Anestesiology and medical emergency

A.Y. 2020/2021
Overall hours
Learning objectives
- Evaluate the patient's preoperative clinical conditions.
- Choose the type of anesthesia (local anesthesia; conscious, inhalation or intravenous sedation; general anesthesia) for different dental procedures.
- Recognize and treat the main medical urgencies and emergencies, which may occur during dental treatment.
Expected learning outcomes
- Be able to perform an accurate pre-operative assessment of the patient and choose the appropriate anesthetic technique according to his clinical conditions.
- Being able to recognize and treat the main urgencies and emergencies that may occur during dental treatment.
Course syllabus and organization

Single session

Teaching methods
Lectures will be held on the Microsoft Teams platform and can be followed both in synchronous (live) according to the established timetable. Lectures will be available to students on the same platform.
Program and reference materials
The program and reference materials will not change.
Assessment methods and criteria
The exam consists of an oral communication and will be held online using the Microsoft Teams platform or in presence, if the regulation allows it, oral or written test.
Course syllabus
Local anesthetics and loco-regional anesthesia techniques
Local anesthetics
· Amino-esters and amino-amides
· Physico-chemical properties of local anesthetics
· Site of action of local anesthetics and nerve conduction block
· Biophysical characteristics of local anesthetics: liposolubility and potency, pKa and onset time, protein binding and duration of action
· Factors affecting local anesthesia
· Adrenaline
Local Anesthesia Techniques
· The devices for local anesthesia
· Basic injection technique
· Blocks of the upper jaw
· Techniques of mandibular anesthesia
· Additional injection techniques
Local complications of local anesthesia
· Needle breakage
· Injection of AL into the parotid lodge: clinical manifestations and treatment
· Hematoma: causes and treatment
· Trismus: causes and treatment
Patient evaluation
· Physical and psychological evaluation. Vital parameters
· Finalized medical history.
Urgencies and emergencies in the dental practice. Signs and symptoms and therapeutic algorithms
Urgency and respiratory emergencies:
· Oxygen therapy and maintenance of airway patency.
· Central hyperventilation syndrome
· Bronchospasm, asthma
· Acute pulmonary edema
· High airway obstruction
· Hemlich maneuver and dorsal strokes
· Cricotirotomy: exercise on the mannequin.
· Safety position
Cardiovascular urgencies and emergencies:
· Vaso-vagal syndrome
· Hypotension
· Hypertensive crisis
· Angina
· Acute Coronary Syndrome
· Anaphylactic shock
· Drugs that affect cardiovascular function and coagulation disorders drugs.
Cardiocirculatory arrest
· Diagnosis
· Basic life support (BLS)
· Advanced life support (ALS)
· The self-expanding balloon
· The Semi-automatic Defibrillator (AED)
· Exercise on the manekin
Urgencies and emergencies in the diabetic patient
· Hypoglycemia
· Hyperglycemia
· Insulin and glucagon
Treatment of the patient with severe renal insufficiency
Systemic complications of local anesthetics
· Toxic reaction from local anesthetic. Treatment of epileptic seizures
· Adrenaline overdose
· Iatrogenic methemoglobinemia

Allergic reactions in dentistry
· Allergic reaction from local anesthetics
· Latex allergy
· Latex-free environment
Conscious Sedation
· The anxious patient and the dento-phobic patient
· Inhalation sedation with nitrous oxide
· Practice with the Sedation Machine
· Oral sedation. Benzodiazepines.
General anesthesia
· Selection criteria in the dental patient
The emergency and medical emergency cart in the dental office
Drugs and devices for first aid

Mannekin-based simulations
· Cardiopulmonary resuscitation: Basic life support (BLS) and advanced life support (ALS)
· Venipuncture
· Cricothyrotomy

Conscious sedation with nitrous oxide
· Simulation with the sedation machine
Prerequisites for admission
The corse of Anesthesiology and treatment of urgency and emergency requires the preliminary knowledge of anatomy, physiology and pathophysiology, in order to:
· perform accurate preoperative evaluation of the patient and choose the appropriate anesthesia technique according to his/her clinical conditions (local anesthesia, conscious sedation or general anesthesia) and
· recognize and treat the main urgencies and emergencies that may occur during dental treatment.
Teaching methods
Teaching is carried on through lectures and discussion of clinical cases and the teaching material is delivered to students via telematic means. Students will have the opportunity to take elective courses on specific topics (cardio-pulmonary resuscitation, cricothyrotomy, venipuncture. Conscious sedation with nitrous oxide).
Teaching Resources
S.F. Malamed: Manuale di Anestesia Locale, 5° Edizione Italiana a cura di C. Tommasino, Editore Masson
S.F. Malamed: "Medical emergencies in the dental office", Mosby Editor
Harrison's Principles of Internal Medicine 17th edition, McGraw-Hill Professional Publishing
Assessment methods and Criteria
Verification of learning takes place through two written tests for:
First test at the end of the first semester, with 30 questions (open or multiple choice) on local anesthetics and local anesthesia techniques used for dental treatment.
Second test at the end of the second semester, with 30 questions (open or multiple choice) on the emergencies and medical emergencies that can occur in the dental office and on clinical cases
Reference materials are not allowed during the test. The final mark represents the weighted average of the two tests and will be expressed in 30/30.
MED/41 - ANAESTHESIOLOGY - University credits: 9
Lessons: 60 hours
Practicals - Exercises: 75 hours