Department of Oral- and Maxillofacial Surgery, Semmelweis University Budapest Head of Department: Dr. Németh Zsolt General anaesthesia in oral surgery and outpatient surgery Dr. Rónaszegi – Somogyi Zsófia History 1844 Horace Wells nitrous oxide extraction of one of his own wisdom teeth by a colleague 1846 William Morton (pupil of Wells) ether extraction 1946 introduction of lidocaine General anaesthesia should be strictly limited to those patients and clinical situations in which local anaesthesia (with or without sedation) is not an option. Bourne JG. General anaesthesia in the dental surgery. B Dental J 1962; 113: 54-7. Coleman F. The history of nitrous oxide anaesthesia. Dental Record 1942; 62: 143-9 Naveen Malhotra General Anaesthesia for Dentistry ndian Journal of Anaesthesia 2008;52:Suppl (5):725-737 Types of general anaesthesia Outpatient anaesthesia • Dental chair anaesthesia Relative analgesia  for simple extraction • Day care anaesthesia Conscious sedation (Sedoanalgesia)  for minor oral surgery In patient anaesthesia Intubation with or without neuromuscular blocking   for complicated extractions, oral- and maxillofacial surgical procedures Indications of general anaesthesia • Acute infection (pain) • Children • Mentally challenged patients • Dental phobia • Allergy to local anaesthetics • Extensive dentistry & facio-maxillary surgery Equipments • anaesthesia machine, vaporizers • oxygen, nitrous oxide • breathing circuits (adult and pediatric) • nasal and facial masks • oral and nasal air-ways • different laryngoscopes with all sizes of blades • nasal and oral tracheal tubes • Independent suction apparatus Monitoring standards • Peripheral arterial oxygen saturation, • ECG, • non-invasive blood pressure and capnography • All resuscitation drugs • Defibrillator Conditions of genereal anaesthesia • Anaesthesiologist • Dedicated assistant • Dentist • Dental assistant Minimum of four people are required! Written and informed consent by the patient or parent/guardian! Procedure Only ASA physical status class I & II patients should be administered Steps • Pre-anaesthetic preparation • Premedication • Induction of anaesthesia • Intubation • Maintenance • Recovery Pre-anaesthetic preparation Preoperative examinations are indicated: • Anamnesis • Physical examinations (by the anaesthiologist) • Blood tests • Urine tests • ECG • Lung x-ray • Informed consent form! Premedication Clear fluids are allowed up to 4 hours (children) or 6hours (adult) preoperatively. (preoperative fasting) Premedication • Anxiolysis Benzodiazepine: midazolam-Dormicum, alprazolam- Xanax   Sedation, Amnesia, Anticonvulsive • Preemptive analgesia NOA (non opioid analgetic) metamizol, diclofenac, ibuprofen, paracetamol In case of need opioid Tramadol, Pethidin, Morphin • Antisalivation Parasympatholythic (Anticholinerg): Atropin (0.03mg/kg), Scopolamin, Glycopyrrolat (reflekt. Bradycardie) • Antacide Antihistamins: (H2-Blocker) ranitidin, famotidin Protonpump inhibitors: omeprasole, esomeprasole, Na-citrat (p.o. 30 ml) • Antibiotic prophylaxis (in case of need) Cefazolin1-2 g, Ampicillin/clavulic acide 1.2 g or Amoxicillin/sulbactam or Clindamycin 600 mg.