Dental extractions in preparation for cardiac surgery

garychleung

PIG Meeting: 1st July 2021

67-year-old man for 2 dental extractions in preparation for AVR

Background:

  • Asthma – daily Ventolin for dyspnoea but no admissions or steroids
  • OSA – compliant with CPAP
  • TIA – 2019
  • Chronic kidney disease – stage 3
  • Chronic cellulitis and lymphoedema – on long term antibiotics

Issues:

  • Severe AR – awaiting AVR.
  • HFrEF – 39%
  • AF – Apixaban and Sotalol
  • Pulmonary hypertension – recent right heart catheter; PAP = 57mmHg
  • NYHA class 3 Dyspnoea

Discussion:

Anaesthetic techniques

  • High risk patient for low-risk procedure
  • Dental extractions under local anaesthesia would be lowest risk
  • General anaesthesia would carry significant risk of cardiovascular morbidity and require arterial line/prolonged recovery stay

Anticoagulation

  • Maxillo-facial surgeons happy to perform 1-2 dental extractions on anticoagulation

Plan:

  • Local anaesthetic approach with continuation of anticoagulation
  • Discuss with procedural anaesthetist and surgeon