Dental Restoration

Indications

Rampant dental caries and extensive dental work must be performed at one time

Pts with cerebral palsy, Down Syndrome, or uncooperativeness who are not candidates for a local anesthetic

Airway Access

Usually nasal. If possible, ask pt through which nostril they can breathe the best

Topical vasoconstrictive nasal spray during preop to reduce or prevent bleeding from intubation

Mask induction followed by placement of nasal trumpets to dilate the nostril.

Placement of the nasal ETT on the opposite side of the surgical site.

• ETT may be sewn to the nasal septum

Use of throat packs to prevent swallowing of blood leading to PONV.

• Ensure removal post-surgery

Anesthetic considerations

Pt may have congenital anomalies, so consider a small oropharynx, enlarged tonsils, large tongue, and increased secretions. Consider Atlantoaxial instability and congenital heart disease

Usually, nasal RAE 0.5-1mm smaller diameter than for oral intubation

GETA

Pts may have gingival hyperplasia

• Which can be caused by anticonvulsants, Ca-channel blockers, and cyclosporine

The gingival is highly vascular, and surgical manipulation may cause increased bleeding

Surgical time depends on the amount of work to be done

Blood loss is usually not a problem

May need Ketamine dart for the patient in the pre-op area depending on medical history

• 6-10 mg/kg IM or 1-2 mg/kg IV

Chart placement of throat pack and removal of throat pack

Check and pad pressure points

Check and pad eyes

Secure Nasal RAE using "half-moon" pink foam; note the high risk of pressure on the nostril

Morbidities

Pain

Airway obstruction secondary to retained throat pack

PONV

Aspiration of dental debris

Swelling