• Document: Chair Dental Anaesthesia
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Dental Anaesthesia Dr E Rawlings Anaesthetic Directorate Chair Dental Anaesthesia Day Stay Surgery ! Dental chair ! Isolated site ! Brief duration ! Shared airway ! Young children/Nervous adults ! Rapid recovery History " General anaesthesia & dentistry closely associated 157 years " 1800 - Nitrous oxide # Analgesic properties noted Humphrey Davy • Suffering from gingivitis " 1844 - Surgical potential noted # Horace Wells Gardner Quincy Colton Great-success 1st patient # Horace Wellsextraction of wisdom Colton (Dentist) tooth – (24,000 GA’s+N – 2O no fatalities) History " 1868 – Nitrous available in cylinders " 1887 - Hewitt # - Designed apparatus for administering N2O & O2 mixtures " 1899 - invention of nasal mask " 1926 - Demand flow apparatus McKesson " 1920’s Walton machine # Demand flow # Remained in service until 1970’ 1970’s Nitrous oxide Commonly used 100% nitrous patient cyanosed/twitching (cerebral hypoxia) 100% oxygen Patient pink (5-10 mins. for extractions) Still practised in late 1950’s " 1956 - Halothane " 1955/6 Klock & Tom - oxygen restriction unnecessary " 1957- 1998 – Methohexitone ! Methohexitone Better than thiopentone Rapid induction # Popular induction agent. Shorter duration of action # Sedation (Drummond Jackson – 1965) # Rapid recovery popular – minimal incremental technique Narrow therapeutic margin – sedation & anaesthesia " 1983 - Operator anaesthetist banned " 1996 – introduction of Sevoflurane Standards! " 1981 Wylie report " 1991 Poswillo report " 1998/9 General Dental Council & Royal College of Anaesthetists " 1999 - November - Committee on Safety of Medicines ! Halothane withdrawn from use outside hospital setting " 31st December 2001 – Department of Health ! All chair dentals must be administered in hospital setting Statistics on general anaesthetics for Minor Dental procedures " 1950’s – 2 million GA’s per annum " 1965 - 1.5 million dental GA’s " 1998 - 300 000 dental GA’s Overall reduction of caries " Why 1973 the reduction? - 7% children caries free 1993 - 50% children caries free " 1948 Health service – started # All treatment free " 1950’s – sweets off ration # Large increase in need for dental treatment Dental Health - improvements " Improved dental hygiene & education # 1955 – 1st advert Gibbs SR # 1974 - toothpaste (fluoride) " fluoride # naturally occurring # added to water # tablets & drops Dental health improvements (cont). " Conservation # lignocaine 1948 # air rotor drill (1960) • High speed " Sedation techniques # Intravenous - midazolam # Inhalational – relative analgesia (nitrous & oxygen) " Improvements in general health & diet ! 30’s poverty & poor nutrition ! Poor dental health " Dentists no longer giving GA’s ! No longer training dentists to give GA’s Dental anaesthetists – qualifications & experience? " Before 1998 – variable # Dentalsurgeons # General medical practitioners # Consultant anaesthetists Dental Anaesthesia Technique " Induction - inhalation/IV # nasal mask " Adequate anaesthesia # open mouth # insert pack + prop # extract teeth " Recovery # lateral position # head down Anaesthetic considerations Sitting – potential cause of mortality Posture Differentiate Considerable debate over merits true “sitting” of posture & semi-reclining position Sitting Position Pro’s Cons " Reduces likihood of " Reduction of venous passive regurgitation of return reduced cardiac gastric contents output, cerebral " Airway maintenance hypoperfusion easier " Unrecognised vasovagal " Floor of mouth angles syncope forwards facilitates " Debris passing posterior suction

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