Chapter 126

CHAPTER 126 ■ Dental Procedures: Anesthetic Considerations 2089
good candidate for a an in-office nonintubated general anesthetic.
Regarding surgeon/dentist selection, the nuances of working
within a relatively unprotected airway requires some understanding
and modification of surgical technique, such as minimal
use of water spray to cool the tooth while drilling, which may
migrate to the glottis and lead to laryngospasm. Additionally, there
can be considerable differences in anesthesia time with slower
versus faster surgeons. Lastly, some procedures, such as more complex
maxillofacial procedures, may require intubation and preferably
potent inhalation agents or mechanical ventilation, thus
necessitating a formal operating room suite with full anesthesia
capabilities. Regardless of the surgical procedure, provision should
be made for duplicates of all critical pieces of equipment, both for
anesthesia and surgery, should some device fail prior to procedure
completion. Lastly, should a surgical or anesthetic complication
arise which necessitates transfer to the hospital, arrangements
should be made in advance for how and where this will be
accomplished.
SUMMARY
General anesthesia for dental and oral surgery is frequently
necessary for uncooperative patients, patients for whom local
anesthesia is difficult to obtain, procedures of significant surgical
complexity, or when local anesthesia cannot be obtained. Particularly
for pediatric patients, there is an increasing use of hospital
and office-based general anesthesia for dental procedures. The
anesthesiologist is faced with the challenge of sharing the airway
with the dentist/surgeon and the frequent need for nasotracheal
intubation. Proper preoperative planning and consultation with
the dentist/surgeon will enhance the safe and comfortable
administration of anesthesia for the patient and dentist.
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