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
