Contraindications for general anesthesia in dentistry

Chief editor of the site:

Snitkovsky Arkady Alexandrovich

Chief physician of the professorial dentistry “22 Century”, dentist, orthopedic dentist

Author of the article:

Scientific team of dentistry “22 Century”

Dentists, candidates and doctors of medical sciences, professors

There are and cannot be absolute contraindications for general anesthesia in dentistry, because, you must agree, the procedure of general anesthesia (anesthesia) in the 21st century can be used at any time, both for the treatment of acute, emergency conditions, and for planned medical procedures. Another question is HOW to carry out general anesthesia SAFELY, where to carry it out, under what conditions? Emergency or delayed, with lengthy preparation?

General anesthesia contraindications

As already mentioned, contraindications to both superficial (sedation) and deep anesthesia during dental treatment can only be relative, not allowing the planned non-emergency intervention to be performed “right now”, requiring time to prepare the patient for this type of anesthesia. This:

General anesthesia for dental treatment

• Decompensated , in simple terms, untreated chronic diseases, such as: Hypertension and other diseases of the cardiovascular system;
• Bronchial asthma;
• Diabetes;
• Other diseases in the stage of decompensation.

What to do if you get sick after laser vision correction?

Catching ARVI is unpleasant. But discovering signs of a cold immediately after laser vision correction is also alarming! How will this affect the outcome of the operation? There is enough frightening information on this topic on the Internet, so to avoid panic, we will tell you what the patient can expect in this case and how to act.

Any wound is a gateway to infection

Laser vision correction is a low-traumatic procedure, but it is still a surgical intervention. It leaves a wound surface that is vulnerable to infections. To prevent them from getting into the wound:

• the patient must be healthy at the time of the operation (fever, runny nose, cough, herpetic rashes appear - the operation should be postponed);
• after vision correction, the doctor must prescribe antibiotic drops, which must be dripped according to a certain pattern;
• You must follow post-operative restrictions (do not visit the pool, sauna, solarium, do not use cosmetics, etc.).

Before surgery, the patient must be explained how important it is to comply with these conditions. Laser vision correction is an outpatient procedure. After it, the patient remains at home, without round-the-clock medical supervision, and successful restoration of the cornea depends, among other things, on following medical recommendations. We talked about this in detail here.

But then the unexpected happened.

Yesterday you had vision correction surgery, you returned home (even, perhaps, you had already left for another city), you did everything as prescribed, and the next day your temperature rose. Is it really urgent to return to the clinic to see the surgeon?

What to do?

The first thing you need to do is calmly analyze your well-being. Perhaps the increase in temperature is the body’s response to your experiences associated with the operation and preparation for it. This is just a psychosomatic reaction that will pass in a day. This is rare in sensitive and emotional patients, but it does happen.

If a cough and runny nose appear along with a fever, start treatment as you usually do for ARVI. But with some limitation: drugs and procedures that can irritate the mucous membrane of the eye (steam inhalation, essential oils) are not recommended. If necessary, contact a related specialist (ENT specialist, therapist) so that specific treatment can be prescribed. It can be safely combined with medications prescribed by an ophthalmologist after laser vision correction.

Treat your cold as usual and don’t forget to put drops in your eyes after laser correction - the medications can be easily combined.

All this time you need to carefully monitor the condition of the eye and the nature of the discharge from it.

What's within normal limits

The eye may be slightly pink, there may be a light, translucent mucous discharge, more often after sleep, there may be discomfort from dryness and itching. These symptoms are associated with the reaction of the eye to mechanical damage to tissue during surgery, and this is a normal variant. They will go away within one to two weeks after surgery. Continue to drip the medications prescribed by the surgeon according to the pre-agreed schedule.

What should you be wary of?

If your eye becomes swollen or begins to fester during a cold, consult a doctor immediately.

If the eye becomes very red, swollen, pain appears, and/or the discharge becomes yellowish-green (purulent), you need an in-person consultation with an ophthalmologist!

After the operation, preventive examinations are provided to assess the condition of the cornea after 1 day, 7 days, 1 month. If alarming symptoms appear, call the clinic immediately, without waiting for a preventative visit. It is urgent to prescribe additional treatment, as an infection has developed.

The antibiotic included in the drops that were initially prescribed by the doctor after surgery is not effective for all microorganisms, and those that are not sensitive to it may be activated. The instillation regimen or choice of drug must be adjusted.

What are the dangers of infectious complications?

Fortunately, all possible complications that may arise as a result of an infection are reversible and can be easily treated with medication. Provided that the therapy is carried out in a timely manner.

The healing of the corneal flap will slow down. The eye will need more time to recover, but this will not affect the quality of vision in the future.

Of the most significant, it is worth highlighting keratitis (inflammation of the cornea), in which infiltrates appear in the cornea and it becomes cloudy. Keratitis is usually accompanied by pain and sensitivity to light. It can be caused by bacteria, viruses, and fungi. The treatment regimen depends on the cause of keratitis, which only a specialist can identify. Antibacterial, antifungal or antiviral therapy will be required. For treatment, eye drops, tablets or injections are prescribed.

At the first signs of keratitis, you should consult an ophthalmologist as soon as possible. In the early stages it is successfully treated. If you delay visiting a doctor, scars may remain on the cornea after treatment and the quality of vision will deteriorate. In addition, the infection can spread to other structures of the eye, which can lead to blindness.

Quick and timely measures will help avoid serious consequences!

You need to know about this in advance

Infectious complications can significantly affect the course and timing of the recovery period. To avoid them, after surgery:

• strictly follow your doctor's recommendations;
• if possible, avoid contact with infectious patients or observe the quarantine regime (mask, ventilation);
• dress according to the weather;
• delay any vaccinations for at least a month.

If you do get sick immediately after laser vision correction, be treated as usual, but be attentive to the symptoms. If you have any concerns, do not hesitate to contact an ophthalmologist. Preferably in the same clinic where the operation was performed. If this is not possible (for example, for out-of-town patients), then contact an ophthalmologist at your place of residence.

Good vision to you!

Dangers of anesthesia due to a cold

As is known, ARVI is characterized primarily by damage to the respiratory tract and can occur in various forms - bronchitis, laryngitis, tracheitis, rhinitis, pharyngitis, which are often caused by a viral infection. The airways are inflamed during a cold and for some time after it, and therefore are very sensitive to the action of external irritants.

Long-term operations under anesthesia are accompanied by intubation, that is, the insertion of a special tube into the lumen of the trachea, which additionally irritates the mucous membrane of the respiratory organs. Such irritation can lead to acute respiratory failure, a condition after which the oxygen level in the blood drops sharply. As a result, oxygen starvation of the brain and other vital organs develops. The consequences can be very serious - after prolonged oxygen starvation, the cerebral cortex is damaged and the patient may not recover from anesthesia.

The warnings apply not only to the acute period of a cold - surgery is not recommended for 2-3 weeks after complete recovery. For any person, surgery is stressful, negatively affecting the immune system. A weakened body is susceptible to the influence of negative factors, so there is a risk of relapse of an infectious disease or infection with a new one. After re-infection, the new disease will be much more severe, even leading to the development of severe inflammatory diseases, such as pneumonia.

A chronic infectious process in the respiratory system during general anesthesia can be complicated by the addition of opportunistic bacterial flora. Weakened immunity after ARVI is not able to fight potentially dangerous microorganisms. It is possible for bacteria to be carried from the primary source of infection (tonsils, nose) into the surgical area, which threatens the development of purulent complications of the operated area.

During anesthesia, the nasal passages must be free of mucus, so if you have a severe runny nose, it is better to postpone the operation. With minor manifestations of rhinitis, you can drip vasoconstrictor drops into the nasal passages.

Surgery under general anesthesia and fever

Is it possible to perform surgery under anesthesia at a fever?

The ability to perform surgery under general anesthesia at elevated temperatures is determined by many factors. It is important to differentiate the cause that caused hyperthermia, as well as to evaluate the level of increase in other indicators of inflammation. A high temperature against the background of a cold is an absolute contraindication to surgery, as is the cold itself.

An increase in temperature for no apparent reason to values ​​exceeding 37.5ºC requires a more thorough diagnosis. It can be assumed that hyperthermia is associated with the underlying disease for which surgery is planned. As for low-grade fever (up to 37.5–37.8ºС), low-grade fever is not a contraindication to surgery using anesthesia if the patient is not diagnosed with cold symptoms.

Summing up, we can conclude that with the development of ARVI (with a runny nose, sore throat, fever and cough), the planned surgical intervention is best done after the patient has recovered - on average it takes 2 weeks for mild ARVI, in more severe cases - up to 4 weeks.

University

→ Home → University → University in the media → Pills or bed rest? How to treat colds and flu

Clinical pharmacologist with half a century of experience, Professor Mikhail Kevra recommends not to get carried away with medications for seasonal respiratory infections.

The specialist expressed concern about the growing drug addiction among the population and doctors, and also commented on several myths regarding methods of prevention and treatment of colds and flu. The medicine was created, but the virus has changed

— Mikhail Konstantinovich, during the cold season, people actively buy “anti-cold” pills, that is, antiviral pills that are sold without a doctor’s prescription. A typical request to a pharmacy worker is to advise the best. And judging by the advertising, all the drugs are “powerful and work flawlessly.” As a specialist who has spent his entire life studying the effects of medications on the human body, what do you recommend?

- Today not a single name will come out of my mouth. And not only because of the reluctance to support the commercial interests of producers. The fact is that most of the existing so-called. Antiviral drugs only alleviate the symptoms of the disease, but do not have a detrimental effect on the virus itself. Unfortunately, recently created drugs that inhibit the reproduction of viruses are rapidly losing their effectiveness.

This is primarily due to the rapid variability of the antigenic structure of the virus. For example, it has been established that the influenza virus, under the influence of various environmental factors, can change dramatically within 6–10 months and become resistant to those medications that were recently effective. It is impossible to develop a new drug in such a period of time, and the virus will become different again... And this process is endless.

Lie down - and no work!

—So you want to say that if a cold is treated, it will go away in 7 days, but if not, then you will be sick for a week? — The body itself fights the pathogen of ARI. He needs help. The first thing to do is to ensure complete rest (especially in the first three days of the disease). Previously, in clinical guidelines for the treatment of respiratory infections, the first point was to prescribe bed rest, and only then medications. Why? Because the virus greatly weakens the body, and if a person continues to lead a normal lifestyle or, even worse, exposes himself to increased stress, then there is simply no strength left to fight the pathogen. The weaker the immune system, the more actively pathogenic viruses cling and the more opportunistic flora multiplies. Today, unfortunately, the emphasis in treatment has shifted to the use of drugs. The sick person takes pills and continues to go to work. What does this lead to? To a protracted course and the occurrence of complications. In time pressure, it is very difficult to overcome the pathogen. The second important condition for the fight against the virus is plenty of warming drinks (tea with lemon, honey, raspberries, milk with honey, herbal tea). Toxins produced by the pathogen are removed with the liquid. — To hear such recommendations from a clinical pharmacologist, frankly speaking, is unexpected... — There is a pharmacomania in society: many cannot imagine recovery without pills, injections and droppers. And doctors to whom the patient “indicates” that he was prescribed few medications or the wrong ones that help, is easy to understand: sometimes specialists prescribe the required medications under moral pressure, fearing conflicts and complaints. To some extent, they are right: if a person believes that such a drug is effective, a placebo will help him recover. But this has nothing to do with the real effectiveness of the medicine. We must understand that the body perceives any chemical as foreign and hostile. The first reaction of the cells that meet it is protest and fight. It turns out that instead of conserving the strength the body needs to suppress and destroy the pathogen, we force our body to spend it on adapting to the drugs. A comparative study was conducted in the UK: some patients with a respiratory viral infection were treated with antiviral drugs, while others were treated with hot chicken broth with spices. In the group of those who did not take chemicals, the results were better. This was explained not only by the warming effect of the liquid, but also by the presence of extractive substances in the broth that help the body cope with the infection. — Is drug prophylaxis possible for ARI? One of the medications, according to the instructions, can be taken to prevent infection. “It is very difficult to stop the spread of the virus using the drug. I consider regular hand and face washing a much more realistic option. Most often, we get the virus not through inhaled air, but through our hands. He scratched his nose, rubbed his eyes - and the pathogen penetrated the mucous membrane. When coming from the street, after communicating with a sick person, you should immediately wash your hands - and the risk will decrease. But life shows that pharmacologists cannot be convinced of this! Since ancient times, people have used plants containing phytoncides (garlic, onion) to prevent viral infections. — It is not uncommon for people with ARI to prevent complications to take antibiotics like amoxicillin, which can be bought without a prescription... — If complications have not developed, there is no inflammation caused by bacteria, then what is the antimicrobial drug aimed at destroying? To other flora, including microorganisms that are beneficial in the fight against disease. In addition to pathogens, so-called pathogens live on mucous membranes. saprophytic microorganisms that do not themselves cause disease, but help fight the virus. If they are destroyed, the virus has an additional opportunity to survive. The immune system, which has already survived the blow, weakens even more. The use of antibiotics “for prevention” leads to the fact that microbes become increasingly resistant to antimicrobial drugs. Is there any benefit from immunomodulators - The conclusion suggests itself: it is necessary to support the immune system. There are many drugs that stimulate it... - The best immunity against acute respiratory infection is developed in the body after a person has had it. Therefore, in children and young people, the flu is more “brighter” and more often causes complications, because their immune system has less experience in fighting it. But since there are so many pathogens of ARVI, a person gets sick again and again. The second most effective means is vaccination: a weakened pathogen or its antigenic determinants are specially introduced into the body, thereby “warming up” the production of antibodies. The effect of drugs that are positioned as immunostimulants and immunomodulators is questionable. Clinical trials conducted on small groups of people are not proof! In the West, drugs that supposedly stimulate the activity of the immune system are not prescribed because most insurance companies do not pay for such therapy, not seeing any real benefit from it. There is also an assumption that stimulating the production of lymphocytes and other protective cells can simultaneously activate the growth of cancer cells.

Super-persistent myths about vitamins

— What can you say about the advisability of vitamin support for ARI, primarily ascorbic acid? Many are sure that this promotes a speedy recovery and strengthens defenses.

— If there are not enough vitamins in the blood (the deficiency is confirmed by laboratory tests), then replenishment will have a positive effect. But with the same success, other essential substances - amino acids, sodium, calcium and other microelements - will “stimulate” the immune system!

The use of large doses of vitamin C (up to 3 g per day) to prevent colds was proposed by the famous chemist, two-time Nobel Prize winner Linus Carl Pauling.

First impressions of this use of ascorbic acid were optimistic. However, in more in-depth studies based on a double-blind control method (when neither the patient nor the doctor knows which drug is being used), it turned out that the frequency of colds under the influence of high doses of ascorbic acid does not decrease. And yet, there is still an opinion among the population about the miraculous properties of vitamin C. Unfortunately, such advice can also be found in the media.

Many clinical studies back in the 1970s convincingly proved that the administration of high doses of ascorbic acid to people with normal levels of it in the body does not reduce the incidence and severity of colds in either adults or children.

It should be noted, however, that there are situations with ARI when high doses of vitamins really help. For example, with influenza, scarlet fever, measles with hemorrhagic manifestations. In this case, they help strengthen the walls of capillaries.

Vitamins are essential organic substances. They must be constantly supplied with food, since the human body cannot store them for future use. But few are needed.

Vitamins created artificially are chemical substances with pronounced pharmacological activity. In therapeutic doses (which are 2-3 times higher than preventive doses), vitamin C can cause disruption of capillary permeability, which impairs the nutrition of organs and tissues. You need to be careful when prescribing these drugs to pregnant women and those who are planning to conceive: unreasonable use is fraught with disruptions in the course of pregnancy and even threatens the death of the embryo.

— Mothers and pediatricians really like to turn to vitamins... Are they wrong too?

- The child is lethargic and tired - they start feeding him “to raise his tone”, not knowing the level of these substances in the blood. Meanwhile, the child is overloaded at school and in clubs; he simply wants to relax and be in the fresh air. Synthetic substances will not compensate for this deficiency, but they can cause health problems.

It has been established that long-term intake of vitamin C in high doses (for preschoolers and primary school students this is 100-200 mg per day, i.e. 2-4 tablets of ascorbic acid with glucose) can lead to a decrease in the number of red blood cells and hemoglobin in the blood, an increase leukocyte content and a decrease in the number of lymphocytes. Even a single dose of ascorbic acid can provoke tachycardia (an increase in the number of heartbeats per minute), and a long-term dose can disrupt the nutrition of the heart muscle, which is easily determined by an electrocardiogram.

— At the end of winter, many of us are accustomed to buying vitamin complexes...

— Seasonal fluctuations in the content of vitamins in the blood are the norm, not a pathology. In summer and autumn, the level of vitamins in the blood will certainly increase even without taking complexes, and in winter and spring it will decrease.

Vitamins have been known to mankind for about 100 years, but they learned to obtain them artificially a little over 50 years ago. But summer and autumn, winter and spring have always existed, and with them seasonal fluctuations in the content of vitamins in the body. These are normal natural biorhythms that should not be interfered with. It wouldn’t even occur to anyone to “even out” the level of sex hormones during a woman’s monthly cycle!

If you really need to nourish the body, it is better by eating fresh fruits, vegetables and other foods that contain vitamins. It is almost impossible to create hypervitaminosis through regular food, but it is easy to create with the help of artificially created substances. Elena Kleshchenok Medical Bulletin , January 26, 2017

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