3. General Anesthesia Flashcards
Indications for GA with kids
- 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
Contraindications to GA
- Medical reasons
- Healthy/cooperative patients
- Minimal dental needs
Documentation needed for GA
- Parent consent
- Some insurances require proof of poor behavior
Other alternatives to GA
- Papoose
- Sedation (great for short procedures- patient with minimal dental needs- rule is 4 teeth or less)
What are the prereqs needs to gain hospital privileges
- Graduate an accredited dental school
- Licensed to practice dentistry in that state
- High moral/ethical standards (LOR’s needed)
- Have liability insurance
What are the prereqs for privileges are a children’s hospital
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)
Most GA cases are (inpatient/outpatient) and why
outpatient… advances in anesthesia, more pediatric anesthesia providers, decreased morbidity and mortality
What is the difference between inpatient and outpatient
Inpatient receives food and lodging overnight
Outpatient is NOT hospitalized overnight
What are the advantages of outpatient care compared to inpatient
- Faster
- Better tolerated by pt, parents, and hospital team
- Less traumatic for pt
- Less cost for pt and insurance
Patient selection for outpatient surgery must include what criteria for acceptance
- 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)
Pre-op evaluation for outpatient care consists of
- Med hx
- Physical exam
- Anesthesia assessment
- Limited hematologic evaluation outside of hospital
Indications for inpatient surgery are
- 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
Most common GA complications for kids are… what can you do to treat them
- Vomiting (antiemetic like Zofran)
- Fever (acetaminophen)
- Sore throat (ice chips/ popsicle)
T/F There are no significant long-term complications from GA
t
Consent for the treatment under GA is obtained from who
parent or legal guardian
Prior to surgery a letter should be mailed to parents with pre-op instructions. When should this be sent out
2 weeks prior to surgery
Inpatient may arrive (day of surgery/day before surgery) and outpatient may arrive (day of surgery/day before the surgery)
Inpatient= either (depends on severity of medical issues) Outpatient= same day
NPO means…. who determines this
NPO= nothing by mouth… determined by the anesthesiologist.
Only allowed to have clear liquids up to _ hrs prior to the arrival time
2 hrs
According to OSHA, what attire is required when in the surgical suite, hallway, and recovery room
- Scrubs
- Mask
- Shield/eyewear/goggles
- Cap/bonnet
- Sterile gloves
- Gown
- Show covers
- Hood for facial hair
GA in the OR for dentistry is (sterile/clean) procedure
clean (mouth is not sterile and can’t be made sterile)
Why is nasotracheal intubation preferred in dental procedures
good access to oral cavity
Things that should try to be avoided during intubation are
- Laryngospasm
- traumatic intubation
- Aspiration/ tooth avulsion
- compromised airway
What type of monitoring equipment is used during GA
- Pulse oximetry
- Percordial stethoscope
- BP
- Thermometer
- Capnography device
IV fluids consist of… why give IVs
5% dextrose lactated ringer solution… used due to NPO (Kids haven’t have had anything to eat/drink for a while)
Why are drapes placed over the patient in GA
- Maintain body temp
- Maintain clean field
Throat pack is placed where
down the pharynx
Purpose of the throat pack is
- 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
What will happen in the throat pack is not removed at the end of the procedure
obstruction (die)
Why is LA not needed for post-op pain management
-Administer morphine during surgery for pain
When is the time you may want to use LA
hemostasis
What must you consider if you are using LA in GA
- Weight limitations
- PAT (tacchycardia) possible)
- Weight risks v.s benefits
Why might you see a change in HR/ BP during extractions
-Pain receptors are still being activated but pain is not being interpreted by the CNS
Why are SSCs preferred to larger fillings in the OR
- Greatest longevity (less failure rate)
- Least maintenance
Pulpally involved teeth in the OR should receive (pulpectomy/pulpotomy/exo)
exo- always extract questionable teeth
T/F SSCs are indicated for primary and permanent teeth
t
Indications for SSC
- 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
Post op care includes
- Apply gauze to exo sites
- Pain control
- Diet specifications
- No sticky candy/ gun/ etc.
When can the patient be discharged
- Patient is awake and alert
- Displays appropriate behavior
- Maintains own airway
- Stable vitals
- No uncontrolled bleeding or pain
Follow up after OR should be when
2 weeks
What caution should be taken in treating kids with down syndrome under GA
- Caution to prevent atlantoaxial subluxation or dislocation
- This can lead to paralysis or impairment or rotation
- **Get a cervical spine X-ray_
T/F Patients with SBE should be pre-medicated before GA
t
Patients with malignant hyperthermia should be the (first/last) case of the day and why
first to have a clear room
For outpatients when should their IV be discontinued
when released from recovery
Inpatient IV should be maintained at what rate
40 mL/hr
When should inpatient IV be discontinued
when empty or if it infiltrates (longer if indicated)
Vitals in recovery are obtained how frequently
every 15 mins until stable then every 2 hrs in recovery room (for inpatient)
Inpatients should have their head elevated _ degrees
30
If the patient is swollen what should be done
apply ice pack for 30 min
How frequently should the inpatient be checked for hemostasis
every 15 mins for 1 hr
T/F Not all medications should be maintained in the patient after surgery
f
Tylenol should be given to the kids in what dose for pain when needed
1 grain per year of age every 4 hrs as needed
If the patient suffers from croup what can you do
moisten the air with mist
