Removal of teeth under General anaesthesia: anesthesia, pain when removing
Removal of teeth under General anesthesia for obvious reasons, demand among the clients of dental clinics. A loss of consciousness at the time of manipulation allows the patient to fall asleep and Wake up when necessary intervention will be over. This person will not experience the pain and fear. The apparent convenience is forcing many patients to insist on conducting this type of anesthesia. However, in most cases, the doctors deny its visitors in such request. Why is this happening? What are the positive and negative sides have General anesthesia? In some cases, the treatment and removal of teeth under General anesthesia are shown, and in which to ask the doctor about «sleep» is useless?
What is the anesthesia
Anesthesia (General anesthesia) is the method of artificial inhibition of activity of the Central nervous system associated with immersion of the patient in medication sleep and a complete lack of all kinds of sensitivity.
Simply put, anesthesia is a very strong sleep caused by medications. For the patient everything can look exactly as he is: a prick, a dream, a revival. In fact, General anesthesia is a complex manipulation, for which you require specialized anesthetic equipment, the presence of a physician anaesthetist, well-trained operating maxillofacial profile.
General anesthesia during the tooth removal can be of two types:
In the first case, the patient is immersed in anesthesia with injectable drugs (propofol, sodium thiopental). Their validity is minimal, so an injectable form of anesthesia used for short procedures. Of course, the extirpation of the tooth under anesthesia, the injection may be accompanied by technical difficulties and delayed in time. The duration of sleep must be increased. It is permissible, however, the physician is limited to a maximum allowable dose of the drug, which he can enter.
Extractions under inhalation General anesthesia is performed in cases where a complex and vysokotravmatichen surgery that will require prolonged analgesia. Due to the nature of dental surgeries, the use of «mask» method of introduction of the anesthetic mixture is impossible. Therefore, it is necessary to intubate the patient.
Important! Intubation — the introduction of a breathing tube into the trachea (windpipe). Is made for the purpose of inhalation anesthetic mixture directly into the lungs and ensure adequate breathing of the patient during the procedure. In addition, intubation prevents the inhalation by the patient’s saliva and, with the development of vomiting, vomit.
Intubation of the trachea, which is accompanied by General anesthesia during the tooth removal itself is fairly a unpleasant procedure. May be accompanied by vomiting, and bradycardia (vagal effect). Therefore, before the introduction of the breathing tube the consciousness of the patient «shut off» using injectables. Before complex interventions intubation can be performed through the nose.
Who is the anesthesia
Despite the demand among patients, anesthesia is applied only in the presence of certain indications. Among them include:
|Child age of the patient.||When complex and painful tooth extraction can lead to the child psychological trauma, which in the future will become the reason for the categorical rejection of the visits to the dentist. In children with high anxiety and low pain threshold, this effect can develop even under pain causes mestnoanesteziruyuschy shot. General anesthesia during dental extractions allows the child to easily move the manipulation and creates for the doctor a more comfortable working environment.|
|Contraindications to local anesthesia.||Analgesic local effect at the tooth extraction often leads to the development of allergic reactions. When you have a history of local injection does not apply. Small intervention can be conducted without anesthesia, large under anesthesia.|
|Traumatic surgery.||Large operations almost always, even after local anesthesia, accompanied by pain. In addition, the patient may experience discomfort from prolonged stay in one position, kind of bloody instruments and swabs of the working doctors conversations. To avoid this, the patient is euthanized.|
|Panic the patient’s condition.||Able to remove the tooth from the patient who is in a state of panic, is almost impossible. The patient interferes with the doctor is moving, can not open your mouth wide. There were cases when people refused from further treatment at a time when it was made an incision in the gums. To avoid this, apply a tooth extraction under sedation or anesthesia.|
|Mental illness.||The patient has a mental disease, even in remission is a reason for the introduction of anaesthesia means. The fact that to predict the behavior of such people is almost impossible. At any time the patient may begin to behave inappropriately, which will cause harm to yourself or doctor.|
|The risk of vomiting.||In severe gag reflex patient may feel sick at the time of surgery. However, there is a risk of inhaling vomit, leading to aspiration pneumonia or respiratory failure. To avoid this, to pull out a tooth need against the background of oppressed reflexes.|
When anesthesia is contraindicated
Even under such difficult procedures like removal of impacted tooth anesthesia generic profile does not apply in the following cases:
- Post-infarction condition and the acute phase of AMI. Removal of teeth under anesthesia may be no earlier than six months from the end of the acute period.
- Stage of decompensation heart failure. The anaesthetic can cause a critical decline in blood pressure, collapse with all the ensuing consequences.
- Aggravation of endocrine diseases
- Acute inflammatory processes of other organs and tissues
- Pneumonia in all its manifestations
- Bronchial asthma
- Alcohol or drugs
Of course, many of the above contraindications are relative. When life-threatening conditions of the patient take «on the table», despite their availability. However, anesthesia for tooth extraction is planned. Therefore, the risk associated with the presence of even relative contraindications, unfounded.
Positive and negative aspects of General anesthesia
At first glance, to remove teeth under General anesthesia is extremely comfortable for the patient. Indeed, the patient does not feel pain, experiences during surgery, he does not need a long time to be in the chair in a stationary state. Easy tooth removal by a similar method attracts many patients. In reality, the specialists prefer to avoid General anesthesia, as it requires:
- A thorough preliminary examination
- Preliminary preparation of the patient
- Operating and anesthetic equipment
- The presence of the operating team (surgeon, anesthesiologist, nurse anesthesiologist, nurse)
To treat your dental disease under anesthesia is risky because CNS depression can be deferred, and immediate negative consequences. Deferred consequences include:
- Memory impairment
- Violation of mental functions due to hypoxia
- Temporary memory loss
Such effects often occur after a long and deep inhalation anesthesia. The injection of hypnotics, in turn, may provoke respiratory arrest. In the absence of a breathing apparatus of such a complication is extremely dangerous.
Preparation for anesthesia
Due to the presence of contraindications, extraction of the tooth under General anesthesia requires a thorough examination. Shortly before surgery, the patient needs to be tested:
- Biochemical blood
- KHS + electrolytes
- Total urine
In addition, you may need an electrocardiogram, ultrasound examination of abdominal cavity, x-ray examination of the lungs. RG jaw, on which the planned intervention is mandatory.
The day before to remove the tooth under General anesthesia, the patient should go to a light vegetable diet.
The evening allowed a dinner consisting of easily digestible foods. On the day of surgery there should not be. The night before the manipulation or the morning of the day of its implementation, it is recommended to do a cleansing enema.
Before surgery, you need to brush your teeth. This removes plaque, which contains a large number of bacteria. In marked psycho-emotional excitation of the patient is administered a sedative. What drug is used depends on the degree of excitation of the patient. In some cases, a therapeutic dose of Valerian extract, other essential Relanium and narcotic analgesics. Operating directly in the oral cavity is treated with chlorhexidine or other antiseptic nesperova in the mouth inserted the ring-expander, the person is draped with sterile sheets. After that, proceed to operation.
The job of the anesthesiologist during anesthesia
The job of the anesthesiologist during the administration of anesthesia includes continuous monitoring of the patient’s condition (pulse, pressure, saturation, level of consciousness). Also the doctor adjusts the duration and depth of sleep of the person lying on the operating table. To remove tooth do not require too deep of oppression nervous system functions, so in most cases anesthesia goes without complications. Deducing from the state of medication sleep start for a few minutes before the end of the operation. The time required to Wake-up, depends on what medicine was used. For the full recovery of body functions usually takes about 4-5 hours. All this time the patient must be under the supervision of an anesthesiologist.
Recovery from anesthesia
Usually, by the time of the awakening patient, he is still on the ventilator inserted into the windpipe tube. This is a major inconvenience. Tube is removed after spontaneous breathing is fully restored. It doesn’t take more than 1.5 hours. After removing the patient may experience sore throat that persists for 1-2 days. In addition, in the first day after anesthesia in humans may include the following phenomena:
- Inappropriate behavior (immediately after awakening)
- Impaired coordination
- Pain in the area of interference, which arise when the removal of teeth under local anesthesia.
- Nausea or vomiting
In severe pain the patient is assigned to injection of anaesthetic. Psychomotor agitation is an indication for the introduction of sedatives. The anesthesiologist evaluates and General condition of the patient, the degree of recovery of reflex activity. If necessary, correction. For early recovery can be assigned nivalin dose of 50-60 mg.
Whether or not anesthesia
General anesthesia is a great opportunity to pull out a tooth or conduct other dental operation without causing the patient pain. In this deleted item will be extracted efficiently, because the doctor will be given the opportunity to work without distraction on the mental state of the patient.
We should not forget that anesthesia is a serious interference in the work of the body, which has its side effects and contraindications. Therefore, it should only be used in cases when local anesthesia is impossible. If the cause of the wishes of the patient is extremely nervous before the surgery, you should convince him that anestezirutmi modern means areas are completely deprived of sensitivity. Therefore, to endure the pain will not even have under local anesthesia.