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Anaesthetic and analgesic considerations in dentistry and oral surgery

image of Anaesthetic and analgesic considerations in dentistry and oral surgery
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Abstract

Dental and oral surgical procedures present the clinician with unique challenges in terms of anaesthetic techniques and skills. This chapter provides information on the anaesthetic techniques and skills required in dental and oral surgical treatment, as well as management of perioperative pain.

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Figures

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6.1 An example of an anaesthetic record sheet. (Courtesy of the University of Helsinki)
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6.4 Anaesthetic trolley ready for use.
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6.6 Endotracheal tube secured with a coloured plastic tie (Trinity Trach-Tube Ties; www.trachtubeties.com) in a 5-year-old female spayed European Domestic Shorthaired cat that showed difficulty closing the mouth due to a fractured and displaced right maxillary fourth premolar tooth.
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6.7 Pharyngotomy intubation. (a) Anatomical location of incision. (b) Diagram of tube placement through the pharyngotomy site. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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6.8 Wire-reinforced pharyngotomy tube in place. (Courtesy of Dr J. Yee)
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6.9 (a) Sponge flange mouthpack. (b) Pack placed to occlude the pharynx around the endotracheal tube.
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6.10 Simple intravenous fluid pump.
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6.11 (a) Bair Hugger™ forced air pump. (b) Warm water circulating under-blanket. (c) Darvall over-blanket for use with a Bair Hugger™ warming unit.
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6.12 Selection of (A) lip/cheek holders, (B) rubber mouth props and (C) a spring-loaded gag. Use of a spring-loaded gag should be avoided.
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6.21 (A) Dental aspirating syringe with thumb ring. (B) Glass vial containing mepivacaine. (C) Needle.
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6.23 Right infraorbital nerve block in a dog. (a and c) Skull demonstration. (b and d) Clinical case. The needle has been inserted into the infraorbital canal to provide analgesia to the maxillary fourth premolar tooth and surrounding tissues. To be effective it only needs to be placed just past the infraorbital foramen, decreasing the risk of iatrogenic trauma to the neurovascular bundle. (© Dr Alexander M. Reiter)
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6.24 Right maxillary nerve block in a dog. (a) Skull demonstration. (b) Clinical case. (© Dr John Lewis)
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6.25 Right major palatine nerve block (rostral approach) in a dog. (a) Skull demonstration. (b) Clinical case. (© Dr John Lewis)
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6.26 Intraoral right inferior alveolar nerve block in a dog. (a) Skull demonstration. (b) Clinical case. (© Dr John Lewis)
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6.27 Right middle mental nerve block in a dog. (a) Skull demonstration. In this case the needle was inserted into the middle mental foramen, but this should be performed with caution as damage to the vessels and nerve is possible. (b) Clinical case. The tip of the needle was placed near the middle mental foramen to anaesthetize the rostral mandibular soft tissues. (© Dr John Lewis)

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