- Preoperative Assessment and Screening: Conduct a detailed history of the patient’s substance use, including type, duration, frequency, and last use, to identify risks of acute intoxication, withdrawal, or comorbidities like liver dysfunction. This is crucial for tailoring sedation plans and deciding whether to proceed or delay the procedure.
- Tolerance and Drug Dosing Adjustments: Patients with substance abuse often have cross-tolerance to sedatives and opioids, requiring higher doses for effective IV or oral sedation, but careful titration is essential to avoid overdose or respiratory depression during the extensive dental procedure.
- Withdrawal Prevention and Management: Continue any medication-assisted treatment (e.g., buprenorphine or methadone) and monitor for withdrawal symptoms like agitation or tachycardia, which could complicate sedation and recovery in an ambulatory setting.
- Airway and Hemodynamic Monitoring: Heightened vigilance for airway issues (e.g., aspiration risk from alcohol or opioid use) and cardiovascular instability (e.g., from stimulants), especially during IV sedation for a procedure involving oral manipulation and potential bleeding.
- Multimodal Pain Management and Relapse Prevention: Use opioid-sparing techniques postoperatively, such as NSAIDs, acetaminophen, or regional blocks, to manage pain from extractions and implants while minimizing relapse risk, with psychological support and follow-up referrals.
Top 5 Anesthetic Considerations for a Patient with Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease increases anesthetic risk during dental procedures due to limited respiratory reserve and sensitivity to sedatives. This article outlines five key considerations to support safe sedation, oxygen management, and respiratory monitoring.
