 and N2O (fail safe
mechanism)
 10 l/min for 60 min
 E cylinder(650 litres)
 Pin-indexed yoke system
 Efficient scavenger
Nasal Mask
Rubber Dam
Monitoring
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Clinical Observation
Pulse Oximetry
Precordial/pretracheal Stethoscope
BP
ECG
Resuscitation Equipments
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Full range of tracheal tubes& accessories
Two working laryngoscope
IV agents: Succinylcholine & atropine
Emergency drugs
Defibrillator
Training
Out-Patient Dental Anesthesia
Induction
 Inhalational (mask) induction
 Intravenous Induction
Out-Patient Dental Anesthesia
Maintenance
 Inhalational agents/N2O
 Nasal mask, mouth gag, pack
 Maintain airway
Supine Position
 Less hypotension
 less bradycardia
 high risk of aspiration
 Airway obstruction&
 Decrease ERV
Out-Patient Dental Anesthesia
Recovery
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Left lateral position
100% O2
Suction Observation & monitoring
Discharge criteria
Instructions
Analgesia (NSAIDs)
Office-Based Dental Sedation
Sedation
It is a technique where one or more drugs are used to
Depress the Central Nervous System of a patient thus reducing
the awareness of the patient to his surrounding
According to the degree of CNS depression:
 Conscious Sedation
 Deep Sedation
 General Anesthesia
Conscious Sedation
It is a controlled, pharmacologically Induced, minimally
depressed level of consciousness that retains the patient’s
ability to maintain a patent airway independently and
continuously and respond appropriately to physical and/or
verbal command
Deep Sedation
It is a controlled, pharmacologically induced state of
depressed level of consciousness. from which the patient is
not easily aroused and which may be accompanied by a partial
loss of protective reflexes,including the ability to maintain a
patent airway independently and/or respond purposefully
to physical stimulation or verbal commands
Cons. Sedation
Deep Sedation
Minimally Depressed Consciousness
Deeply depressed consciousness
 Anxiolysis
 Sleeplike state
 Interactive
 Non-Interactive
 Non-interactive/arousable
 Non- arousable
(except with tense stimulation)
Cons. Sedation
 Airway is maintained
Deep Sedation
 Inability to maintain airway
 Protective reflexes are intact  Partial loss of reflexes
 Responses to command are  Difficult to respond to command
intact
Sedation Techniques
Non Titrable Technique
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Oral Sedation
Rectal Sedation
Intramuscular Sedation
Submucosal Sedation
Intranasal Sedation
Titrable Technique
 Inhalational Sedation
 Intravenous Sedation
Combination Of Two
Combination of Methods and Techniques
AUGMENTATION OF THE EFFECT + REDUCE THE DOSE OF STONGER
DRUGS.
Most complications occurred with polypharmacology in
the hands of untrained personnel
Dental Chair Complications
 Respiratory Complications
 Cardiovascular Complications
 Allergic Reaction
 Miscellaneous
Respiratory Complications
 Airway Obstruction
 Respiratory Depression
Respiratory complications
Airway Obstruction
Respiratory Depression
Causes
 Tongue
 Blood, debris
 Laryngeal spasm
 Narcotics
 Over-sedation
Clinical Picture
 A-W Obstruction
 Hypoxia
 Hypoventilation
 Hypercapnia
 Hypoxia
Management
 Patent airway
 Oxygenation
 Ventilation
 Reversal Agents
Airway Obstruction
Most common cause: tongue and/or epiglottis
Open the Airway
Position
Jaw thrust
Head tilt–chin lift
Open the Airway
Oropharyngeal Airway
Open the Airway
Nasopharyngeal Airway
Open the Airway
Endotracheal Intubation “Aligning Axes of the Airway”
Open the Airway
Endotracheal Intubation “ Laryngoscopes ”
Open the Airway
Endotracheal Intubation “ Visualization of the Cord ”
Open the Airway
Laryngeal Mask Airway (LMA)
Oxygenation
Adjunct Devices
Ventilation
Bag-Mask Ventilation
 Key ventilation volume: “enough to produce obvious chest rise”
1 Person
difficult, less effective
2 Persons
easier, more effective
Cardiovascular Complications
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Hypotension
Bradycardia
Dysrhythmia
Fainting
 Hypotension
Induction of anesthesia
Carotid sinus compression
Over-sedation
 Bradycardia
Tooth extraction
Halothane (nodal rhythm)
 Dysrhythmias
Aetiology
(Tachy-arrhythmias)
(Tooth extraction)
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High preoperative catecholamines
Light anesthesia
Airway obstruction & hypoxia
Halothane & local anesthesia
Local anesthesia with vasopressors
Significance
 Controversial
 Significant with unexpected cardiac disease
(viral myocarditis)
 Fainting
Causes Previous factors cardiovascular
complications, 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
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)
Manifestations
 Hypotension, tachycardia, arrhythmias
 Bronchospasm, cough, dyspnea, pulmonary
oedema, laryngeal oedema, hypoxia
 Urticaria, facial oedema, pruritus
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)
Miscellaneous
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Nasal Trauma, Epistaxis
Pulmonary Aspiration
Diffusion Hypoxia
Continued Bleeding
Post operative Sore Throat
Post operative Nausea & vomiting
Post operative Pain & swelling
THANK YOU