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
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.
Use of throat packs to prevent swallowing of blood leading to PONV.
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
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
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
Pain
Airway obstruction secondary to retained throat pack
PONV
Aspiration of dental debris
Swelling