- Fracture Risk and Careful Positioning: Patients with severe osteoporosis have fragile bones, increasing the risk of iatrogenic fractures during the procedure. Ensure gentle handling, proper padding of pressure points, and avoid excessive force or awkward positioning, especially in the head, neck, and jaw areas for dental implants.
- Medication Review and Interactions: Review the patient’s osteoporosis medications, such as bisphosphonates, which can lead to osteonecrosis of the jaw (ONJ)—a critical concern in dental implant procedures. Adjust or pause if necessary, and consider drug interactions with sedatives that could affect bone healing or increase bleeding risk.
- Airway and Respiratory Management: Elderly patients may have reduced respiratory reserve; choose sedation agents that minimize depression (e.g., avoid deep sedation). Monitor closely for airway obstruction or aspiration, particularly with IV sedation, and be prepared for potential difficulties due to bone fragility in the mandible or teeth.
- Sedation Choice and Titration: Opt for minimal to moderate sedation (oral or IV, e.g., midazolam or dexmedetomidine) to balance anxiolysis with safety, as deeper levels increase risks like hypotension or prolonged recovery in the elderly. Titrate doses lower due to age-related pharmacokinetic changes.
- Postoperative Monitoring and Fall Prevention: Heightened risk of postoperative delirium, falls, or fractures due to residual sedation effects and frailty. Provide extended observation, multimodal pain control (non-opioid preferred), and strategies like reorientation to ensure safe recovery.
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.
