GA for children Flashcards
why does after 1960 there is a significant drop in the use of GA?
fluoride introduced
why have there been no deaths due to GA since 2000s?
GA only done in secondary care settings
what are the different priority ratings for GAs?
- Priority level 1a Emergency - operation needed within 24 hours
- Priority level 1b Urgent - operation needed with 72 hours
- Priority level 2 Surgery that can be deferred for up to 4 weeks
- Priority level 3 Surgery that can be delayed for up to 3 months
- Priority level 4 Surgery that can be delayed for more than 3 months
what is classed as priority level 1a?
Emergency/Urgent cute spreading infection with or
likely to have airway compromise and/or severe trismus. Uncontrolled
pain, not resolving with analgesics, having severe impact on child and
family (eg self-harming)
what is classed as priority level 2?
Regular or current pain on eating or sleeping that is
responding to analgesia, more than one previous course of antibiotics,
current chronic infection (intraoral swelling/sinus
what is classed as priority level 3?
Little or no pain, no disturbance to eating or sleeping,
symptoms resolved with analgesics, no more than one previous course
of antibiotics for dental condition
who works in the theatre team?
- consultant anaesthetist
- ODP (helps anaesthetist)
- 2 dental nurses
- recovery staff
- surgeon (dentist)
what is the journey of GA for a child?
what are the risks and benefits of GA ?
Eliminates need for
behaviour management
during treatment
Completion of extensive
treatment at single visit
Control of complications
Risk to pt
Range of Work
Limited Access
Cost
Can be a Traumatic Experience
resources
waiting lists
what are the risks to pts ?
what are the risks for a child in good health having minor surgery ?
- 1 child in 10 experiences a headache or a sore
throat - 1 child in 10 experiences sickness or dizziness
- 1 child in 5 becomes agitated on waking
- around 1 child in 10,000 develop a serious
allergic reaction to the anaesthetic - the risk of death from anaesthesia for healthy
children having minor or moderate non
emergency surgery is less than 1 in 100,000
list some health inequalities
- Poor oral health remains a significant public health
problem in England, particularly in deprived areas. - Links between oral health and ethnicity are complicated
and often confounded by socio-economic status, the
prevalence of certain oral diseases is higher in some
ethnic groups. - Attempts have been made to improve the availability of
NHS dental services in many parts of the country
although there is some evidence to suggest that
utilisation of dental services varies between different
ethnic groups. - Further research is needed into ways to improve the
acceptability of dental services for people from black
and minority ethnic groups.
what are some of the ethnic inequalities ?
- People from Black and minority ethnic groups experience
inequalities in health outcomes as well as inequalities in access to
and experience of health services compared to White groups. - Complex picture with variation between and within ethnic groups,
and understanding is limited by a lack of good quality data and
analysis - The COVID-19 pandemic has taken a disproportionate toll on
groups already facing the worst health outcomes, including some
Black and minority ethnic groups. - NHS to focus on its key role in improving population health and
reducing inequalities. Diversify leadership, quality of data,
investment in community engagement work
what are the 2 lists for GA ?
- comprehensive care = need loads of work done not just extractions
- out patient GA = pts who only need extractions and nothing else. very quickly, loads of pts seen in one day compared to comprehensive
what is the cost of GA ?
- The costs to the NHS of hospital admissions for
tooth extractions in children aged 0 to 19 years
were £64.3 million for all tooth extractions and
£40.7 million for decay-related tooth extractions
2022 to 2023. - DGA for full mouth rehabillitation £3,000
- DGA for exodontia only £1,300
what are some of the environmental impacts of GA?
- Greenhouse gas emissions associated with inhaled
anaesthetic agents: sevofluorane 100x more potent than
CO2 in terms of global warming potential (GWP)
-Nitrous oxide: Often used in combination has 300x GWP
compcare with CO2 - Environmental persistence: Anaesthetic gases not
easily broken down in the atmosphere further exacerbating
impact (e.g. sevofluorane has lifetime of 14yrs) - Waste and by-products: single-use materials, impromper
disposal of anaesthetic agents and materials can lead to
environmental contamination - Energy consumption: theatres are energy-intensive
environments
how can GA be a traumatic experience ?
- Where children are already anxious about dental treatment, DGA does nothing to alleviate this anxiety- Object of DGA is compliance
- Increase in dental anxiety following treatment under GA
- negative outcomes from children ‘hunger and difficulty sleeping’ also ‘negative feelings of being worried or scared and the discomfort following placement of the
intravenous cannula’ - Improvements in oral health related quality of life following treatment
- Many parents view them as an acceptable and convenient method of treatment
- Parents generally rate high levels of satisfaction with treatment under GA
how do we select Pts ?
coop
MH
type and extent of tx
list some pt cooperation factors that help us select pt for GA ?
- The co-operative ability of the
child. - Learning disability
- Pre cooperative
- Uncooperative
- Phobic
- The perceived anxiety and how
the child has responded to similar
procedures
list some MH factors that help us select pt for GA?
- The medical status of the child
- Pre op tests and information
- Risk to patient
- Inpatient vs Day Case
- Special Precautions
- Specialist Management
(Possible multidisciplinary)
what do we mean by type and extent of tx for pt GA selection criteria ?
- The degree of surgical trauma anticipated.
- ## The complexity of the operative procedure
what 3 principles do we look at when tx planning ?
- the tx
- the tooth
- the pt
what are the things we need to consider with the tx for a GA ?
- Restorations on primary teeth must last until exfoliation
- Reduce potential for further treatments
- Consider success rates of restorations – preformed metal crowns are the most
predictable and durable restoration (unless very minimal occlusal carious lesion) in primary teeth - Consider bruxism with planning preformed metal crowns
- Caution with pulp therapy
what are things we need to consider with the tooth for GA?
- Maintain second primary molars where possible (prevents mesial drift of 6s and reduced dental arch width, Ball 1993)
- Less impact for removal of first primary molars or primary anterior teeth
- Balancing extractions for primary canines
what are the things we need to consider with the pt for GA ?
- Caries risk: Extent of disease
- Medical: bleeding disorders, cardiac – risk of infective endocarditis
- Patient: commitment to ongoing prevention/tooth brushing/dietary advice
- Learning disability: ability to accept on- going dental care/maintenance and
prevention - Social considerations: access to GDP and regular dental care, parental expectations and motivation
exodontia v compcare
- Clinical related factors ie. ability to have full clinical
exam and radiographs - Parental expectations/wishes
- Restorability of carious teeth
- Caries risk of child
- Availability of comprehensive care services
- Co-existing medical conditions
how do we discuss the tx and procedure to the pt ?
Clear justification for the use of a general
anaesthetic must be made in a referral
What the alternatives are
What the relative risks are
Give an idea of treatment and limitations
Warn about possible waiting times
Emergency treatment
how do we get consent from parents ?
- The risks and benefits of each
procedure and its components,
both to the patient concerned - Written consent prior to procedure,
re-confirmed on the day - Clear plan – indicate primary or
permanent teeth involved - Interpreting services where needed
- As specific as possible
what are some cultrural considerations ?
- Be aware that cultural perceptions of anaesthesia from different cultural
and socio-economic backgrounds may influence parental decision-making - Language – cited as a barrier to black and minority ethnic groups
accessing dental services. May affect appointment booking, understanding treatments and terminology, accurate medical history taking and informed
consent. Interpreter to be used for GA consent - High repeat rates and GA usage within the same family and that GA for tooth extraction is culturally acceptable in some communities. Welsh
children were more likely to have ever used a dental GA than their English counterparts, which may reflect the contrasting prevalence and severity of
childhood dental caries between the two countries
