Environmental implications of anesthetic gases.

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.

Perioperative dental evaluation.

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 quiescent and potent odontogenic infection. In the perioperative period, the deleterious effects of such an infection can not only compromise surgical outcome, but also magnify treatment and expenses. This article will elaborate on the connection between oral health and systemic disease, and discuss the barriers that exist with improving oral health. It will review pertinent dental nomenclature and anatomy, as well as emphasize the practice and value of a preoperative dental evaluation. Various compromised intraoral conditions are presented among a range of patient populations. The importance of treating an acute odontogenic infection before surgery is also discussed. Healthcare providers who recognize significant perioperative dental conditions can implement effective and preventive actions that can contain costs and achieve optimal patient care.

Nasal foreign body: an unexpected discovery.

Abstract Nasal foreign bodies may result from the abundant availability of tiny objects in our society and a curious child exploring his or her nasal cavities. An inserted object that is not witnessed or retrieved can remain relatively asymptomatic or cause local tissue damage and potentially yield more serious consequences. An unusual case of a young child who presented for dental rehabilitation under general anesthesia is described. Immediately prior to the nasotracheal intubation, an unanticipated foreign body was detected and safely removed before any injury occurred. This case report discusses the presentation and pathophysiology of nasal foreign bodies. Moreover, applicable suggestions are provided to aid in the prevention and management of the unexpected discovery of a nasal foreign body after the induction of general anesthesia.

Nasal foreign bodies in children: considerations for the anesthesiologist.

The combination of a curious young child exploring his/her nasal cavities, with the abundance of small inert and natural objects in our society, culminates in a significant number of nasal foreign bodies (NFBs). Usually NFBs are benign entities, yielding relatively simple resolutions and mild morbidities. However, their presence can lead to much more serious consequences if they are inserted unwitnessed, grow asymptomatically for several months or years, and significantly affect surrounding tissues. Moreover, if these substances become displaced posteriorly and enter the lower respiratory tract, dire circumstances may occur. This article discusses the different types of NFBs, various clinical presentations, diagnosis, pathophysiology, and pertinent considerations for the anesthesia care provider. Increasing one's awareness of the implications of NFBs, can optimize the safe treatment of patients harboring this development.

Geriatric patients: oral health and the operating room.

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.

Perioperative dental considerations for the anesthesiologist.

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.

Dental considerations for cardiac surgery.

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.

Considerations for the use of enteral sedation in pediatric dentistry.

Treating an uncooperative, uncontrollable child can be unpleasant for all parties involved. Despite the dentist's best efforts to employ traditional techniques, the behavioral management of challenging pediatric dental patients often requires more than "tell, show, do". Consequently, pre-operative pharmacological intervention may be necessary. Enteral sedation may be the optimal adjunct for the dental treatment of such a challenging patient population. However it must be utilized with caution and is not an appropriate treatment modality for all. This paper will present various considerations for the safe, appropriate and effective use of enteral sedation in contemporary pediatric dentistry. With the strong demand for this service, properly trained practitioners can broaden their practice and provide a win-win scenario for themselves and their patients.