General Anaesthesia

Question 1

What is the definition for GA?

Answer 1

• Technique using equipment/ drug(s)
• Producing LOC and abolition of protective reflexes
• Associated with medical interventions

Question 2

What drugs are used in GA?

Answer 2

INHALED

• NO
• Sevoflurane
• Haloflane
• Desflurane
• Isoflurane

INTRAVENOUS
- Propofol

Question 3

What are the types of airways used?

Answer 3

• Laryngeal Mask Airway (LMA)
• Nasal Endotracheal Intubation (NEI)
• Oral Endotracheal Intubation (OEI)

==> THROAT PACK ALWAYS REQUIRED

Question 4

What are the stages of anaesthesia?

Answer 4

1. Induction
2. Excitement
3. Surgical anesthesia
4. Respiratory paralysis/ overdose

Question 5

What are the indications for GA?

Answer 5

• Child needs to be asleep = too young, too anxious, uncooperative
• Dentist needs pt to be guaranteed stillness, complex tx

Question 6

What are the risks and complications of GA?

Answer 6

MAJOR (uncommon)

• Death
• Will not awaken
• Brain damage

MINOR

• Pain
• Headache
• Nausea/ vomiting (allergy)
• Sore throat/ nose (damage)
• Nose bleed
• Drowsiness
• Upset
• Increases anxiety about future dental tx
• Associated risk with tx

Question 7

What should be included for full consent for GA?

Answer 7

• Written consent
• Describe procedure (pre-, peri, and post-op)
• Risk vs benefits
• Alternative tx
• Allow to ask questions
• Allow to go away and think about it

Question 8

Who is allowed to consent on behalf of the child?

Answer 8

MOTHER (always)

FATHER if

• Married to mother at child’s conception
• Unmarried but on birth certificate (AFTER 04/05/06- Scotland)
• Court ordered/ mother agreement parental responsibility

ADOPTIVE
- Legally adopted

STEP/ CIVIL PARTNERSHIP
- Court ordered/ mother agreement parental responsibility

LEGALLY APPOINTED GUARDIAN

CHILD
- ‘Gillick competent’

Question 9

What are the post-op instructions given following GA?

Answer 9

• Analgesia
• Rest
• Monitoring
• Look our for bleeding, pain
• Extraction advice

Question 10

What is included in a referral letter for GA?

Answer 10

• PATIENT = name, address, contact number (parents), MH, GP details
• PARENTAL responsibility
• JUSTIFICATION for GA
• Proposed TX PLAN
• PREVIOUS TX details
• RELEVANT XRs (most recent) or justifications as to why none (pt uncoop etc.)