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PAU Guidelines for Anesthesia in Dental Clinic vs. Main OR

 

In general, the Dental Clinic OR has a more comfortable ambience for patients. Presence of family for induction is easily accomplished. Waiting times are generally shorter.

 

The staff at the Dental Clinic at the Ottawa Hospital often care for patients who have impaired cognition, or a variety of comorbidities that require anesthetic services to accomplish their dental care. The clinic, while well equipped, is considered a “Remote Location”, and there are limitations of available personnel and equipment as a result.

 

Patients suitable for dental clinic procedures requiring general anesthesia include :

1.            Patients should be cooperative, or can be managed safely with oral sedation and reassurance from dental clinic staff, family members or case workers that accompany the patient.

 

In the dental clinic setting, oral Midazolam in a dose of up to 0.5 mg/kg not exceeding 30 mg mixed with 650 mg acetaminophen elixir can be used as a preoperative sedative ½ hour prior to the procedure for patient anxiety and agitation. Intramuscular sedation with Ketamine should rarely be used and physical restraints should be used infrequently and only to protect the patient and staff. If the patient requires intramuscular Ketamine or physical restraints, the care givers should consider cancelling the case and rebooking it in the main OR.

 

If it is anticipated that the patient is violent, or additional help may needed to restrain the patient, please refer them to the Main OR.

 

2.            Patients must have an airway that can be managed with airway adjuncts such as glidescope, bougie, lighted stylette, LMA. If awake fiberoptic intubation, major difficulty with bag-mask ventilation or possible emergency surgical airway is anticipated, this patient should be referred to the Main OR.

 

3.            Patients must have comorbidities that can be managed safely in a remote location .

If the patient is very medically complex, and there is a potential need for the presence of anesthesia colleagues, crash cart or echocardiography, please refer them to the Main OR.

 

4.            Patients must not require extended postop monitoring

Patients who require postop monitoring, such as MH susceptible patients, should be referred to the main OR. Because local anesthesia is used, long-acting opioids are rarely used and OSA patients may not need extended monitoring. Pacemaker/ AICD patients rarely, if ever, require re-programming as cautery is seldom used.

 

 

 

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