Sleep Dentistry and Operating Theatre

At Bangkok International Hospital (BIDH), we are committed in provide patients with safe and effective use of Anesthesia for investigation, procedure and dental treatment (Local anesthesia, sedation and general anesthesia).Our dentist complies with standard and professional qualifications.

Our dental hospital provided services care of patient in part of oral surgery, orthognathic surgery and oral maxillofacial surgery under sedation /anesthesia at operating theater for complicate cases or major treatments:

  • Full mouth dental implant surgery
  • Jaw surgery or Orthognathic surgery
  • Multiple teeth extraction and/or major surgical teeth removal

Sedation Options

Definitions

Performing anesthesia for investigation, procedures or dental treatment is to administration of sedative or dissociative agents with or without analgesics in order to change consciousness and helping patient to tolerate with pain and undesirable feeling during investigation, procedure or treatment while cardiac and respiratory function can be maintained.

The administration of those medication is covered all kind of medication, dosage, and any route administration in order to change patient‘s consciousness and helping them to tolerate during investigation, procedures or dental surgery and treatment.

Level of sedation /analgesia and anesthesia classified into 4 levels by American Society of Anesthesiologist as follows:

Level 1 : Minimal Sedation / Anxiolysis
A drug –induced state during which patient respond normally to verbal commands although perception or body coordination is partial loss but ventilating and cardiovascular functions are unaffected.

Level 2 : Moderate Sedation / Analgesia (Conscious Sedation)
A drug-induced depression of consciousness during which patients response purposefully to verbal commands, either alone or accompanied by light tactile stimuli. Reflex withdrawal from painful stimuli is not considered a purposeful response. No interventions are required to maintain a patient’s airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

Level 3 : Deep Sedation / Analgesia
A drug –induced depression of consciousness during which patients cannot be easily aroused, but patient still responds purposefully following repeated or painful stimuli. The ability to independently maintain ventilation function may be impaired. Patient may require assistance in maintaining a patient airway and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

Level 4 : General Anesthesia
A drug-induced to make a patient loss of perception , unresponsive to stimuli even pain, impairment of ventilation function and need assistance to maintain patient’s airway and possibly need ventilation support due inadequate spontaneous respiration .Cardiovascular function may be impaired.

  • Moderate sedation / analgesia will be performed under supervision of anesthesiologist or dentist or other non –anesthesia physician who has privilege only in the hospital.
  • Deep conscious sedation will be administered only by a physician who has hospital privileges for deep sedation.

Practice Guideline

Pre-anesthetic assessment and preparation

Every patient requires assessment and preparation including health history, physical examination, and review past illness history, laboratory tests or additional special investigation such as x-ray, ECG.
Explain the method of anesthesia, benefit and disadvantage complications or possible risks that may occur and other options for patient’s understanding, providing consent form for patient signs.

Medical equipment

Medical equipment ready and available prior anesthesia as follows:

  1. Oxygen delivery system
  2. Positive pressure breathing apparatus (face mask and self-inflating breathing bag)
  3. Airway opening and intubation supplies and equipment e.g. oral airway
  4. Suction equipment
  5. Intravenous access equipment
  6. Monitoring equipment
  7. Emergency drugs
  8. Emergency call system
  9. Crash cart with defibrillator

Each equipment is required suitable size and its function appropriate to patient’s body, age and gender.

Monitor and Care of Patient during Moderate Sedation

1. Patient will be monitored as follows:
1.1 Level of consciousness: Consciousness assessment will be perform to be ensure that patient still response to verbal command with soft touching. If patient dose not response, it mean that level of anesthesia is changed to deep or general anesthesia which is risk for in adequate ventilation.
1.2 Blood oxygenation saturation is monitored continuously by using pulse oximeter which the alarm and sound have been set properly to patient and alarm tone will be changed according to level of blood oxygen saturation.
1.3 Ventilation and respiratory rate will be monitored by observing pattern and sound of respiration all the time (If it cannot be directly observed, operate capnometer to detect level of carbon dioxide from breathing as well.)
1.4 Blood pressure and heart rate will be monitored before anesthesia and every 5 minutes during investigation procedure or surgery.
1.5 Electrocardiogram will be monitored in cardiac output or those procedure which may cause Arrhythmia
Monitor of No.1.1-1.5 will be recorded as minimum when:

  • Before anesthesia or conscious sedation.
  • After administration of anesthetic or sedative agents.
  • Every 5 minutes during investigation, procedures or surgery.
  • During recovery period.
  • Before discharge from post anesthetic care unit.

2. Staff, who monitors patient and care of patient, is responsible for monitoring and patient care only.Staff who monitors and care of adult patient will be trained about Basic Life Support (BLS) and for pediatric patient will be trained about Pediatric Advance Life Support (PALS) and obtaining knowledge and competency as follows:

  • Need for monitoring.
  • Assisting when complication occurred.
  • Antidote of anesthetic and sedatives agents.
  • Criteria of recovery.

Monitor patient during deep anesthesia or general anesthesia

Patient will be monitored and recorded based on Standard of The Royal College of Anesthesiologist of Thailand and Standard of American Society of Anesthesiologist.

Care of patient : post-procedure/investigation: recovery and preparing for discharging

  1. Each patient will be assessed at examination room or procedure room before being discharged or transferred to the PACU or ward.
  2. Patient receiving moderate/deep sedation will transfer to the PACU or another recovery area after investigation or procedure.
  3. Patient transferred to the PACU or recovery area will be accompanied by personnel (Nurse) who are knowledge about the patient’s condition. The patient will continuously assessed and treated during transportation with monitoring and support appropriate to the patient’s condition.
  4. In recovery area the conditions of patient will be continuously monitored such as vital signs, oxygenation, ventilation and level of consciousness. All of these should be recorded continuously until patient is out from recovery room.
  5. Recovery area: equipment for monitoring and resuscitation drugs available same as anesthetic location minimally and assisting of Basic Life Support (BLS) and for pediatric patient well trained about Pediatric Advance Life Support (PALS)
  6. Nurse who care for monitoring patient in recovery room has qualified and trained as follows:
    • In case of adult patient who got moderate sedation, nurse has pass training of Basic Life Support (BLS).
    • In case of adult patient who got deep sedation analgesia /general anesthesia , nurse has pass the training of Advance Cardiac Life Support (ACLS)
    • In case of pediatric patient who got moderate sedation , nurse has pass the training of Pediatric Advance Life Support (PALS)
  7. Nurse who care for monitoring in the recovery room will obtain knowledge about criteria for patient discharged with scoring record clearly together with documentation about time arrival till discharged from recovering room.

PACU Discharge criteria

1. Aldrete score 8-10
2. Patient do not meet baseline of criteria may need specialized care unit such as PACU until clinically stable and then transfer to inpatient room.

Home discharge criteria for outpatient

  1. In additional to meeting the Aldrete criteria, the patient will be:
    • Have a minimum of one-hour observation prior to discharge.
    • Be thermodynamically stable.
    • Be clear secretions.
    • Be oriented to time, person and place and be able to follow instructions appropriate to age.
    • Tolerate liquid or soft diet according to physician’s order.
    • Be able to ambulate.
  2. Hospital will take care of safety appropriately prior patient arrives home.
  3. Patient and their relatives will be recommended about nutrition, medication and activity and contacting telephone in case of emergency. ( Call No.02-115-8977 )

About Us

DENTAL TECHNOLOGIES

At a Glance

Facilities

5,933 sqm. space
7 storey building
33 Dental Treatment Rooms
2 VIP Treatment Rooms
1 Dental Emergency Room
1 Operating theater
2 Post-Anesthesia Care Unit (PACU)
4 Inpatient Rooms
1 Consultation Room
4 Panoramic and CT Scan
2 Meeting Rooms
1 Conference Hall
Basement Parking
Handicapped Toilet

Safety Mechanisms

Central Supply Sterile Department (CSSD)
Fire Protection System
Smoke Compartment Door
CSSD Water Quality Control
Medical Devices Inspection & Packaging
Loading & Sterilization Process
Sterilization Process Monitoring
Sterilized Storage & Distribution

Conclusion

There are various sedation / anesthesia options for investigation, procedure and dental treatments. Initially ask our hospital staff team which type of anesthesia / sedative options is suited for you and then schedule appoint with our dentists for further dental treatment plan.

Sukhumvit Dental Hospital

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