Although anesthesiologists consistently work in the mouth of patients, they may not have been exposed to a comprehensive education of teeth, surrounding tissues, and intraoral prostheses. Since perioperative dental damage is one of the most common anesthesia-related adverse events and is responsible for the greatest number of malpractice claims against anesthesiologists, several dental considerations are warranted. The likelihood of perioperative dental trauma increases with the vulnerability of a patient's dentition and the presence of associated anesthesia risk factors. Minimizing dental injuries begins with the anesthesiologist's preoperative assessment of the patient's dentition and intraoral tissues. Clear documentation of the patient's preoperative dental condition and notifying the patient of the potential dental damage will diminish costs for any related postoperative dental treatment. Upon discovery of a potentially hazardous dental condition, a consultation with a dentist should be considered before proceeding with the surgical procedure. Exercising cautionary measures during provocative events, such as laryngoscopy and tracheal extubation, can aid in the prevention of dental trauma. In the event of such an injury, several management tactics can promote a swift and reasonable resolution. Establishing an increased awareness of intraoral conditions and the related perioperative risk factors may diminish the incidence of dental damage and financial costs.
For several decades, anesthetic gases have greatly enhanced the comfort and outcome for patients during surgery. The benefits of these agents have heavily outweighed the risks. In recent years, the attention towards their overall contribution to global climate change and the environment has increased. Anesthesia providers have a responsibility to minimize unnecessary atmospheric pollution by utilizing techniques that can lessen any adverse effects of these gases on the environment. Moreover, health care facilities that use anesthetic gases are accountable for ensuring that all anesthesia equipment, including the scavenging system, is effective and routinely maintained. Implementing preventive practices and simple strategies can promote the safest and most healthy environment.
Many patients requiring cardiac surgery possess poor oral health. The presence of decayed teeth, untreated dental abscesses, and periodontitis can all represent potentially potent causes of an odontogenic infection. Ultimately, such an infection can have catastrophic consequences if it occurs during or soon after certain cardiac procedures. Since an association exists between poor oral hygiene and various systemic diseases, many patients scheduled for cardiac procedures inherently possess poor oral hygiene and untreated dental infections. Inadequate patient education, financial constraints, and dental phobia all serve as barriers for patients receiving routine intraoral care. Consequently, patients may unknowingly present for cardiac surgery with undetected oral infections that can magnify the likelihood of an adverse outcome, leading to increased costs, morbidity, and possibly mortality. It is recommended to view oral health in the perspective of systemic health, specifically, recognizing the deleterious impact that an untreated odontogenic infection can have upon cardiac surgery. Therefore, considering scheduling constraints and the urgency of the operation, if time and resources permit, then it is suggested that patients who undergo elective cardiac surgery should be screened preoperatively to ensure that any oral infection is diagnosed and definitively treated. Such an investment can yield significant improvements in surgical outcome and overall patient health.
Typically, a patient's intraoral condition is not a chief perioperative concern. The need for proper dental care is often unmet prior to a surgical procedure. Consequently, patients presenting for surgery may possess untreated decayed teeth and/or periodontal disease. These individuals may be harboring a
Prior to cardiothoracic or vascular surgery, a patient's oral health is not usually a high priority for the surgical team. Yet, oral neglect often mirrors systemic disease and the need for proper dental care is often unmet. In the perioperative period, the presence of untreated decayed teeth and periodontal disease can result in a potent odontogenic infection with significant consequences. Patients can unknowingly present for such operations with undetected oral infections that can magnify the likelihood of an adverse outcome, increase costs, morbidity, and possibly mortality. Considering scheduling constraints and the urgency of the procedure, a pre-operative dental screening is suggested for patients who undergo elective cardiothoracic or vascular surgery, to ensure that any oral infection is diagnosed and definitively treated. Implementing such an effective and preventive approach can improve surgical outcome and overall patient health.
In the operating room, safely administering anesthesia amidst a major power failure can instantly present one with a formidable challenge. A case is presented involving a 23-year-old healthy woman who underwent a complex oral and maxillofacial surgery to correct a dentofacial deformity. Three hours into the case and with the patient's maxilla downfractured, the overhead surgical lights blacked out, and there was an apparent loss of the anesthesia machine's ability to function. Providing adequate oxygenation, ventilation, anesthesia levels, monitoring of vital signs, and transportation of the patient were some of the challenges faced, and the response to this unexpected event is recounted. The importance of one's familiarity with an anesthesia machine's backup battery supply, routinely checking machinery, ensuring that appropriate and sufficient supplies are readily available, exercising calm leadership with clear communication, and formulating a clear plan with backup alternatives are discussed. Various recommendations are proposed with respect to the preparation for and the prevention of a power failure in the operating room. This report's account of events is aimed to ''shed some light'' on this topic, serve as a check of one's own preparedness, and facilitate the optimal management of a similarly unexpected incident.
Many patients requiring surgery possess poor oral health. The presence of decayed teeth and periodontitis represent potentially potent causes of odontogenic infection that could significantly compromise the surgical outcome. Geriatric patients presenting for surgery who have not had a dental examination for years may be harboring an undetected oral infection. In the perioperative period, the harmful effects of such an infection are amplified in terms of treatment and expenses. This article will elaborate on the association between oral health and systemic disease, present unique intraoral characteristics of elderly patients, and emphasize the importance of obtaining a dental evaluation and treating any acute oral infection before surgery. Augmenting the awareness of the perioperative dental considerations in the geriatric population can lead to the implementation of effective and preventive measures that can contain costs and achieve optimal patient care.
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