Tel: 533 599 66

Treatment under general anesthesia


Nagu kokkuleppisime, siis me kohtume reedel Lydias. Kui sulle sobib, siis seoses kohtumisega saadaksin sulle mõned küsimused ette, et natuke lihtsustada meie reedest arutelu ja et me suudaksime hiljem paremat tagasisidet anda. Kui sa leiad momendi, siis palun vaata need küsimused sulle sobival ajal üle.   Mõned täpsustavad küsimused:  1) Mis hotelli kohta on küsitluse .xls koondaruanne tehtud? Dorpat, Lydia või mõlemad koos? 2) Kuidas kuude lõikes küsitluse vastused korrelleeruvad hotelli täituvusega samas perioodis? 3) Kuidas te tõlgendate / hiljem kasutate küsitluse vastuseid? Sealhulgas ka booking.com ja tripadvisor.com vastuseid. Ma viimastel kordadel ise Dorpatis ööbides küsitluslehti kahjuks toas ei silmanud. Äkki ma lihtsalt ei osanud vaadata. 4) Kuidas need hotellid on positsioneeritud, millist brändi-identiteeti soovitakse. Millistele ressurssidele on üles ehitatud konkurentsieelised, millised on peamised müügiargumendid ja hotellide positsioneeringud tervikuna. 5) Milliseid kliente te peamiselt sihite, kuidas nendega kontakte luuakse,  6) Kes on teie peamised partnerid/ vahendajad klientidele väärtuse loomiseks või klientideni jõudmiseks,  7) Kui palju on lojaalseid/ korduvkliente, kuidas lojaalsust hinnatakse ja jooksvalt mõõdetakse, millist lojaalsust soovitakse (käitumuslik või hoiakuline) kui palju tähtsustatakse, kuidas lojaalseks muudetakse 8) Kas me võime suhelda ka Cäthy Ojaga? Kas tema see, kes otse vastab review-dele ja päringutele booking.com, tripadvisor.com ja muudes avalikes portaalides. 9) Milliseid online/ offline kampaaniaid te teete, kui sagedasti ja kuidas hindate nende tulemuslikust? 10) Soovitusturundus – kas te kuidagi hindavate seda, kuidas kliendid teid leidnud on?    Oleksin väga tänulik, kui saame nende teemade ja ka teiste küsimuste üle reedel arutleda. Meid tuleb vähemalt 3 inimest kohtumisele.Hammaste ravi üldnarkoosis – kellele ja miks?
Kuigi üldnarkoosi kasutatakse hambaravis eelkõige mastaapsemate kirurgiliste sekkumiste puhul, selleks, et vähendada  kaasnevat valutunnet või ravi puhul ilmnevaid vastureaktsioone, on üha sagedasem põhjus taolise ravimeetodi kasutamiseks väga suur hirm hambaravi suhtes.
“Üldnarkoos tähendab seda, et patsient pannakse raviprotseduuri ajaks nö magama ehk aju ei taju valu signaale ning ravi protseduurist annab märku alles taastumine – selliste protseduuride vastu on huvi märgatavalt tõusnud võrreldes aasta taguse ajaga, “ ütles Sakala Hambaravi hambaarst doktor Kaja Kiige, tõdedes, et üldnarkoosis ravile on siiski ette nähtud kindlad põhjused ning kergekäeliselt sellesse protseduuri suhtuda ei tohiks, seda enam, et ka üldnarkoosist taastumine on omaette väljakutse.
Hambaid tuleks üldnarkoosis ravida siis, kui koostöövõime puuduse tõttu pole võimalik patsienti ravida tavameetodil. “Kui inimesel on meditsiiniliselt näidustatud ravi mittevõimalikkus või patsiendil esineb paaniline hirm hambaarsti suhtes, mis tuleneb 
näiteks kõrgest valulävest või vastumeelsusest hamba eemaldamise suhtes, siis tuleb kasutada  üldanesteesias hambaravi meetodit,” ütles Kiige, täpsustades, et on teatud protseduurid, mis nõuavad narkoosi rohkem kui teised. “Üldnarkoosis eemaldatakse (tarkus)hambaid, ravitakse tsüste ning eemaldatakse hambajuur, tehakse huule-ja keelekida operatsioone ning veelgi keerukamaid operatsioone nagu hamba eemaldamine põskkoopast,” rääkis Kiige.
Kui ühe hambaarsti külastuse käigus tuleb arstil läbi viia lausa mitmeid protseduure, näiteks eemaldatakse hambad ja pannakse implantaadid või proteesid, siis on samuti vajalik üldnarkoos, mille mõju kestab reeglina kuus tundi. Narkoosiga hambaravi teostatakse vaid koostöös anestesioloogiga, kellega kaardistatakse põhjalikult patsiendi meditsiiniline taust. 
Üldnarkoos on tänuväärne ka seetõttu, et võimaldab arstil teha tööd segamatult – patsiendi keha on operatsiooni ajal fikseeritud ning mõningaid protseduure saab seetõttu ka kiiremini teostada. 
“Selleks, et patisentidele üldanesteesias abi pakkuda, tuleks hambakliinikul muretseda narkoosiaparaat ning ühtlasi peavad ka ruumid olema teenuse osutamiseks vastavalt planeeritud. Kuna meditsiiniseadmed on väga kallid, siis paljudel kliinikutel neid tõesti veel pole ning ühtlasi on oluline anestesioloogi kiire kättesaadavus,” tõdes Kotka Tervisemajas resideeruva Sakala Hambaravi tegevjuht Hendrik Kiige. Kiige lisas, et kuna patsientide nõudlus teenuse vastu aina kasvas, siis investeering kaasaegsesse meditsiinitehnoloogiasse sai tehtud, seda enam, et tegutsedes Kotka Tervisemajas on võimalik tihedat koostööd teha Kotka Erahaigla anestesioloogiga.
Ka riigitasandil oli möödunud aasta jooksul arutelu all üldnarkoosis hambaravi teenuse hüvitamine ning 1.juulist jõustuva hambaraviürituse korral hakkab riik tasuma ka üldnarkoosis hambaravi eest juhul, kui see on täiskasvanule meditsiiniliselt näidustatud. Sellest muudatusest on eelkõige abi nendele, kes kannatavad psüühika- ja käitumishäirete ning närvisüsteemihaiguste käes või kellel on raske füüsiline puue. 

Although general anaesthesia for dental treatment is primarily used in case of more extensive surgical interventions to reduce the sensation of pain or reactions during treatment, the growing reason for using such treatment is phobic patients. Dental treatment under anaesthesia is a very effective method because usually it takes one visit to the dentist and requires minimal, if any, patient cooperation.

General anaesthesia means that the patient is, so to speak, “sent to sleep” during the procedure so that the brain does not process pain signals; only during recovery the patient can notice that the procedure has taken place. General anaesthesia for dental treatment is indicated in certain cases and this procedure should not be taken lightly especially because coming out of general anaesthesia is a challenge in itself.

Üldnarkoosis hambaravi Sakala Hambaravis

Using general anaesthesia for dental treatment

General anaesthesia for dental treatment should be used when, because of the patient’s inability to cooperate, it is impossible to treat him or her with regular methods. The main indications for general anaesthesia for dental treatment are lack of cooperation on the part of the patient (65%), dental fear (37%) and a need for an extensive treatment (26%). Certain procedures require anaesthesia more than others. Usually general anaesthesia is used to perform teeth restoration and dental treatments (57%), removal of teeth (24%) and root treatment (4%). General anaesthesia is also used to perform radiological tests, caries prevention and periodontal treatment.

General anaesthesia procedure for dental treatment

 1. Initial dentist consultation: the dentist looks over and maps the state of the mouth; if necessary, X-rays are taken. The patient is given general anaesthesia questionnaires to fill in that are then forwarded to an anaesthetist.

 2. Repeat consultation: the dentist has prepared a treatment plan that is reviewed with the patient. The discussion covers the following aspects:

  • Which teeth are intended to be treated under general anaesthesia;
  • What are treatment options;
  • How many treatment sessions in general anaesthesia are required;
  • What is the price of the treatment; 
  • What is the expected length of the procedure and general anaesthesia etc.  

By this appointment, the anaesthetist has given his or her answer whether it is possible to use general anaesthesia for dental treatment for the patient.

3. A prepayment invoice that sets out the expected price of general anaesthesia is given to the patient. Payment of the invoice is a precondition of the procedure.

4. The patient comes to the clinic for the dental treatment to be conducted in general anaesthesia. After the procedure is finished and the patient has come out of general anaesthesia, it is necessary that there is a person to accompany the patient when he or she leaves the clinic.

Five indications for general anaesthesia for dental treatment

In case of children and adults, the indications for general anaesthesia for dental treatment are following: 

  • Patients that are unable to cooperate due to psychological reasons or emotional immaturity and/or mental or psychic disability or medical indication;
  • Patients in whom local anaesthesia does not have the required effect due to acute infection, anatomical specifics or allergy towards local anaesthetics; 
  • Patients that are not cooperative, are extremely fearful, anxious or have communication difficulties;
  • Patients that require extensive surgical or immediate extensive treatment;
  • Patients in whom general anaesthesia for dental treatment prevents psychic disorders or under other psychiatric indications.

General anaesthesia is also useful because it enables the dentist to work uninterrupted: the patient’s body is fixed in place during the surgery that allows performing some procedures faster. 

In our clinic, the rooms are planned so that they can be used to perform treatments on patients in general anaesthesia. We work with the most modern equipment, including general anaesthesia equipment to offer the most advanced treatment for our patients.

According to the dental care benefit that will become effective on 1 July 2017, the state will also pay for general anaesthesia for dental care in adults if it is medically indicated. This amendment is beneficial primarily for patients that suffer from psychic and behavioural disorders and diseases of nervous system or who have severe physical disability. 

Pricing of general anaesthesia

Pricing of general anaesthesia is following: first hour of the service and then every 15 minutes. In addition to the price of general anaesthesia, the usual treatment price will be added. You can find the price list of our services here: https://www.sakalahambaravi.ee/en/price-list-0.

General anaesthesia risks

General anaesthesia is today quite safe; however, all medical procedures carry certain risks. Life-threatening complications (cardiac arrest, respiratory arrest, blood clots in large vessels, brain damage etc.) occur very rarely provided that all anaesthesia related standards/precautions have been applied or taken. Malignant hyperthermia (body temperature rise) is very rare (1 : 50 000). The risk to die during anaesthesia for a patient in good health is less than 1 : 200 000–1:400 000, which can be compared to the risk of being killed in a plane crash and is significantly smaller than the risk to be killed in a traffic accident.

General anaesthesia related risks are higher if:

  • You suffer from some chronic disease, e.g. high blood pressure, ischemic heart disease, asthma, diabetes etc.;
  • You are allergic to medicines;
  • You smoke;
  • You use alcohol or drugs;
  • You are pregnant.

General anaesthesia related risks

  • During inserting of an intubation tube, vocal cords or teeth may be damaged.
  • Very rare are situations where at the beginning or end of anaesthesia the patient wakes up, i.e. she/he hears what is going on but is unable to move.
  • As the usual protective functions of the body do not function or function partly in unconscious state, there is a risk that if the patient’s stomach is full, its content may end up in airways and cause life-threatening complications. This is why it is forbidden to eat or drink 6 hours before an operation, with the exception of water, which should not be taken 4 hours before the operation. If this rule has not been followed, the operation may be postponed or not performed to ensure the patient’s safety.
  • During anaesthesia, muscles have no tone that may cause muscle compression due to their position, which may result in numbness or nerve irritation in some parts of the body that lasts for weeks.

Good to know

  • All needles used during general anaesthesia are used one time to prevent infection transmission from one patient to another. 
  • Do not eat or drink 6 hours before the operation, do not smoke or chew a gum. If necessary, take the drugs prescribed and permitted by the doctor/anaesthetist with a small sip of water.
  • Inform the surgeon and anaesthetist about any chronic diseases that you have, previous operations and drugs you take regularly. If your doctor has not suggested otherwise, take the drugs that you have been prescribed until the operation day. Take your drugs with you to the clinic.
  • Do not consume alcohol a week before the operation.
  • Do not apply make-up or polish your nails. Polished, gel and artificial nails prevent attaching a monitoring device to the tip of your finger (pulse oximeter). If necessary, nail polish or an artificial nail may be removed during the operation.
  • Use toilet before your operation.
  • Take off jewellery and rings/studs, remove your glasses and/or contact lenses and take off removable dentures and give them to the assistant.

When you are allowed home after the operation, it is suggested that you leave the clinic accompanied by another person. You are not allowed to drive a car, operate complicated apparatus or tools, sign legal documents or consume alcohol 24 hours after the end of the operation.