LOCAL ANESTHESTIC Definition & Indication

Definition Produce loss of sensation to pain in a specific area of the body without the loss of consciousness Indication Any surgical pressure that can be anticipated to be painful for the patient requires local anesthesia. Following are few indications: 1) Extraction of teeth 2) Apicetomy 3) Gingivectomy 4) Periodontal surgery 5) Pulpectomy,Pulpotomy 6) Alveloplasty 7) Bone grafting 8) Implants 9) Gingivoplasty 10) Treatment of jaw fracture (reduction and wiring) 11) Replacement of avulsed tooth 12) Dental cyst 13) Removal of tumors 14) Pericoronitis 15) Removal of odontomes 16) Stitching and muco-periosteal flapping.

Contraindication Severe degree of S.A, A.V. block Severe hypertension Spinal deformities and neurological disorders Liver diseases. Special precaution in elderly with liver and renal disorders.

Pre-anesthetic Examination & patient Management 1. Pre-anaesthetic examination 2. Premedication - if indicated. 3. Proper injection procedure . 4. Prevention of complications & dealing with them when they occur.

Purpose & Goal of pre-anesthetic examination(PAS) The purpose and overall goal of Pre-Anesthesia Screening (PAS) is to gather the clinical information necessary for the safe and effective administration of anesthesia through a process that is convenient for patients and physicians and results in efficient surgical throughput.

Functions of the PAS Process

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Assess patients' medical status as soon as they are scheduled for surgery If needed, obtain diagnostic tests to medically screen patients Identify potential patients at risk Increase patient confidence in how to prepare, what to expect and what they will physically encounter during their surgical stay and how that may affect their care after surgery Inform patients about the risks and benefits of different types of anesthesia - Provide patient-specific instructions (meds, diet) for the day of surgery - Initiate post-op care expectations for patients and their families

Steps to Establish a PAS Process 1) Form a multidisciplinary committee (anesthesiologists, PAS nurse, pathologist, radiologist, cardiologist) 2) Identify patient health conditions indicating: 3) Identify surgical procedures creating risks independent of patients' underlying health status a. Need for additional diagnostics (x-ray, labs, ECG) b. Need for specialist consultation (cardiology) c. Need for anesthesiologist interview REFERENCE: 1. http://www.surgerymanagement.com/presentations/pre-anesthesiascreening.php#pashow