Preoperative Medical Evaluation: Part 1: General Principles and Cardiovascular Considerations

Abstract

A thorough assessment of a patient's medical status is standard practice when dental care is provided. Although this is true for procedures performed under local anesthesia alone, the information gathered may be viewed somewhat differently if the dentist is planning to use sedation or general anesthesia as an adjunct to dental treatment. This article is the first of a 2-part sequence and will address general principles and cardiovascular considerations. A second article will address pulmonary, metabolic, and miscellaneous disorders.

Hospital dental practice in special patients

“…Hypertensive patients can develop complications such as ischemic heart disease, stroke, renal failure, heart failure, blindness, and even malignant hypertension - a serious emergency condition (7,8). …”

“…In addition, the patient should be placed in the Trendelenburg position, vagal nerve maneuvering may be used, and we should be prepared to perform life support measures and to emergency evacuate the patient if necessary (7,8). …”

“… Table 1 shows the measures indicated for preventing infectious endocarditis in these patients (7,11). …”

Preoperative Medical Evaluation: Part 2: Pulmonary, Endocrine, Renal, and Miscellaneous Considerations

“…1 Although the categories of disease addressed in these articles are so complex that they justify a medical specialty dedicated to each, our focus is to provide only a basic understanding of the pathophysiologic features of the principal conditions. This will enable the provider to comprehend the patient's status and to properly design a plan for appropriate management while providing dental care.…”

Recognition and Management of Complications During Moderate and Deep Sedation Part 1: Respiratory Considerations

“…Principles of preoperative assessment have been reviewed in previous continuing education articles in this journal. 1,2 Airway management is the most important aspect of patient care and examination of the patient's airway is an essential component of the preoperative assessment. Documentation of a Mallampati airway classification, or more specifically the Samsoon and Young modification of the original classification, has become a standard of care when providing any level of sedation or general anesthesia 3,4 ( Figure 1).…”