- Email: [email protected]
Pre-Operative Evaluation
Symposia This presentation will provide proof of principal evidence of the treatment of periodontal defects and a variety of localized ridge defects for implant placement. The topics include the sinus elevation, horizontal and vertical ridge augmentation and bone preservation for compromised extraction sites.
Tissue Engineering John E. Davies, DDS, Toronto, Ontario, Canada No abstract provided
SYMPOSIUM ON PEDIATRIC ANESTHESIA: EVALUATION & MANAGEMENT Friday, October 16, 2009, 7:30 am–9:30 am
Anatomic, Physiologic, and Pharmacologic Considerations/PreOperative Evaluation Benjamin Davis, DDS, Halifax, Nova Scotia, Canada Providing anesthesia for the pediatric population presents a number of special challenges for the clinician. Thankfully, pediatric anesthesia is safe when carried out on healthy patients by experienced clinicians; however there have been several well-publicized adverse outcomes reported in the media. A recent 3-decade review of pediatric anesthesia liability noted decreasing proportion of claims for death, brain damage, and respiratory events, but the very young (3 years of age or less) and very ill (PS ASA 3-5) still seem to be at particular risk for adverse outcomes. The anatomical and physiologic differences between a child and adult are numerous and are not just a function of a discrepancy in size. Some of the most important differences involve the cardio-respiratory system. The differences at the level of the airway are many and place this area at particular risk when administering anesthesia and performing surgery in the oral and maxillofacial region. A higher rate of oxygen consumption and a smaller oxygen reservoir also causes rapid desaturation with the resulting hypoxia induced bradycardia profoundly affecting cardiac output in the very young. Due to better training and equipment, the incidence of perioperative cardiac arrest due to airway obstruction or hypovolemia is thankfully decreasing. Our knowledge of the pharmacokinetic and pharmacodynamic properties of anesthetic agents cannot be linearly extrapolated from adults to children. Children are not “little adults” and this becomes obvious when discussing the pharmacology of agents used during the perioperative period. Finally, the significant psychological differences between the developing child and the adult patient need to be understood when preparing a child and their family for anesthesia. This lecture will demonstrate how the anatomy, physiology, pharmacology, and psychology of infants and children differ from adults, and how knowledge of these AAOMS • 2009
differences helps improve their care during anesthesia and the perioperative period. References Flick RP, Sprung J, Harrison TE, et al: Perioperative cardiac arrest in children between 1988 and 2005 at a tertiary referral centre: a study of 92,881 patients. Anesthesiology 106:226, 2007 Jimenez N, Posner KL, Cheney FW, et al: An update on pediatric anesthesia liability: closed claims analysis. Anesth Analg 104:147, 2007
Pediatric Anesthetic Techniques Patrick Giroux, DMD, MSc, FRCD(c), Quebec City, Quebec, Canada We are nowadays very far from the times when pediatric anaesthesia was merely considered a small size variant of adult care. An original field in its own anatomical and physiological characteristics, it also harbors specific principles and applications particularly in the outpatient setting. Our review will examine the most currently accepted ambulatory anaesthesia protocols. A deeper insight will be given on specific techniques and approaches designed to maximize patient comfort, safety and quick recovery, with a closer look at adjunct agents and presedation as collaborators to sedative and anxiolytic effects as well as their synergy with inhalation agents. Finally, the focus of teaching centers on the development of tools that provide not only up to date knowledge or skills but also link academic concepts to their clinical applications will be outlined. Other features of training pertinent to the optimization of patient care through life like simulations and scenarios will also be exposed and discussed. Current knowledge in concepts and skills should lead to benefits in safety, efficacy and superior patient care. References Inhalation induction with sevoflurane in paediatrics: what is new? Ann Fr Anesth Reanim. 2006 Apr;25(4):413-6. Epub 2006 Feb 7 Oral clonidine premedication reduces minimum alveolar concentration of sevoflurane for tracheal intubation in children. Anesthesiology. 1997 Dec;87(6):1324-7
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Tissue Engineering John E. Davies, DDS, Toronto, Ontario, Canada No abstract provided
SYMPOSIUM ON PEDIATRIC ANESTHESIA: EVALUATION & MANAGEMENT Friday, October 16, 2009, 7:30 am–9:30 am
Anatomic, Physiologic, and Pharmacologic Considerations/PreOperative Evaluation Benjamin Davis, DDS, Halifax, Nova Scotia, Canada Providing anesthesia for the pediatric population presents a number of special challenges for the clinician. Thankfully, pediatric anesthesia is safe when carried out on healthy patients by experienced clinicians; however there have been several well-publicized adverse outcomes reported in the media. A recent 3-decade review of pediatric anesthesia liability noted decreasing proportion of claims for death, brain damage, and respiratory events, but the very young (3 years of age or less) and very ill (PS ASA 3-5) still seem to be at particular risk for adverse outcomes. The anatomical and physiologic differences between a child and adult are numerous and are not just a function of a discrepancy in size. Some of the most important differences involve the cardio-respiratory system. The differences at the level of the airway are many and place this area at particular risk when administering anesthesia and performing surgery in the oral and maxillofacial region. A higher rate of oxygen consumption and a smaller oxygen reservoir also causes rapid desaturation with the resulting hypoxia induced bradycardia profoundly affecting cardiac output in the very young. Due to better training and equipment, the incidence of perioperative cardiac arrest due to airway obstruction or hypovolemia is thankfully decreasing. Our knowledge of the pharmacokinetic and pharmacodynamic properties of anesthetic agents cannot be linearly extrapolated from adults to children. Children are not “little adults” and this becomes obvious when discussing the pharmacology of agents used during the perioperative period. Finally, the significant psychological differences between the developing child and the adult patient need to be understood when preparing a child and their family for anesthesia. This lecture will demonstrate how the anatomy, physiology, pharmacology, and psychology of infants and children differ from adults, and how knowledge of these AAOMS • 2009
differences helps improve their care during anesthesia and the perioperative period. References Flick RP, Sprung J, Harrison TE, et al: Perioperative cardiac arrest in children between 1988 and 2005 at a tertiary referral centre: a study of 92,881 patients. Anesthesiology 106:226, 2007 Jimenez N, Posner KL, Cheney FW, et al: An update on pediatric anesthesia liability: closed claims analysis. Anesth Analg 104:147, 2007
Pediatric Anesthetic Techniques Patrick Giroux, DMD, MSc, FRCD(c), Quebec City, Quebec, Canada We are nowadays very far from the times when pediatric anaesthesia was merely considered a small size variant of adult care. An original field in its own anatomical and physiological characteristics, it also harbors specific principles and applications particularly in the outpatient setting. Our review will examine the most currently accepted ambulatory anaesthesia protocols. A deeper insight will be given on specific techniques and approaches designed to maximize patient comfort, safety and quick recovery, with a closer look at adjunct agents and presedation as collaborators to sedative and anxiolytic effects as well as their synergy with inhalation agents. Finally, the focus of teaching centers on the development of tools that provide not only up to date knowledge or skills but also link academic concepts to their clinical applications will be outlined. Other features of training pertinent to the optimization of patient care through life like simulations and scenarios will also be exposed and discussed. Current knowledge in concepts and skills should lead to benefits in safety, efficacy and superior patient care. References Inhalation induction with sevoflurane in paediatrics: what is new? Ann Fr Anesth Reanim. 2006 Apr;25(4):413-6. Epub 2006 Feb 7 Oral clonidine premedication reduces minimum alveolar concentration of sevoflurane for tracheal intubation in children. Anesthesiology. 1997 Dec;87(6):1324-7
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