General Anaesthesia Flashcards
Define “general anaesthesia”
A state of uncontrolled unconsciousness during which you feel nothing, and can be described as “anaesthetised”
What is the purpose of GA in peadiatric dentistry?
It is a pharmacological means of achieving pain control and behaviour management that enables dental treatment to be carried out in children (where justified)
How can we reduce the number of children undergoing GA due to dental issues?
- Prevention and educating parents
- Reducing barriers to dental care
Who is involved in referring a child for GA?
- GDP (if pt presented initially at primary care)
- Dentists w experience in Peadiatric dentistry (or a specialist)
- Anaesthetist (good to have their opinion)
What are the patient factors that would indicate suitability for GA?
- Pre-cooperative or uncooperative patients
- Highly anxious child
- In certain MH where IHS is contraindicated
- Certain physical and learning disabilities
What are the dental factors that would indicate suitability for GA?
- Difficult or complex treatment
- Prolonged treatment
List some examples of tx which may require GA?
- Surgical extractions e.g. impactions and ankylosed teeth, 6s
- Symptomatic pain in >2 quadrants where bilateral IDB would be required
- Severe pulpitits with signs of spreading infection
- Dento-alveolar surgery
- Biopsies
What is a pre-cooperative child? why are they described as this?
Children between ages 4-5
- They do not have the vocabulary, concentration and cognitive means to be able to cooperate appropriately with procedures
What do we take into account in children with learning disabilities?
Their cognitive age vs their chronological age
- A child that is 12 may have a cognitive age of 5 and may therefore be deemed pre-cooperative
What are the circumstances which rarely justify the use of GA
- Carious, asymptomatic teeth with no clinical or radiographic signs of sepsis
- Orthodontic extractions of sound premolars in a healthy child
- Routine extractions of deciduous teeth
- Parental/carer pressure for GA where other techniques have not been attempted
What extenuating circumstances may override the clinical situations where GA is rarely jusitifed?
- Physical, emotional or learning impairment (or a combination)
- Children where LA alone and LA + IHS has been attempted but unsuccessful
- Medical problems which are better controlled with the use of GA
What setting is GA undertaken in and who is involved?
- Hospital setting where there is a paediatric critical care facility (since 2001)
- Physician anaesthesiologist, dentist and nurses
What are the minor risks associated with GA?
Pain Headache Sore throat Nausea Vomiting Upset stomach Agitation on waking Risk of procedure: pain, bleeding, bruising, swelling, infection, loss of sensation, more teeth removed than planned, roots left
Why are roots sometimes left behind during XLA under GA?
- If the tooth was healthy (no underlying infection) the roots may be left to prevent prolonging the GA, as we want to keep it as quick as possible
What are the major risks of GA
- Allergy
- Brain damage
- Death
What are the statistics for serious allergy to GA
1 in 10,000
What is the statistic for death of a healthy child having minor or moderate non-emergency surgery under GA
1 in 100,000
Why does tx planning for GA have to be thorough?
- We don’t want repeat GAs due to the risks associated, therefore any teeth at the time of GA with caries (even early lesions) will be removed
Describe balancing extractions under GA
- if Cs or Ds are to be removed under GA, the contralateral C and D will also be removed as this is considered best practice to prevent shifting of the midline
- This is not done under LA as it will be to traumatic
If a child presents with multiple carious lesions and requires GA for any other reason, what options do you have for treating the caries?
1 - Attempt to restore the carious lesions before the planned GA if the child is cooperative
2 - Carry out prolonged GA (1hr) and restore the teeth during the GA (better than xla if there are multiple carious lesions)
3 - Remove all the teeth with caries at the time of GA
How can you tell if a child has undergone GA on a DPT?
Premature loss of all (or two contralateral) Cs or Ds
What information is given to the patient when consenting to GA?
- Details of proposed tx plan, including risks and benefits
- Availability of alternative tx options and their risks and benefits
- Process of GA, including side effects and complications
- Pre-op fasting, escorts, suitable home transport, post-op care and analgesia
–> ALL THESE MUST BE GIVEN VERBALLY AND WRITTEN
Who can consent to GA for a child?
- Mother
- Father if he was married to the mother at the time of birth, or after birth
- Unmarried fathers who acquire parental responsibility
- Child’s legally appointed guardian
- Local authority designated in a care order for a child
What is a ‘day case GA’
Most common GA given for children
The child is not kept overnight, they go home after their normal bodily functions are restored
What are the types of GA?
- Open airway (NAMI)
- Laryngeal mask
- Intubation
Pre-operative checks before GA
- Check fasting
- Check pt has gone to the toilet
- Ensure all radiographs and special tests are available
- Final consent and ensure parent remains for recovery
Post-op instructions for GA
- Analgesia
- Warn about post op nausea and vomiting, residual effects of GA
- If xla - bleeding and how to manage
- Details of sutures if relevent
- OHI and care of sockets
- Eating
- Lines of communication in the event of post op complications
