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Melody
medicine forum beginner
Joined: 30 Apr 2005
Posts: 5
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 Posted: Fri May 13, 2005 3:40 pm Post subject:
Bite block
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Is a bite block required during orthopedic surgery under general
anaesthesia? What is the standard care? |
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Dave S
medicine forum beginner
Joined: 09 May 2005
Posts: 42
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| Posted: Mon May 16, 2005 1:38 pm Post subject:
Re: Bite block
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Melody wrote:
| Quote: | Is a bite block required during orthopedic surgery under general
anaesthesia? What is the standard care?
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Under general anesthesia, why would you expect a patient to be biting
anything?
Therefore, why are you asking if one is required in that situation?
Also, why would only question its use in ONLY orthopedic general
anesthesia cases as compared to any other general anesthesia case? |
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Melody
medicine forum beginner
Joined: 30 Apr 2005
Posts: 5
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| Posted: Mon May 16, 2005 2:48 pm Post subject:
Re: Bite block
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Aren't patients who are emerging from general anesthesia at the end of their
surgeries prone to bite the ET tube, be they ortho patients or otherwise?
"Dave S" <Dastaten@earthlink.net> wrote in message
news:A73ie.1507$X92.1190@newsread2.news.pas.earthlink.net...
| Quote: |
Melody wrote:
Is a bite block required during orthopedic surgery under general
anaesthesia? What is the standard care?
Under general anesthesia, why would you expect a patient to be biting
anything?
Therefore, why are you asking if one is required in that situation?
Also, why would only question its use in ONLY orthopedic general
anesthesia cases as compared to any other general anesthesia case?
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wc
medicine forum addict
Joined: 25 Mar 2005
Posts: 66
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| Posted: Mon May 16, 2005 6:34 pm Post subject:
Re: Bite block
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Patients are indeed required to have a "bite block" in their mouth when
they undergo General Anesthesia. There are exceptions, of course. The
exception would be if the patient is having an oral surgery, plastic or
neck/throat surgery, etc.
The reason for the "bite block" is so the patient will not bite their
tongue when emerging, or if they are "too light" -- so they will
not bite down on the orotracheal tube which goes into the trachea for
breathing. Usually, they are not called "bite blocks" but that is what
they are, really. Oral airways are used for a "bite block". The
appropriate size is chosen for the patients size and age. . . for
example, a large framed male would take a # 4 or
5 size Guedel Oral Airway, Guedel being Dr. Guedel who came up with a
hard, black rubber airway, many years ago, and have the "Guedel Curve."
Now, they are plastic. An average female would take a # 3, a small girl
a # 2.
There is a specific device known as a bite block, usually red rubber,
and that fits back in the mouth between the upper and lower molars.
Also, there is a soft rubber bite block used in Electro Convulsive
Therapy. It is inserted so the patient will not bite the tongue when
convulsions start. The convulsion is not as severe as it once was,
as the patient is anesthetized with Pentothal, then succinylcholine
is administered to paralyze the patient, relax the skeletal muscles,
and prevent injury to the patient during the convulsion.
So yes, a form of "Bite Block" is used during General Anesthesia. At
the end of the case, when the oral tracheal breathing tube is removed,
the oral plastic "bite block" serves as an airway in a still
anesthetized patient. The Recovery Room Nurse usually removes it when
the patient awakens from the anesthesia, or the patient removes it.
Will, CRNA |
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Melody
medicine forum beginner
Joined: 30 Apr 2005
Posts: 5
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| Posted: Mon May 16, 2005 8:35 pm Post subject:
Re: Bite block
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Is it acceptable practice to insert a rubber or gauze bite block at the end
of the surgery, before or shortly after the reversing agents are
administered?
"wc" <wc@worldnet.att.net> wrote in message
news:Dt7ie.773821$w62.448619@bgtnsc05-news.ops.worldnet.att.net...
| Quote: | Patients are indeed required to have a "bite block" in their mouth when
they undergo General Anesthesia. There are exceptions, of course. The
exception would be if the patient is having an oral surgery, plastic or
neck/throat surgery, etc.
The reason for the "bite block" is so the patient will not bite their
tongue when emerging, or if they are "too light" -- so they will
not bite down on the orotracheal tube which goes into the trachea for
breathing. Usually, they are not called "bite blocks" but that is what
they are, really. Oral airways are used for a "bite block". The
appropriate size is chosen for the patients size and age. . . for
example, a large framed male would take a # 4 or
5 size Guedel Oral Airway, Guedel being Dr. Guedel who came up with a
hard, black rubber airway, many years ago, and have the "Guedel Curve."
Now, they are plastic. An average female would take a # 3, a small girl
a # 2.
There is a specific device known as a bite block, usually red rubber,
and that fits back in the mouth between the upper and lower molars.
Also, there is a soft rubber bite block used in Electro Convulsive
Therapy. It is inserted so the patient will not bite the tongue when
convulsions start. The convulsion is not as severe as it once was,
as the patient is anesthetized with Pentothal, then succinylcholine
is administered to paralyze the patient, relax the skeletal muscles,
and prevent injury to the patient during the convulsion.
So yes, a form of "Bite Block" is used during General Anesthesia. At
the end of the case, when the oral tracheal breathing tube is removed,
the oral plastic "bite block" serves as an airway in a still
anesthetized patient. The Recovery Room Nurse usually removes it when
the patient awakens from the anesthesia, or the patient removes it.
Will, CRNA |
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wc
medicine forum addict
Joined: 25 Mar 2005
Posts: 66
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| Posted: Tue May 17, 2005 12:45 am Post subject:
Re: Bite block
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Melody wrote:
| Quote: | Is it acceptable practice to insert a rubber or gauze bite block at
the end |
of the surgery, before or shortly after the reversing agents are
administered?<<
Usually, it isn't needed, it would/could be adverse. The Oral Airway,
as described in my previous post is already in place. No bite block
of any kind is needed, as one is in place. Now, there are always
exceptions . . . one would be for a full mouth extraction of teeth
under general anesthesia. This isn't a usual procedure, yet it
happens often. For example, a patient with Downs or similar mental
problem might not "stand" Regional anesthesia or just a block due to
anxiety, so general would be used.
Back to your question. It is acceptable to put a large gauze bite
block in the side or even midline, for dental surgery, or perhaps
something other than that. It would be on an individual patient
basis. Personally, I would awaken my patient on the operating table
with the tube in place, insert the gauze bite block to absorb blood,
then take the patient to the post anesthesia room, awake, after I have
extubated. The gauze could not obstruct the airway, as the patient is
now awake, and can "take care of" the airway without artificial help.
So no it isn't common, yes, it can and does occur, but on a special basis.
Will, CRNA |
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Melody
medicine forum beginner
Joined: 30 Apr 2005
Posts: 5
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| Posted: Tue May 17, 2005 11:50 am Post subject:
Re: Bite block
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Will, thank you for you comments. Is it appropriate to intubate a patient
with just an ET, with no oral airway or bite block, so long as an oral
airway is inserted before reversal drugs are given and the patient is
lightened up?
"wc" <wc@worldnet.att.net> wrote in message
news:7Vcie.775432$w62.99576@bgtnsc05-news.ops.worldnet.att.net...
| Quote: | Melody wrote:
Is it acceptable practice to insert a rubber or gauze bite block at
the end
of the surgery, before or shortly after the reversing agents are
administered?
Usually, it isn't needed, it would/could be adverse. The Oral Airway,
as described in my previous post is already in place. No bite block
of any kind is needed, as one is in place. Now, there are always
exceptions . . . one would be for a full mouth extraction of teeth
under general anesthesia. This isn't a usual procedure, yet it
happens often. For example, a patient with Downs or similar mental
problem might not "stand" Regional anesthesia or just a block due to
anxiety, so general would be used.
Back to your question. It is acceptable to put a large gauze bite
block in the side or even midline, for dental surgery, or perhaps
something other than that. It would be on an individual patient
basis. Personally, I would awaken my patient on the operating table
with the tube in place, insert the gauze bite block to absorb blood,
then take the patient to the post anesthesia room, awake, after I have
extubated. The gauze could not obstruct the airway, as the patient is
now awake, and can "take care of" the airway without artificial help.
So no it isn't common, yes, it can and does occur, but on a special basis.
Will, CRNA |
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wc
medicine forum addict
Joined: 25 Mar 2005
Posts: 66
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| Posted: Tue May 17, 2005 12:40 pm Post subject:
Re: Bite block
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| Quote: | Will, thank you for you comments. Is it appropriate to intubate a patient
with just an ET, with no oral airway or bite block, so long as an oral |
airway is inserted before reversal drugs are given and the patient is
lightened up?<<
No, it is not, usually. When the anesthesia is "lightened" or toward the
end of the case when the vapor concentration is lessened, or the
intervenous drugs are no longer being given, the patient will get
"light" and perhaps start to move. That could include biting down on
the endotracheal tube, and then a real problem ensues. There is no
airway, as the patient is occluding his own airway with his teeth. To
solve that problem, the patient would have to be given a muscle relaxant
IV *stat* and that is not a good way to do things. The best way to
solve that problem is give the patient undivided attention throughout
the entire case and don't let that happen, and that attention includes
uppermost to protect the airway. An oral airway that fits neatly
between the teeth into the oropharynx is the answer. If surgery is
being done around the mouth where an airway cannot be inserted, or even
gauze packing, then intervenous muscle relaxants can be used to prevent
the patient from biting.
I know there are exceptions to what I've written, and I also know there
are anesthetists that do what you've described . . . most do not. Let
me make a sweeping (probably untrue) statement: Nurse Anesthetists
would always use an oral airway with the tube, as "insurance" for the
airway. M.D. anesthetists might not. ;-)
Will, CRNA |
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Norminn
medicine forum Guru Wannabe
Joined: 05 May 2005
Posts: 157
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| Posted: Tue May 17, 2005 9:00 pm Post subject:
Re: Bite block
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clipped
| Quote: |
I know there are exceptions to what I've written, and I also know there
are anesthetists that do what you've described . . . most do not. Let
me make a sweeping (probably untrue) statement: Nurse Anesthetists
would always use an oral airway with the tube, as "insurance" for the
airway. M.D. anesthetists might not. ;-)
Will, CRNA
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What I believe you have described is very different from what I observed
when working in OR. Patients were paralyzed prior to inserting ET tube,
thus no need for protecting anything from a bite. Anesthesia was
lightened as the case proceeded, to the point that the ET tube was
removed when the patient was able to breathe on own just as surgery was
completed. Only times I recall plastic airways being used was when the
ET tube was pulled a little too soon and the patient not breathing fully
on their own, or just a tad too relaxed or full of secretions. Anyone
no longer paralyzed would likely have gagged on the airway. Did I not
understand what you have stated? |
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