Learning objective: Oral and maxillofacial disorders require general anaesthesia for appropriate treatment. Therefore, anaesthesia and pain management are crucial areas of veterinary dentistry. An analgesic plan including a multimodal approach should be in place during the perioperative period and for several days to a week after hospital discharge, and it includes local anaesthetic techniques performed preoperatively. Patients must be comfortable and relaxed in order to provide comprehensive dental therapy. Although patients may be sedated deeply enough to tolerate local anesthetic blocks and dental procedures, sedation leaves the airway and lungs unguarded. An unguarded airway predisposes patients to aspiration pneumonia, both from regurgitation and from the water and debris associated with the procedure. Placement of an endotracheal tube is the safest way to protect the lungs. With an endotracheal tube in place, inhalant anesthesia is easily administered and becomes the best option for anesthetic maintenance in nearly every patient.
Anesthetic monitoring is significantly correlated with decreased morbidity and mortality. The following vital parameters should be monitored during general anesthesia: pulse oximetry, which can be a challenge to monitor during anesthesia for oral procedures since the probe can be easily displaced; however, it can be placed over the ears and paws. Mean blood pressure, which is particularly important in dogs and cats with chronic kidney disease. Respiration should be ideally monitored using a capnograph since monitoring of respiratory rate does not provide information of the “quality of the respiratory function”. Body temperature should be maintained between 37 and 38°C, and monitoring it is necessary to react on time and prevent hypothermia.
Most oral and maxillofacial disorders and therapies involve inflammation and tissue damage/trauma. Oral disease and associated pain are welfare issues since they impact quality of life and nutritional status. Dental disorders cause pain suffering, alter behaviour and cause physiological signs of stress. Pain management is not only important from the ethical and welfare point of view but also as a therapeutic strategy. Pain management is performed preoperatively and postoperatively. It involves use of anesthetic drugs, techniques and their combinations aiming to minimise postoperative pain and discomfort.
Opioids are the first line of treatment in acute pain management. Unless contraindicated, NSAID therapy is commonly administered for approximately 3–7 days depending on type of oral disease/procedure. Local anesthetic drugs produce a reversible block of sodium and potassium channels and transmission of nociceptive input. Specific local nerve block techniques for oral and maxillofacial procedures include: inferior alveolar nerve block, palatine, infraorbital, and maxillary nerve blocks.