Izinhlobo ze-Anesthesia ku-Dentistry
I-anesthesia iyingxenye ebalulekile yomkhuba wamazinyo ngoba iyasiza ekunciphiseni ubuhlungu, ukukhathazeka, kanye nokungakhululeki ngesikhathi sezinqubo. Ngokukhetha uhlobo olufanele lwe-anesthesia, odokotela bamazinyo bangenza izinqubo ngempumelelo, kuyilapho iziguli zizizwa ziphephile futhi zikhululekile. Ngokuvamile, i-anesthesia kwezokwelapha amazinyo ingahlukaniswa ngezigaba eziningana eziyinhloko: i-anesthesia yangaphandle, i-anesthesia yendawo, i-sedation (i-anesthesia elula kuya kwephakathi), kanye ne-anesthesia ejwayelekile. Ngayinye inezinkomba zayo, indlela yokusebenza, izinzuzo, kanye nezingozi ezibalulekile ukuyiqonda.
1. I-Anesthesia Yendawo Engaphandle
Imithi yokubulala izinzwa esetshenziswa endaweni ethile iwuhlobo lwemithi yokubulala izinzwa esetshenziswa ngqo ebusweni bezicubu, ngokuvamile i-mucosa yomlomo (izinsini, izihlathi zangaphakathi, noma ulimi). Ingasetshenziswa njengamajeli, amafutha okugcoba, izifutho, noma ama-patches. Imithi yokubulala izinzwa esetshenziswa endaweni ethile isebenza ngokuvimbela imizwa yezinzwa engxenyeni engaphandle yezicubu, inciphisa umuzwa wobuhlungu endaweni lapho isetshenziswa khona.
Ukusetshenziswa okuyinhloko kwemithi yokubulala izinzwa esetshenziswa endaweni yokwelapha kuhlanganisa:
– Kunciphisa ubuhlungu ngesikhathi somjovo wendawo wokubulala izinzwa, ngokuqeda izinhlungu endaweni yomjovo kuqala.
– Kunciphisa ukungakhululeki ngesikhathi sezinqubo ezincane, njengokuhlanza i-tartar ezindaweni ezibucayi noma ukufaka izinto ezithile zokulungisa amazinyo.
– Ukusiza iziguli ezine-gag reflex eningi (ngaphansi kwezimo ezithile nangokuqapha).
Izinzuzo zemithi yokubulala izinzwa esetshenziswa endaweni yokwelapha ukuthi kulula ukuyisebenzisa, isebenza ngokushesha, futhi iphephile ngokuvamile. Kodwa-ke, imiphumela yayo ikhawulelwe endaweni engaphezulu futhi isikhathi sayo sifushane. Kwezinye iziguli, ikakhulukazi izingane, ukusetshenziswa ngokweqile kuthwala ingozi yokugwinya, okudinga odokotela bamazinyo ukubala ngokucophelela umthamo kanye nendlela yokusebenzisa.
2. I-Anesthesia Yendawo
I-anesthesia yendawo iyindlela evame ukusetshenziswa kakhulu yokubulala amazinyo. Inhloso yayo ukuthulisa indawo ethile yomlomo ngaphandle kokuthinta ingqondo yesiguli. I-anesthesia yendawo ivame ukufakwa eduze kwemizwa ethile noma ezicutshini eziseduze nendawo yenqubo.
Ngokwemishini, izidakamizwa zokubulala izinzwa zasendaweni zivimbela ukudluliselwa kwemizwa yezinzwa ngokuvimbela iziteshi ze-sodium emangqamuzaneni eseli lezinzwa, zivimbele izimpawu zobuhlungu ukuthi zingafiki ebuchosheni. Izibonelo zezidakamizwa zokubulala izinzwa zasendaweni ezisetshenziswa kakhulu zifaka i-lidocaine, i-articaine, i-mepivacaine, kanye ne-bupivacaine. Izindlela zokubulala izinzwa zasendaweni zivame ukuhlanganiswa nezidakamizwa zokunciphisa ukuvuvukala (isb., i-epinephrine) ukuze kwandiswe ukusebenza kwazo futhi kuncishiswe ukopha.
a. Ukungena ngokungemthetho
Indlela yokungena ihilela ukufaka umuthi wokubulala izinzwa ezicutshini ezizungeze izinyo ukuze zelashwe. Le ndlela ivame ukusetshenziswa emhlathini ongaphezulu ngoba ithambo ligcwele izimbobo, okuvumela umuthi ukuthi ungene kalula emithanjeni emincane.
Izinkomba: ukugcwalisa amazinyo, ukwelashwa kwembobo, ukwenza umqhele, kanye nezinqubo ezincane endaweni.
b. Ukuvinjelwa Kwemizwa
Emakhonweni okuvimba izinzwa, i-anesthetic ifakwa eduze kwesiqu senzwa esiyinhloko, okwenza indawo ebanzi yokuba ndikindiki. Isibonelo esaziwa kakhulu yi-inferior alveolar nerve block yezinqubo zamazinyo ze-mandibular.
Izinkomba: ukukhishwa kwe-molars engezansi, ukwelashwa kwezimpande zomsele emhlathini ongezansi, noma ukuhlinzwa ngomlomo okudinga indawo ebanzi ye-anesthesia.
c. I-Intraligamentary (PDL) kanye ne-Intraosseous Anesthesia
I-intraligamentary anesthesia ihilela ukufaka i-anesthetic ku-periodontal ligament ezungeze impande yezinyo, kuyilapho i-intraosseous anesthesia inikezwa ngqo ethanjeni elizungeze izinyo. Zombili zisetshenziswa lapho ukungena noma ukuvimba kwemizwa kungasebenzi kahle noma lapho kudingeka i-anesthesia egxile kakhulu.
Izinzuzo zokusebenzisa i-anesthesia yendawo ukuthi iyasebenza, iyashesha, futhi isiguli sihlala siqaphile. Izingozi zingafaka phakathi ubuhlungu ngesikhathi somjovo, i-hematoma, ukungazweli isikhathi eside, ukusabela kokungezwani komzimba (okungavamile), kanye nemiphumela yomzimba uma umuthi ungena egazini. Ngakho-ke, ukuncela ngaphambi komjovo nokuqapha isimo sesiguli kubalulekile.
3. Ukwelapha Amazinyo
Ukudambisa ubuhlungu kuyindlela yokunciphisa ukukhathazeka nokwandisa induduzo yesiguli, ikakhulukazi ezigulini ezinenkinga yokukhathazeka kwamazinyo, ukuzizwa zikhathele kakhulu, noma labo abenza inqubo ende. Ukudambisa ubuhlungu kuhlukile ekudambiseni ubuhlungu kwendawo: ukudambisa ubuhlungu kuthinta izinga lokuqwashisa kanye nokuzola, kuyilapho ukudambisa ubuhlungu kwendawo kuthuntubeza indawo ethile. Empeleni, ukudambisa ubuhlungu kuvame ukuhlanganiswa ne-anesthesia yendawo ukuqinisekisa ukulawulwa okuphelele kobuhlungu.
a. Ukuphumula Okuncane (i-Anxiolysis)
Ukupholisa okuncane kuvumela isiguli ukuthi siphumule kodwa sihlale siqaphile futhi sikwazi ukuphendula kahle emiyalweni. Ngokuvamile kuhilela imithi yomlomo (isb., ama-benzodiazepines anomthamo ophansi) athathwa ngaphambi kwenqubo.
Kufanelekela: iziguli ezikhathazekile kancane kuya kweziphakathi, izinqubo ezimfushane, noma iziguli ezesaba izinaliti.
b. Ukulala Okulingene (Ukulala Okuqaphelayo)
Uma uphuza umuthi ngendlela elinganiselayo, isiguli sihlala siqaphile futhi sisabela, kodwa silala futhi asiqapheli isikhathi nendawo esikuyo. Izindlela ezivame ukusetshenziswa ukuphuza umuthi nge-nitrous oxide (igesi ehlekayo) noma i-intravenous (IV) sedation.
– I-nitrous oxide iqala ngokushesha futhi kulula ukuyisebenzisa. Ngemva kwenqubo, imiphumela yayo nayo iyaphela ngokushesha, okuvumela iziguli ukuthi zikhululeke ngokushesha.
– Ukuthobisa ngemithambo yegazi kunikeza ukulawula okungcono ezingeni lokuthobisa, kodwa kudinga izikhungo eziseduze, ukuqeqeshwa, kanye nokuqapha.
c. Ukulala Okujulile
Ukudambisa umzimba okujulile kwenza isiguli sicishe singazi lutho, okunciphisa kakhulu indlela esisabela ngayo ezintweni ezisikhuthazayo. Ngenxa yengozi ephezulu yokuphazamiseka kokuphefumula kanye nenhliziyo, lolu hlobo lokudambisa umzimba ludinga ukubhekwa eduze futhi ngokuvamile lwenziwa ngabasebenzi abaqeqeshwe abanemishini eyanele yokuvuselela umzimba.
Inzuzo yokwelapha ubuhlungu ukuthi kusiza iziguli okunzima ukubambisana nazo futhi kuvumela udokotela wamazinyo ukuthi asebenze ngokukhululeka. Izingozi zokwelapha ubuhlungu zihlanganisa ukuphefumula okunciphayo, isicanucanu, isiyezi, umfutho wegazi ophansi, kanye nesidingo sokuqapha ngemva kwenqubo. Iziguli ngokuvamile zelulekwa ukuthi zingashayeli futhi ziphelezelwe ekhaya, ikakhulukazi ngokwelapha ubuhlungu ngomlomo noma nge-IV.
4. I-Anesthesia Ejwayelekile
I-anesthesia ejwayelekile yenza isiguli singabi nalwazi nhlobo, singabi nabuhlungu, futhi singakhumbuli inqubo. Lolu hlobo lwe-anesthesia lunikeza izinga eliphezulu lokulawula, kodwa futhi lunezingozi ezinkulu. Kudokotela wamazinyo, i-anesthesia ejwayelekile ngokuvamile ayisetshenziswa ezinqubweni ezivamile, kodwa kunalokho ezimweni ezithile.
Izinkomba ze-anesthesia ejwayelekile zifaka:
– Ukuhlinzwa okukhulu komlomo (isib. ukuhlinzwa okuthile komhlathi).
– Iziguli ezinezidingo ezikhethekile ezingakwazi ukubambisana ngisho nangemva kokuzama ezinye izindlela.
– Izingane ezincane ezibolile kakhulu ngamazinyo ezidinga ukwelashwa okuningi ngesikhathi esisodwa.
– Ukwesaba okukhulu ukwelashwa kwamazinyo, lapho ezinye izindlela zingasebenzanga.
Ngenxa yokuthi i-anesthesia ejwayelekile ithinta yonke imisebenzi yomzimba, le nqubo idinga indawo efanele (isibhedlela noma umtholampilo onezikhungo eziphelele), ukuhlolwa kwezokwelapha ngaphambi kwenqubo, kanye nokuqapha okuseduze udokotela obulala izinzwa.
5. Izici Zokunquma Ekukhetheni Uhlobo Lokubulala Izinzwa
Ukukhetha indlela yokubulala izinzwa akwenziwa ngokungahleliwe. Odokotela bamazinyo bacabangela izici eziningana, njenge:
– Uhlobo kanye nobude benqubo (isib. i-small patch vs ukuhlinzwa).
– Amazinga okukhathazeka kwesiguli kanye nokubambisana.
– Umlando wezokwelapha (umfutho wegazi ophakeme, isifo senhliziyo, i-asthma, isifo sikashukela, izinkinga zesibindi/izinso).
– Ukungezwani nemithi kanye nomlando wemiphumela yokubulala izinzwa.
– Ubudala kanye nesimo somzimba (izingane, asebekhulile, abesifazane abakhulelwe).
– Isidingo sokulawula ukopha, ikakhulukazi ezinqubweni zokuhlinzwa.
Ukuhlolwa kokuqala kanye nengxoxo yomlando wezokwelapha kusiza udokotela wamazinyo ukuthi anqume izinketho eziphephile kakhulu. Ukuxhumana phakathi kwesiguli nodokotela wamazinyo nakho kubalulekile ukuze isiguli siqonde ukuthi yini okufanele siyilindele nokuthi yini okufanele siyilindele ngemva kokwelashwa.
Isiphetho
I-anesthesia kwezokwelapha amazinyo ihlanganisa izinketho eziningi, kusukela kuma-anesthetics angaphandle ukuze kuncishiswe ubuhlungu bomphezulu, ama-anesthetic endawo ukuze kuqede indawo, ukudambisa ukucindezeleka ukuze kuncishiswe ukukhathazeka futhi kwandiswe induduzo, kanye ne-anesthesia ejwayelekile yamacala adinga ukungazi lutho ngokuphelele. Uhlobo ngalunye lunezinzuzo nezingozi ezahlukene, ngakho-ke ukukhetha kufanele kuhambisane nezidingo zenqubo, isimo sempilo yesiguli, kanye nenduduzo. Ngendlela efanele, i-anesthesia ingenza ukwelashwa kwamazinyo kube yinto ephephile kakhulu, ephumelelayo, futhi engahluphi kangako iziguli.
