Anaesthesia in Dental Surgery,ENT General Principles,Tonsillectomy,Esophageoscopy

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ANESTHESIA AND ASSOCIATED DISEASES

Related topics

Anaesthesia General Principles

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Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Childrens hospital

Dental surgery :

General Principles:

Children may require GA more frequently than adults for dental procedures.
Many Children who present for GA have previous failed attempts at surgery under LA and are very apprehensive.
Some children have behavioral disorders or retardation syndrome and require special consideration.
Some children have other medical conditions which require special considerations.
Endotracheal intubations should be performed for all children. Nasal intubation per se causes bacteremia and is an indication for prophylactic antibiotics if heart disease is present.
Special care must be taken to ensure that no foreign body should remain in the airway at the end of the procedure.

ENT:

General principles:

As many of these operations involve the airway, the anesthesiologist must be prepared to provide good surgical access to that area while maintaining a safe ventilatory pathway for the patient.
The use of laser to treat lesions of the larynx, has added some additional potential problems of anesthesia management.

Tonsillectomy:

Sharing the airway with the surgeon.
When acute infection or extreme lymphoid hypertrophy is present, intubation may be difficult.
Danger of bleeding post-operatively.
History of bleeding or recent salicylate therapy.
History suggestive of sleep apnea or OSA.

Bronchoscopy:

Difficulty maintaining adequate ventilation during the procedure, when the airway must be shared with the endoscopist.
Existing impairment of ventilation in some cases.

Esophageoscopy:

The child may have undergone esophageoscopy repeatedly and thus be very apprehensive.
In small infants, passage of an esophageoscope may compress the trachea and obstruct ventilation, even when ETT is in place.
Coughing or other movements can result in esophageal perforations during the procedure. Patients must be anaesthetized adequately to maintain complete immobility.
Lower esophageal stricture or achalasia may have resulted in esophageal dilatation higher up. Food and secretions accumulated in the dilated segment may be aspirated during anesthesia.

Next : Anaesthesia in Hematological Disorders

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