فصل 5 بیهوشی های مالامد

1. ‫عمومی‬ ‫مالحظات‬
‫بیهوشی‬ ‫در‬

2. syncope (common faint) is the medical emergency most
often reported in the dental environment, accounting for
more than 50% of all emergencies
initial management of the unconscious person,
regardless of cause, is the same; these steps are
directed primarily toward certain basic, life-sustaining
procedures: P (position), C (circulation), A (airway), and
B (breathing)

3. Predisposing factors
(1) stress, (2) impaired physical status, and (3) the
administration or ingestion of drugs.
And Others :
NEUROGENIC CAUSES :Breath holding
VASCULAR CAUSES:Cerebrovascular disease
ENDOCRINOPATHIES:Hypoglycemia
EXPOSURE TO TOXINS AND DRUGS
Psychogenic problems
Cardiogenic causes:Dysrhythmia
DISORDERS OF OXYGENATION:Anemia

4. Prevention
• Loss of consciousness can be prevented in many, if not most,
instances by a thorough pretreatment medical and dental
evaluation of the prospective patient. Important elements of
this evaluation include a determination of the patient’s ability
to tolerate the stresses—both physiologic and psychological—
associated with their planned treatment
• The supine position (ideally with the feet elevated about 10 to
15 degrees) prevents the decrease in cerebral blood pressure
that is the most common mechanism producing syncope.
Increasing the use of the supine position during dental
treatment has the potential to dramatically decrease the
number of episodes of syncope occurring during dental
treatment

5. Pathophysiology
• 1. Reduced cerebral metabolism resulting from
inadequate delivery of blood or O2 to the brain
• 2. Reduced cerebral metabolism resulting from general
or local metabolic deficiencies
• 3. Direct or reflex effects on that part of the CNS that
regulates consciousness and equilibrium
• 4. Psychic mechanisms affecting levels of
consciousness with their respective mechanism or
mechanisms.

6. Management
1. Recognition of unconsciousness
2. Management of the unconscious victim, including the
recognition of possible airway obstruction and its
management

7. Recognition of unconsciousness
• Step 1: Assessment of consciousness.
• Step 2: Termination of dental procedure.
• Step 3: Summoning of help.

8. Management of the unconscious
patient
• Step 4: P—Position victim.

9. Management of the unconscious
patient
• Step 5: C—assess circulation.

10. Management of the unconscious
patient
• Step 6: A—Assess and open airway

11. Management of the unconscious
patient
• Step 7a: B—assess airway patency and breathing

12. Management of the unconscious
patient
• Step 7b: B—rescue breathing (if necessary).

13. Management of the unconscious
patient
• Step 8: D—definitive management
End
Q&A?