What is suxamethonium apnoea?
causes prolonged paralysis following suxamethonium (instead of wearing off after a few minutes it takes 6 hours).
What changed the guidelines on GA in dentistry first?
- 1991 POSWILLO REPORT
- DENTAL SURGEONS NO LONGER ALLOWED TO ANESTHETIZE AND OPERATE SIMULTANEOUSLY
What are the symptoms of malignant hyperthermia (5)?
- Symptoms: increase in CO2 concentration, increase in O2 demand, tachycardia, temperature rise, muscle rigidity
What is nitrous oxide?
an ANALGESICS
- supplements anesthesia.
What 3 types of drugs the patient may be taking may influence GA?
- Drugs that cause bleeding.
- Immunosuppressants.
- Blood pressure medicines.
What is suxamethonium?
A short acting muscle relaxant
How is malignant hyperthermia managed?
DANTROLENE limits the process but hard to draw up. ACTIVE COOLING of patient.
What does muscle relaxation do? Why is it used?
Cause MUSCLE PARALYSIS allowing INTUBATION, SURGICAL ACCESS TO BODY CAVITIES, SAFETY DURING NEUROSURGERY
What are the guidelines for GA in dentistry?
- Standards and Guidelines for General Anesthesia for Dentistry 1999 by the royal college of anesthetists.
o If GA will be given in a dental practice, you must have all the same resuscitation, recovery and assessment facilities like in hospital.
What are the 4 steps to providing GA?
- Monitoring
- Benzodiazepines
- Drug to induce anesthesia.
- Inhalational drugs to induce/ maintain anesthesia.
What is conscious sedation?
A drug produces a DEPRESSION OF THE CNS but during which VERBAL CONTACT WITH THE PATIENT IS MAINTAINED THROUGHOUT THE PERIOD OF SEDATION.
What are important allergies to be aware of in patients due to undergo GA?
- Penicillin, latex
- thiopentone
- suxamethonium.
What drugs are used to induce anesthesia?
Propofol, etomidate, thiopental.
What is malignant hyperthermia?
- Inherited disorder of SKELETAL MUSCLE only triggered by certain anesthesia drugs.
What drug is used to manage malignant hyperthermia?
Dantrolene
What is a short acting muscle relaxant? Long acting?
- SA: suxamethonium.
- LA: ATRACURIUM/ ROCURONIUM
What does malignant hyperthemia cause?
- Abnormal accumulation of CALCIUM in muscle cells causes hypermetabolism, muscle rigidity and muscle breakdown (releases toxic metabolites like potassium).
- ANAESTHETIC EMERGENCY: 2% MORTALITY.
Name 2 complications that may arise during GA (specific conditions).
- Suxamethonium apnea.
- Malignant hyperthermia.
What stage is laryngeal reflex lost?
Stage III
What is done in patients with reflux when undergoing GA?
Create a DEFINITIVE AIRWAY using a BREATHING TUBE to ensure airway is clear from any gastric contents.
What are the stages of GA?
- Stage I: Loss of consciousness
- Stage II: Excitement/ delirium - coughing, vomiting, struggling.
- Stage III: Surgical state of anesthesia - from onset of automatic respiration to respiratory paralysis. Laryngeal reflex lost, pupils dilate.
- Stage IV: cessation of respiration and death.
What drug is used as a premiedication in GA?
Benzodiazepines
What does balanced anesthesia involve?
Anesthesia, Analgesia, Muscle relaxants
What stage is state of surgical anesthesia?
Stage III
