General Anaesthesia Flashcards
1
Q
Definition of ga
A
- A state of controlled unconsciousness during which you feel nothing
- pharmological means of achieving pain control and behaviour management that enables dental treatment for children
2
Q
Number of XGAs for U18s in 2016
A
43000
3
Q
Why is there a need for GA
A
- Combination of prevalence of disease and ability of children to cope with treatment
- 31% of 5yos and 45% of 8yos have experience of decay
4
Q
Socio-economic inequalities and decay link
A
- Children from lower income fams twice as likely to have decay
- More likely to experience toothache and report problems in their daily life caused by their oral health
5
Q
Care pathway for GA
A
- Referred child from a primary care setting
- Assessment appointment
- Hospital appointment/ special care hospital setting if mh complex/ other treatment form indicated eg ihs
6
Q
What should a GDP do when referring pt for GA
A
- discuss need for referral
- make fam aware of risks associated with treatment
- refer to a local ga service provider
- clearly justify the need for ga
7
Q
When should u consider la+/- ihs for children
A
- Cooperate children
- Routin conservation
- Single extractions
- Preference of child/patient
- Preferable in certain medical conditions
8
Q
what should assessment of ga patient entail and who should do it
A
- Ideally a paeds specialist
- Assessment, diagnosis, tx plan, management of children
- trained and experienced in behavioural management of children including conscious sedation
9
Q
What general considerations should be taken into account
A
- Co-operative ability of child
- Perceived anxiety and how child has responded to similar procedures
- degree of surgical trauma anticipated
- complexity of the operative procedure
- medical status of child
10
Q
2 main indications for ga
A
- The child is too young, too anxious or uncooperative to accept treatment by any other means
- Surgeon needs the guarantee of a completely still patient usually because the planned procedure is complex
11
Q
all the indications for ga
A
- no cooperation
- very young children
- anticipated distress from la (based on past experience)
- multiple extractions
- surgical extractions
- preference of child/parent
- preferable in certain medical conditions
- extensive treatment
- difficult or complex dental treatment
12
Q
Contraindications of ga and extenuating circumstances of these contras
A
The following circumstances rarely justify GA
- Carious, asymptomatic teeth with no clinical or radiographic signs of sepsis
- Orthodontic extraction of sound permanent premolar tooth in a healthy child
- Patient/carer preference, except where other techniques have already been tried
However, extenuating circumstances that override the above limitations include:
- physical, emotional, learning impairments or combinations of two or more of these
- children who have attempted treatment using la alone or la with ihs and still unable to cooperate
- medical problems which are better controlled with the use of ga
13
Q
Examples of treatment that may require ga
A
- Severe pulpitis
- Sub mandibular abscess
- Dento-alveolar surgery
- Multiple XGAs in under 5s
- symptomatic teeth causing pain in. more than 2 quadrants
- symptomatic teeth where bilateral idb maybe needed
- Ankylosis extractions
- Extraction of FPMs
- Biopsy
- Debridement and suturing
- Full mouth rehabilitation
- EUA (special needs children)
14
Q
Minor risks of GA
A
- Pain
- Headache
- Sore throat
- Sore nose
- Nausea
- Vomiting
- Upset stomach
15
Q
What risks do you have to inform the patient
A
- Minor risks
- Risks of procedure (eg extraction consent
- Major risks
