Preoperative Medical Evaluation: Part 2: Pulmonary, Endocrine, Renal, and Miscellaneous 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 provide sedation or general anesthesia as an adjunct to dental treatment. This article, the second of a 2-part sequence on preoperative assessment, will address pulmonary and other noncardiovascular disorders.

The use of general anesthesia to facilitate dental treatment in adult patients with special needs

“…Where possible, to supplement information about medical history, a cardiac and pulmonary examination is also recommended. Similarly, the patients' physical stamina during exertion could be observed as part of this examination in cases where such information is otherwise unobtainable [ 23 25 28 ].…”

“…Few respiratory diseases cause significant alterations to the anesthetic management of patients. Nonetheless, post-operative lung complications constitute a significant proportion of morbidity and mortality, often being reported at higher rates than cardiac complications [ 28 32 ]. Specifically, the literature mentions an increased risk of atelectasis, infection, the necessity for prolonged mechanical ventilation, respiratory failure, exacerbation of underlying chronic lung disease, and bronchospasm [ 23 ].…”

“…In all pulmonary conditions, the most important aspects to consider in an assessment are the precipitating factors of disease exacerbation, the severity of the condition, and medical management. For patients with clinically significant chronic obstructive pulmonary disease, peri-operative oxygen should be administered with caution to avoid causing respiratory depression through elimination of the hypercapnic drive [ 23 28 ]. Additionally, a history of apnea should be recorded to ensure appropriate post-operative airway management.…”

Hospital dental practice in special patients

“…Once the degenerative disease has started to produce symptoms, early rehabilitation of the oral cavity should be carried out, with the adoption of preventive measures referred to hygiene and bacterial plaque control (12,27,28). …”

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).…”