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Management of patients with respiratory disease |
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¨ In the presence of respiratory impairment, general anaesthesia can be potentially dangerous since respiratory failure may be precipitated. ¨ If infection is temporary then resolution should be awaited. ¨ If GA is unavoidable and the condition is chronic e.g. in cases of COAD or bronchiectasis, then the condition of the patient should be optimised e.g. using preoperative physiotherapy, sometimes antibiotics, bronchodilators such as salbutamol and antimuscarinics such as ipratropium (sometimes nebulised). ¨ Even when treated using LA, these patients may become dyspnoeic, especially when supine. ¨ As part of any pre-operative work up, benefit can be gained by stopping smoking.
In cases of active TB, a GA is contra-indicated, both due to impaired respiratory function or contamination of anaesthetic machine circuits.
Asthmatic patients should have treatment carried out using LA if possible. Effort should be made to allay anxiety as far as possible and treatment should not be carried out if the patient has not brought their normal medication and such medication is otherwise unavailable. Relative analgesia using nitrous oxide and oxygen is preferred to intravenous sedation since the former can be rapidly controlled. GA can be complicated by hypoxia and increased carbon dioxide, which can lead to pulmonary oedema even if cardiac function is normal. If the patient suffers from asthma then aspirin-like compounds should not be prescribed as many asthmatic patients are allergic to these analgesics. A severe asthmatic attack can be life-threatening and as stress may contribute to the onset of such a condition the dentist should have the equipment to deal with such an emergency at hand
The use of supplemental steroids prior to dental surgery in patients at risk of an 'adrenal crisis' is also a consideration see steroid cover protocol
Ref: British Dental Journal 14 June 2003; Volume 194, No. 11
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Relevance of respiratory disorders in the provision of local anaesthesia, sedation, general anaesthesia and management in dental practice is examined in this section. |