Question

joe jackson, a 25 year old male presents for an appointment to restore teeth numbers 3, 4, and 19. joe is a personal trainer and aerobic fitness instructor. he is taking medications vitals are WNL and has no past health issues to report. Joe begins talking nonstop about his job to the point that he has begun to work up a sweat and dentist mentions that it is time to administer anesthesia. After the application of topical anesthetic the patient yawns and becomes unconscious.

1) what is the condition  that rendered the patient unconscious?

2) what rational did you use to determine this?

3) what is joe's ASA status?

4) how doe you treat this emergency?

Answer 1

1Topical anaesthetics are non allergenic ,produce no damage to the tissue,pain-free application ,considered as effective anaesthesia with sufficient duration.There might be two chances,one is the methemoglobinaemia ,in which metemoglobin builds up in the blood,hindering the effective transport of oxygen to body tissues.This could happen in adults with breathing problems,those with heart disease and smokers.Toxic overdose could result in seizures,consciousness and respiratory impairement.

2 As it is not mentioned for which condition the patient is taking medications,it is difficult to co-relate with the condition the patient has.if the patient has been taking medications ,as described above ,then metemoglobinaemia is the villain.

3 American Society of Anaesthesiologists use a global score to determine the physical status of the patient before surgery .ASA 2 -a patient with mild systemic disease.

4 Stop treatment and assess and support the airway,breathing and circulation.,as the level of anaesthetic drug decreases ,patient regains consciousness.