Step 7 - Patient Discharge: It is necessary that the patient is capable to walk with minimal assistance. Postoperative pain and bleeding should be minimal or absent. The patient should be accompanied by a res- ponsible person who will receive verbally and written postoperative orientations . 3.3.2. General Anesthesia The assistance sequence proposed by the present study takes as reference the guidelines of the Ameri- can Dental Association  and the Australian and New Zealand College of Anesthetists . Step 1 - Initial Assessment of the Patient: Com- pletion of a health questionnaire, including medical his- tory, physician reports, hospital treatments, medica- tions in use, health problems, alimentary habits and level of cooperation. Patients included in categories 1 and 2 (Tables 1 and 2 ) are potential for intervention. Step 2 - Preoperative Evaluation: Medical assess- ment by the team which manage the patient; request of laboratory exams (urea, creatinine, complete blood count, complete coagulation exams, X-ray of the chest, electrocardiogram for patients older than 50 years or for patients who have pre-existing cardiac abnormal- ities) ; verbal and written instructions to the patient and / or the responsible person about the procedures before, during and after surgery; informed consent form of the patient / guardian; dietary orientations (absolute fasting of 10 hours). Step 3 - Professionals and Equipment: Among professionals, it is necessary an anesthesiologist, the nursing team and the dental team. Among the equip- ment, a complete surgical center is requested. Figure 5 presents the dental materials for the treatment of SNP under general anesthesia and Figure 6 presents dental procedures performed with the patient under general anesthesia. Step 4 - Patient Monitoring: Responsibility of the anesthesiologist team.
Dental Management of Special Needs Patients Global Journal of Oral Science, 2016, Vol. 2, 41 Step 5 – Dental Treatment: The use of general anesthesia is indicated for cases of more complex dental problems, which involve extensive dental treat- ment. Preventive, restorative and surgical treatment can be performed and concluded in a single appoint- ment. Figure 5: Materials used for general anesthesia. A ) Surgical center. B ) Anesthesia and monitoring device. C ) Portable compressor for micro motor. D ) Photopolymerizer. E ) Ultrasound. F , G and H ) Dental instruments. I ) Sterile gauze. Figure 6: Dental procedures performed in hospital. A and B ) Approximated and extended view of the prepared patient to receive dental care. C ) Prevention procedure using ultrasound. D ) Patient receiving local anesthesia for local tissue ischemia. E , F and G ) Endodontic procedures. H , I ) Restorative procedures. A B C D E F G H I A B C D E F G H I
42 Global Journal of Oral Science, 2016, Vol. 2 Polli et al. Step 6 - Documentation: The whole procedure must be documented, reporting the name of the admin- istered inducing drugs and anesthetics (local and gene- ral), the doses and the pre and postoperative medi- cations.
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