Lecture 14- Anesthesia of the Dental Patient

Dental anesthesia principle

Anesthesia is repetitive but NOT one‑size‑fits‑all; patient‑specific planning required

Know your patient

History; physical exam; diagnostics; comorbidities

Know the procedure

Duration; location; variation; expected stimulation level; access limitations

Common canine comorbidities

Heart disease; hyperadrenocorticism; diabetes mellitus; osteoarthritis; obesity

Common feline comorbidities

Kidney disease; hyperthyroidism; GI/pancreatic disease; obesity; musculoskeletal disease

Dental procedure challenges

Positioning/moving; wet/cold environment; changing pain level; limited access for monitoring

Patient experience: mild–moderate stimulation

Imaging (dental, CT); scaling (hand/ultrasonic); polishing; gingival exam/probing

Patient experience: moderate–high stimulation

Extractions (simple/complex); root pathology; fracture management; tumor surgery; implants

Anesthetic management components

Drugs (before/during/after); monitoring; equipment prep; positioning/padding checks; capnography

Anesthetic plan drugs

Gabapentin pre‑hospital; opioid/sedative premed; propofol/alfaxalone induction; dental local anesthesia; NSAID if needed

Difference in dental anesthesia

Increased stimulation variability; wet/cold environment; airway access challenges; monitoring interference

5 P’s of anesthesia

Prior Preparation Prevents Poor Performance: know comorbidities; diagnostics; stabilization; monitoring needs; additional drugs

Additional drugs during dental anesthesia

Blood pressure support; MAC‑reducing drugs; drugs for comorbidity support

Dental anesthesia complications

Tracheal lacerations; aspiration; corneal ulcers; cardiovascular compromise; pain; hypothermia; vision loss

Tracheal laceration: cause

Traumatic intubation; movement during procedure; cuff overinflation

Tracheal laceration: recognition

Subcutaneous emphysema; respiratory distress; abnormal airway sounds

Tracheal laceration: treatment

Oxygen; supportive care; surgical repair if severe

Aspiration: cause

Water pooling; improper positioning; regurgitation; inadequate airway protection

Aspiration: recognition

Coughing; increased respiratory effort; crackles; hypoxemia

Aspiration: treatment

Oxygen; antibiotics if pneumonia; supportive care

Corneal ulcer: cause

Inadequate lubrication; debris; poor positioning; prolonged anesthesia

Corneal ulcer: prevention

Lubricate eyes; protect from water spray; avoid pressure on globe

CV compromise: cause

Hypotension from anesthetics; blood loss; comorbidities; prolonged procedure

CV compromise: management

Adjust anesthetic depth; fluids; vasopressors; monitor BP closely

Pain: cause

Extractions; fracture management; periodontal manipulation

Pain: management

Multimodal analgesia: opioids, NSAIDs, gabapentin, local blocks

Hypothermia: cause

Wet environment; prolonged anesthesia; small patients; cold surfaces

Hypothermia: prevention

Warmers; dry patient; warm fluids; minimize wet exposure

Vision loss: cause

Hypoperfusion; increased intraocular pressure; corneal trauma

Vision loss: prevention

Maintain BP; protect eyes; avoid pressure on globe

Post‑procedure considerations

Pain management; lingual trauma monitoring; rare complications; use clinical judgment

Dental anesthesia airway challenges

Water spray; limited access; mouth open; monitoring interference

Dental local anesthesia importance

Reduces MAC; improves analgesia; stabilizes hemodynamics

Positioning concerns

Neck rotation; jaw manipulation; pressure points; airway security

Wet/cold environment risks

Hypothermia; aspiration; equipment malfunction

Changing pain level

Requires dynamic anesthetic adjustments; anticipate stimulation spikes

Monitoring challenges

Capnography interference; limited visualization; movement during procedure

Blood pressure support options

Dopamine; dobutamine; ephedrine; phenylephrine depending on cause

MAC‑reducing drugs

Opioids; benzodiazepines; ketamine (low dose); lidocaine CRI

Comorbidity‑specific support

Cardiac: avoid hypotension; renal: avoid nephrotoxic drugs; endocrine: maintain stability; diabetic: glucose monitoring

Dental patient obesity concerns

Hypoventilation; airway difficulty; dosing adjustments; positioning challenges

Hyperthyroid feline anesthesia

Avoid ketamine; monitor HR/BP; increased sensitivity to catecholamines

Cushing’s canine anesthesia

Delayed healing; hypertension; increased infection risk; stress intolerance

Diabetic anesthesia

Avoid prolonged fasting; monitor glucose; adjust insulin; avoid dextrose unless needed

Kidney disease feline anesthesia

Avoid NSAIDs; maintain perfusion; careful fluid management

Osteoarthritis anesthesia

Positioning support; padding; avoid painful manipulation

Airway protection strategies

Cuffed ET tube; suction; pharyngeal packing; head elevation

Capnography importance

Detects hypoventilation; airway obstruction; apnea; equipment issues

Dental procedure movement

Anticipate head repositioning; secure ET tube; adjust monitoring equipment

Lingual trauma

Rare; caused by manipulation or biting; monitor post‑op

Pain prediction

High during extractions; moderate during scaling; variable during fracture/tumor surgery

Anesthetic complication prediction

Hypotension; hypothermia; airway obstruction; aspiration; ocular injury

Dental CT anesthesia considerations

Longer duration; increased radiation safety; deeper anesthesia required

Sedation vs general anesthesia

Dental procedures require GA due to airway protection + pain control

Pre‑hospital gabapentin

Reduces anxiety; decreases MAC; improves perioperative comfort

Opioid/sedative premed

Provides analgesia + anxiolysis; reduces induction dose

Propofol/alfaxalone induction

Rapid airway control; smooth induction; titratable

NSAID use

Only if renal function adequate; avoid in cats with CKD; avoid in hypotension

Dental anesthesia risk summary

High stimulation variability; airway challenges; wet environment; comorbidities increase risk