Pain can be surface somatic (caused by injury to skin), deep somatic (if bones and muscular system damaged), and visceral. A special type of pain is psychogenic pain that occurs in the absence of somatic visceral or neuronal damage and is caused by psychological and social factors.
For modern dentistry, along with quality treatment, the main purposes are to provide patients with comfortable conditions of dental treatment, physical and psychological well-being (before, during, and after treatment,) – it means, first of all, absence of pain, anxiety and fear.
To deal with local manifestations of pain, local anesthesia is used. Local anesthesia relieves or prevents pain in patients who stay conscious. Anesthesia is administered directly to the area requiring dental treatment, in which local pain occurs. After a short period of time this type of anesthesia wears off.
However, local anesthesia does not help to cope with psychogenic pain, anxiety and fear (phobia).
Sedation is used for further correction of the above-mentioned conditions.
General Anaesthesia in Dentistry
Sedation is the administration of drugs to put a patient in the state when they can tolerate unpleasant and painful treatment.
The patient may perceive sedation as "drowsiness", "intoxication", "euphoria", "comfort", "numbness", etc.
A modified sedation scale, a variant of Ramsey and colleagues’ scale assess the sedation level:
|RAMSAY SEDATION SCALE |
|SEDATION LEVEL ||CLINICAL PICTURE |
|I ||The patient is awake, active, restless, conscious. |
|II ||The patient is focused, tranquil, oriented, experiences drowsiness. |
|III ||The patient feels sleepy, wakes up easily in response to commands, follows them - light sleep, normal speech. |
|IV ||The patient is asleep, exhibits brisk and with a short delay response to a loud sound – light sleep, but the patient responds to a normal physical stimulus, for example light glabellar tap |
|V ||The patient is asleep, sluggishly and with a significant delay responds to a loud sound - asleep, but responds to a physical stimulus. |
|VI ||The patient is asleep, exhibits no response to auditory and painful stimuli – the condition is similar to general anesthesia. |
Thus, level VI sedation, together with levels of analgesia, amnesia, and anesthesia reached, is general anesthesia. And the preceding sedation levels are its initial stages.
Analgesia is the inability to feel pain.
Amnesia is the inability to recall (unpleasant) events.
Anesthesia is a medically induced state of unconsciousness with analgesia, which enables the performance of painful or life-threatening diagnostic and \ or treatment procedures. Most vital reflexes are absent, which requires the specialist’s intervention to monitor vital functions and guarantee a positive outcome and a patient’s safety.
It should be noted that the traditional understanding of the dental treatment "under sedation" is nothing but dental treatment under lower sedation levels (levels II-IV) that is accompanied by neither analgesia nor amnesia nor anesthesia. This means that the patient receives dental treatment accompanied by pronounced pain, cannot adequately respond to pain (as he or she is in light sleep) and remembers it after treatment. All this causes subsequent psycho-emotional changes (fear, psychogenic pain, anxiety, etc.) associated with dental treatment.
General anesthesia is a controlled state of suppressed consciousness accompanied by a partial or complete loss of protective reflexes, a method of pain relief that leads to a state of artificial sleep. This is done by the use of modern drugs that allow an anesthesiologist to monitor the patient's breathing, do not cause side effects, and are quickly removed from the body.
Dental Treatment under General Anesthesia
Only a well-trained anesthesiologist can administer anesthesia because of the risk of possible side effects (cardiovascular and respiratory depression caused by an overdose of propofol used for intravenous anesthesia and an overdose of sevoflurane used as an inhalation anesthetic), and the need to monitor a patient’s vital functions at sedation levels IV and V. It is proved that it is not possible to avoid short (several seconds long) periods of level IV sedation under any type of sedation.
Therefore, intravenous cannulation is required for each patient to provide venous access during the treatment procedure (under intravenous and inhalation anesthesia!!!) both at the initial levels of sedation and under general anesthesia (level VI sedation). These requirements should also be observed to prevent and treat allergy reactions (if any) to local anesthesia during dental treatment and administration of antibiotics after tooth extraction.
What to Choose for Dental Treatment?
During teeth treatment, the anesthesiologist’s main goal when administering general anesthesia is to achieve analgesia and amnesia. They provide effective pain and anxiety management, without which many patients are practically unable to undergo the required treatment. Some of pain management methods help provide dental care to particularly vulnerable patients, such as children, the elderly and the disabled.
- it is necessary to provide venous access throughout the treatment process under any type of anesthesia (inhaled or intravenous) to secure the safety of procedures;
- less pronounced side effects compared with inhaled and narcotic anesthetics;
- rapid action and dose-dependent effects (the effect starts within the first few seconds of the drug infusing and ends within 4 minutes after stopping infusing it);
- the most supervisable and controllable effect;
Dentistry under General Anesthesia
PROPOFOL FRESENIUS is the drug of choice to meet the above-stated goals and administer intravenous anesthesia in dental practice. It has anesthetic and sedative pharmacological effect: acts nonspecifically on lipid membranes of the CNS neurons. It has no primary excitatory influence. Anesthesia recovery does not usually cause headache, postoperative sickness, and vomiting. General anesthesia in most patients begins to take effect within 30-60 seconds.
The duration of anesthesia, depending on the dose and concomitant medications, vary from 10 minutes to 1 hour or more. The patient wakes up from anesthesia quickly and in clear consciousness, they are able to open their eyes in 5-10 minutes.