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PEDO (Spring) > 3. General Anesthesia > Flashcards

3. General Anesthesia Flashcards

1
Q

Indications for GA with kids

A
  • Kids with physical, mental and medically compromising conditions
  • Can’t use LA (allergy or infection)
  • Uncooperative, fearful, anxious, physically resistant, or uncommunicative with no expectation of improvement
  • Extensive orofacial/dental trauma
  • Patients with immediate comprehensive needs who wouldn’t receive dental care
  • Protect developing psyche and reduce medical risks
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2
Q

Contraindications to GA

A
  • Medical reasons
  • Healthy/cooperative patients
  • Minimal dental needs
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3
Q

Documentation needed for GA

A
  • Parent consent

- Some insurances require proof of poor behavior

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4
Q

Other alternatives to GA

A
  • Papoose

- Sedation (great for short procedures- patient with minimal dental needs- rule is 4 teeth or less)

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5
Q

What are the prereqs needs to gain hospital privileges

A
  • Graduate an accredited dental school
  • Licensed to practice dentistry in that state
  • High moral/ethical standards (LOR’s needed)
  • Have liability insurance
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6
Q

What are the prereqs for privileges are a children’s hospital

A

Advanced training needed/residency in a teaching hospital in which the dentists has had training to…

  • Evaluate med hx and current medical status
  • Do a physical exam to recognize conditions that will effect dental tx
  • Initiate medical consults when necessary
  • Know procedure for admitting, monitoring and discharging pts
  • Proficient in OR protocol
  • Anesthesia rotation
  • Board eligible (written boards and anticipated oral boards)
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7
Q

Most GA cases are (inpatient/outpatient) and why

A

outpatient… advances in anesthesia, more pediatric anesthesia providers, decreased morbidity and mortality

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8
Q

What is the difference between inpatient and outpatient

A

Inpatient receives food and lodging overnight

Outpatient is NOT hospitalized overnight

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9
Q

What are the advantages of outpatient care compared to inpatient

A
  • Faster
  • Better tolerated by pt, parents, and hospital team
  • Less traumatic for pt
  • Less cost for pt and insurance
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10
Q

Patient selection for outpatient surgery must include what criteria for acceptance

A
  • Free of significant medical disorders (ASA Class I/II)
  • Well controlled chronic systemic disorders can be considered with anesthesia consult (asthma, diabetes, congential heart disease)
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11
Q

Pre-op evaluation for outpatient care consists of

A
  • Med hx
  • Physical exam
  • Anesthesia assessment
  • Limited hematologic evaluation outside of hospital
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12
Q

Indications for inpatient surgery are

A
  • Medical condition requires close follow up
  • Child lives outside general area hospital
  • Parents demonstrate questionable ability to comply with pre and post-op instructions
  • Medically or developmentally disable patients with multiple problems requiring lengthy dental treatment
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13
Q

Most common GA complications for kids are… what can you do to treat them

A
  • Vomiting (antiemetic like Zofran)
  • Fever (acetaminophen)
  • Sore throat (ice chips/ popsicle)
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14
Q

T/F There are no significant long-term complications from GA

A

t

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15
Q

Consent for the treatment under GA is obtained from who

A

parent or legal guardian

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16
Q

Prior to surgery a letter should be mailed to parents with pre-op instructions. When should this be sent out

A

2 weeks prior to surgery

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17
Q

Inpatient may arrive (day of surgery/day before surgery) and outpatient may arrive (day of surgery/day before the surgery)

A 
Inpatient= either (depends on severity of medical issues) 
Outpatient= same day
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18
Q

NPO means…. who determines this

A

NPO= nothing by mouth… determined by the anesthesiologist.

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19
Q

Only allowed to have clear liquids up to _ hrs prior to the arrival time

A

2 hrs

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20
Q

According to OSHA, what attire is required when in the surgical suite, hallway, and recovery room

A
  • Scrubs
  • Mask
  • Shield/eyewear/goggles
  • Cap/bonnet
  • Sterile gloves
  • Gown
  • Show covers
  • Hood for facial hair
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21
Q

GA in the OR for dentistry is (sterile/clean) procedure

A

clean (mouth is not sterile and can’t be made sterile)

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22
Q

Why is nasotracheal intubation preferred in dental procedures

A

good access to oral cavity

23
Q

Things that should try to be avoided during intubation are

A
  • Laryngospasm
  • traumatic intubation
  • Aspiration/ tooth avulsion
  • compromised airway
24
Q

What type of monitoring equipment is used during GA

A
  • Pulse oximetry
  • Percordial stethoscope
  • BP
  • Thermometer
  • Capnography device
25
Q

IV fluids consist of… why give IVs

A

5% dextrose lactated ringer solution… used due to NPO (Kids haven’t have had anything to eat/drink for a while)

26
Q

Why are drapes placed over the patient in GA

A
  • Maintain body temp

- Maintain clean field

27
Q

Throat pack is placed where

A

down the pharynx

28
Q

Purpose of the throat pack is

A
  • Absorbs blood and other bodily fluids that seep into the back of the patient’s throat that can enter the esophagus or lungs
  • Seals area around the tracheal tube preventing gas leakage
  • Stabilizes tracheal tube from displacement
29
Q

What will happen in the throat pack is not removed at the end of the procedure

A

obstruction (die)

30
Q

Why is LA not needed for post-op pain management

A

-Administer morphine during surgery for pain

31
Q

When is the time you may want to use LA

A

hemostasis

32
Q

What must you consider if you are using LA in GA

A
  • Weight limitations
  • PAT (tacchycardia) possible)
  • Weight risks v.s benefits
33
Q

Why might you see a change in HR/ BP during extractions

A

-Pain receptors are still being activated but pain is not being interpreted by the CNS

34
Q

Why are SSCs preferred to larger fillings in the OR

A
  • Greatest longevity (less failure rate)

- Least maintenance

35
Q

Pulpally involved teeth in the OR should receive (pulpectomy/pulpotomy/exo)

A

exo- always extract questionable teeth

36
Q

T/F SSCs are indicated for primary and permanent teeth

A

t

37
Q

Indications for SSC

A
  • Extensive caries
  • Cervical decalcification
  • Developmental defects (hypoplasia/hypocalcification)
  • Interproximal caries beyond the line angles
  • Patients with bruxism
  • Pulpotomy/pulpectomy
  • Abutment tooth for space maintainer
  • Fractured tooth
38
Q

Post op care includes

A
  • Apply gauze to exo sites
  • Pain control
  • Diet specifications
  • No sticky candy/ gun/ etc.
39
Q

When can the patient be discharged

A
  • Patient is awake and alert
  • Displays appropriate behavior
  • Maintains own airway
  • Stable vitals
  • No uncontrolled bleeding or pain
40
Q

Follow up after OR should be when

A

2 weeks

41
Q

What caution should be taken in treating kids with down syndrome under GA

A
  • Caution to prevent atlantoaxial subluxation or dislocation
  • This can lead to paralysis or impairment or rotation
  • **Get a cervical spine X-ray_
42
Q

T/F Patients with SBE should be pre-medicated before GA

A

t

43
Q

Patients with malignant hyperthermia should be the (first/last) case of the day and why

A

first to have a clear room

44
Q

For outpatients when should their IV be discontinued

A

when released from recovery

45
Q

Inpatient IV should be maintained at what rate

A

40 mL/hr

46
Q

When should inpatient IV be discontinued

A

when empty or if it infiltrates (longer if indicated)

47
Q

Vitals in recovery are obtained how frequently

A

every 15 mins until stable then every 2 hrs in recovery room (for inpatient)

48
Q

Inpatients should have their head elevated _ degrees

A

30

49
Q

If the patient is swollen what should be done

A

apply ice pack for 30 min

50
Q

How frequently should the inpatient be checked for hemostasis

A

every 15 mins for 1 hr

51
Q

T/F Not all medications should be maintained in the patient after surgery

A

f

52
Q

Tylenol should be given to the kids in what dose for pain when needed

A

1 grain per year of age every 4 hrs as needed

53
Q

If the patient suffers from croup what can you do

A

moisten the air with mist

PEDO (Spring) (9 decks)

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