GA Flashcards
1
Q
Uncommon side effects + complications of GA
A
- Breathing difficulties
- Damage to teeth, lips, and/or tongue
- Worsening of an existing medical condition
- Awareness during anesthesia
2
Q
Rare or very rare complications of GA
A
- Damage to eyes
- Allergic rxns to drugs
- Death
- Brain damage
- Equipment failure
3
Q
Pre-surgical NPO guidelines + pre-surgical dietary precautions
A
- Clear liquids
- 6-36mo: 2hr
- >36mo: 2hr
- Breast milk
- 6-36mo: 4hr
- >36mo: NA
- Formula
- 6-36mo: 6hr
- >36mo: NA
- Solids/milk
- 6-36mo: 6hr
- >36mo: 8hr
4
Q
ASA Classification
A
- ASA I – Normally healthy patient w/ no organic, physiologic, biochemical or psychiatric disturbance or disease
- ASA II – Mild to moderate systemic disturbance or disease
- ASA III – Severe systemic disturbance or disease
- ASA IV – Severe life-threatening systemic disease or disorder
- ASA V – Moribound patient who is unlikely to survive w/o the planned procedure
- ASA VI – Declared brain-dead patient whose organs are being removed for donor purposes
5
Q
In office GA
A
- Follow state dental board regulations
- Facility must be inspected to obtain an Anesthesia + Sedation Facility Certificate
- Anesthesia administration by a state licensed Physician Anesthesiologist, Certified Nurse Anesthetist, or dentist who holds an anesthesia and sedation permit
6
Q
Mallampati Scoring
A
Airway evaluation; visual assessment used to predict ease of endotracheal intubation
- Class I – Soft palate, uvula, fauces, pillars visible
- Class II – Soft palate, uvula, fauces visible
- Class III – Soft palate, base of uvula visible
- Class IV – Only hard palate visible
High score (Class III + IV) associated w/ more difficult intubation + higher incidence of sleep apnea
7
Q
Brodsky Grading Scale
A
Tonsillar size; based on percentage of oropharyngeal airway occupied by tonsils
- Grade 1 – ≤25%
- Grade 2 – 25-50%
- Grade 3 – 50-75%
- Grade 4 – ≥75%
8
Q
Post-GA orders
A
- Maintain IV (Lactated Ringer’s or D5W) until patient is stable
- Compute IV rate (mL/hr) using the 4:2:1 rule for replacement fluids:
- 1st 10kg x 4mL
- 2nd 10kg x 2mL
- Remaining kg x 1mL each
- Example: 25kg child would receive 40+20+5 = 65mL/hr
- D/c IV fluids once child is fully awake, alert, and has taken PO fluids
- Monitor for any oral bleeding
- Encourage PO intake of fluids once patient is alert + awake
- PO intake may be delayed if EXT + OS were performed
- Clear liquids are most commonly ordered
- Pain medications if none were given intra-operatively
- Vital signs
9
Q
GA Indications
A
- patients who cannot cooperate due to a lack of psychological or emotional maturity and/or mental, physical, or medical disability
- Patients for whom local anesthesia is ineffective because of acute infection, anatomic variations, or allergy
- Patients who are extremely uncooperative, fearful, or anxious
- Patients who are precommunicative or non-communicative child or adolescent
- Patients requiring significant surgical procedures that can be combined with dental procedures to reduce the number of anesthetic exposures
- Patients for whom the use of general anesthesia may protect the developing psyche and/or reduce medical risk
- Patients requiring immediate, comprehensive oral/dental care (e.g., due to dental trauma, severe infection/cellulitis, acute pain)
10
Q
GA Contraindications
A
- a healthy, cooperative patient with minimal dental needs
- a very young patient with minimal dental needs that can be addressed with therapeutic interventions (e.g., ITR, fluoride varnish, SDF) and/or treatment deferral
- patient/practitioner convenience
- predisposing medical conditions which would make general anesthesia inadvisable.
11
Q
GA documentation
A
- rationale for use of general anesthesia
- informed consent
- instructions provided to the parent
- dietary precautions
- preoperative health evaluation
