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Questions and Answers
In which type of patient would it be difficult to conduct dental procedures safely under local anesthesia?
In which type of patient would it be difficult to conduct dental procedures safely under local anesthesia?
- Patients with a history of successful local anesthesia
- Patients with a high level of anxiety
- Mentally challenged patients (correct)
- Adults with a history of allergic reactions to general anesthesia
In what situation would general anesthesia be necessary for a child?
In what situation would general anesthesia be necessary for a child?
- If the child has a history of successful general anesthesia
- If the child does not cooperate with local anesthesia or conscious sedation (correct)
- If the child is allergic to local anesthesia
- If the child is extremely anxious about the procedure
What is the primary reason for using general anesthesia in patients with severe trismus?
What is the primary reason for using general anesthesia in patients with severe trismus?
- The patient has a history of unsuccessful local anesthesia
- The patient is mentally challenged
- The patient is allergic to local anesthesia
- The patient is unable to safely receive a local anesthesia injection (correct)
What type of general anesthesia is typically used for outpatient oral surgical procedures lasting not more than one hour?
What type of general anesthesia is typically used for outpatient oral surgical procedures lasting not more than one hour?
Where is dental chair anesthesia typically administered?
Where is dental chair anesthesia typically administered?
What is the primary outcome of general anesthesia?
What is the primary outcome of general anesthesia?
What are the five important benefits of general anesthesia?
What are the five important benefits of general anesthesia?
What is the main reason behind the concept of balanced anesthesia?
What is the main reason behind the concept of balanced anesthesia?
What is the primary goal of general anesthesia in dentistry?
What is the primary goal of general anesthesia in dentistry?
What is the definition of general anesthesia?
What is the definition of general anesthesia?
What are the phases of general anesthesia?
What are the phases of general anesthesia?
What is the primary purpose of endotracheal intubation?
What is the primary purpose of endotracheal intubation?
What is the typical time frame for unconsciousness to occur after IV induction?
What is the typical time frame for unconsciousness to occur after IV induction?
What is the role of neuromuscular blockers during general anesthesia?
What is the role of neuromuscular blockers during general anesthesia?
What type of anesthetics are commonly used for maintenance of anesthesia?
What type of anesthetics are commonly used for maintenance of anesthesia?
What is the primary goal of the anesthesiologist during the premedication phase?
What is the primary goal of the anesthesiologist during the premedication phase?
What is the purpose of the recovery room?
What is the purpose of the recovery room?
What is a characteristic of enflurane compared to halothane?
What is a characteristic of enflurane compared to halothane?
Which of the following is a disadvantage of using this anesthetic?
Which of the following is a disadvantage of using this anesthetic?
What is a potential complication of using this anesthetic in patients with epilepsy?
What is a potential complication of using this anesthetic in patients with epilepsy?
What is the ratio of patients who may experience hepatotoxicity when using this anesthetic?
What is the ratio of patients who may experience hepatotoxicity when using this anesthetic?
Which of the following is a characteristic of isoflurane compared to halothane?
Which of the following is a characteristic of isoflurane compared to halothane?
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Study Notes
General Anesthesia in Dentistry
- Indications for general anesthesia in dentistry include:
- Mentally challenged patients
- Children who cannot cooperate or have unsuccessful local anesthesia
- Patients allergic to local anesthetics
- Prolonged traumatic procedures
- Inability to safely inject local anesthesia (e.g., severe trismus)
Definition of General Anesthesia
- General anesthesia refers to a drug-induced reversible loss of sensation and complete loss of consciousness, similar to a deep sleep
- Benefits of general anesthesia include:
- Analgesia (loss of pain sensation)
- Lack of awareness (consciousness)
- Amnesia (memory loss)
- Sedation and reduced anxiety
- Skeletal muscle relaxation and suppression of undesirable reflexes
Balanced Anesthesia
- Since no single anesthetic agent can produce all desired anesthetic features, a balanced anesthesia approach is used
- This involves combining multiple drugs to achieve the desired anesthetic effects
Phases of General Anesthesia
- Premedication: Before surgery, the anesthesiologist evaluates the patient and prescribes anxiolytics and/or metoclopramide to hasten gastric evacuation
- Induction: Usually done with an IV agent like propofol, producing unconsciousness in 30-40 seconds
- Maintenance: Commonly provided with volatile anesthetics, which offer good control over the depth of anesthesia
- Recovery: The patient is introduced to the recovery room to be under close medical supervision until consciousness and protective reflexes are restored
Classification of General Anesthetics
- Inhalational anesthetics: Desflurane, Isoflurane, and others
- Intravenous anesthetics: Propofol, Thiopental, Etomidate, Ketamine, and Midazolam
Properties of Ideal Anesthetic Agent
- Should produce unconsciousness, amnesia, analgesia, and muscle relaxation
- Should have a rapid onset and recovery
- Should have minimal side effects and toxicity
Inhalational Anesthetics
- Desflurane:
- Not used today due to its arrhythmic effect and hepatotoxicity
- Contraindicated in epileptic patients as it precipitates seizures
- Isoflurane:
- Preferred anesthetic in neurosurgical procedures due to its mild cerebral vasodilation and less increase in intracranial pressure
- Has no arrhythmogenic effect with adrenaline
- Adverse effects of inhaled anesthetics include:
- Central nervous system effects
- Cardiovascular effects
- Liver effects
- Respiratory effects
- Postoperative nausea and vomiting
- Malignant hyperthermia
Malignant Hyperthermia (MH)
- Definition: A life-threatening hypermetabolic disorder of skeletal muscle that occurs secondary to exposure to halogenated anesthetics or succinylcholine
- Incidence: 1:20,000
- Cause: Genetic abnormality in calcium channel in Ryanodine Receptors in sarcoplasm reticulum of muscle cells
- Symptoms: Muscle spasm, hyperthermia, tachycardia, and hypertension
- Treatment: Administration of Dantrolene and cooling the patient
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