General Anesthesia: A Cutting edge of treatment in pediatric patients

Rapid growth of population is very dynamic as it depends upon the physiologic processes that undergoes drug disposition and rapid changes in pediatrics. Pharmacological consideration requires the specifications in pediatric patients. During administering general anesthesia to children, the surgeons should have a brief knowledge on pharmacologic, physiological differences between the adults and infants.

General Anesthesia

The immediately before, during, and after surgery (perioperative period) immediately is a critical time for pediatric patients. Medications provides a blunt physiologic response and render patients unaware of what is being done to or around them. The increased risk for mortality and morbidity in the perioperative period demands the utmost vigilance. Such risks may be increased in certain disease states. The purpose of general anesthesia is to suppress the conscious perception of, and physiologic response to, noxious stimuli and to render the patient unconscious.

Phases of Anesthesia are:

·         Preanesthetic Phase

·         Induction Phase

·         Maintenance Phase

·         Reversal Phase

Preanesthetic Phase: Numerous classes of medications can be given to children as anticholinergics, histamine blockers, sedatives, analgesics,) during the preanesthetic phase. The phase ensures that the patient arrives in the operating room in a relaxed manner, calm without compromised breathing or impaired cardiovascular status.

Induction Phase: General anesthesia is induced with either inhalation or intravenous (IV) medications. In most instances, the volatile anesthetic agents are preferred in children over IV medications because they do not require IV access. IV medications are used to induce anesthesia in children only in rare circumstances mostly in case of hyperthermia.

Maintenance Phase: This phase is the period between induction and emergence. During this time, the child should be asleep, hemodynamic responses to painful stimuli, and homeostatically supported Neuromuscular blockers are used during muscle paralysis is needed.

Reversal Phase: The volatile inhalation agents rapidly leave the lungs during ventilation and thus do not require other products to reverse their actions.

The above phases are administered for the treatment in infants and pediatric patients.

Is Oral surgery a safety precaution for Dental Management??

Drugs controlling pain, some help to, and while others put into a deep sleep-like state during dental treatment that is termed as dental anesthesia. Local anesthesia is a specific kind of medication prescribed for the prevention of pain in specific area of mouth during the treatment procedure by blocking nerves or transmitting the pain that numbs

the tissues of mouth.

Anesthetics are used topically in painful soothing and mouth sores. Injectable anesthetics are useful in filling cavities, preparing teeth for crowns and treating gum disease. Local anesthetics are classified into maxillary anesthesia and mandibular anesthesia.

Maxillary Anesthesia:

Local anesthesia is deposited at the buccal (cheek) side of the maxillary alveolus which can diffuse through the thin cortical plate of the maxilla, then further into the pulp of the tooth in order to achieve dental anesthesia effect.

Mandibular Anesthesia:

Both infiltration techniques regional block is considered the first-choice injections for anaesthetizing the mandibular teeth.

Different techniques are chosen depends upon different factors:

·         Patient age

Infiltration anesthesia is the preferable method to anesthetize deciduous/ primary teeth in children. The method is like the maxillary buccal infiltration. Ensure the lip/ cheek is stretched in a lateral and inferior direction instead of superiorly and the needle is then penetrated 45’ with the buccal cortical plate of the bone through the taut tissue of the mucco-buccal fold.

·         Tooth to be anesthetized

Infiltration anesthesia should be the first choice of method for pulpal and soft tissue anesthesia of mandibular permanent incisors in adults. Regional block injections are sometimes ineffective due to crossover innervation from the opposite side of inferior alveolar nerve. It is recommended to deposit at least 0.5mL at each buccal and lingual site in the apical region of the tooth of interest. The use of infiltration anesthesia with 4% articaine with 1:100,000 epinephrine in obtaining pulp anesthesia of the mandibular permanent first molar is getting more common these days due to its successful formulation.

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Does Atrial fibrillation after surgery poise a risk?

Post-operative atrial fibrillation (POAF) often is sacked as a transient phenomenon. POAF can significantly increase the risk of stroke and heart attack during the first 12 months after surgery. In bladder cancer patients undergoing a cystectomy i.e., removal of bladder they experience near about 30% of stroke and patients that are aware of POAF they might experience a stroke within a year of surgery.

The postoperative atrial fibrillation is vigilant, transient and establishes the risk of cardiovascular morbidity. Atrial fibrillation is defined as a rapid and irregular heartbeat which decreases the flow to the body. Patients having chronic A-fib are posed to have higher risks of heart failures. Combinations of New onset Postoperative Atrial Fibrillation predicts the long-term cardiovascular events followed by Radical Cystectomy. In order to identify these results several rectal operations to be handled in a proper manner to optimize the best results.

Risks:

Heart attack is a death segment of a heart muscle caused by a loss of blood supply. Blood is cut off when an artery supplying heart muscle is blocked by a blood clot.  It is aroused with the indication of chest pain and electrical instability of heart muscles. Heart attacks are fatal, and it is vital and necessary to recognize the warning signs during the attack. These can be cured by surgical treatments. Surgery of heart is termed as cardiac anesthesia.

Stroke usually occurs when the supply of blood is either reduced or interrupted or reduced. It happens when the brain does not get enough nutrients, oxygen and the brain cells tend to die. It is classified into three types:

Hemorrhagic stroke: It is a result of arteriovenous malformations (AVMs) due to rupture of a weakened blood vessel

Ischemic Stroke: A blood clot prevents oxygen and blood from reaching the brain.

Transient ischemic attacks (TIAs): Also known as mini stroke, it occurs after blood fails to reach the part of brain.