General Anaesthetic - inc referral guidance Flashcards
GDC definitionof a GA
- any technique using equipment/drugs which produces a loss of conciousness in specific situations involving medical/surgical intervention.
- loss of conciousness & abolition of protective reflexes
Aspects of child’s anatomy to consider during GA
- large head/short neck/large tongue
- narrow nasal passages
- high anterior larynx
- large floppy epiglottis
- large surface area/small weight ratio: twmperature control
Aspects of child’s resp physiology to consider during GA
- low FRC
- horizontal ribs/weak intercostal muscles
- high oxygen consumption
Aspects of child’s neurological physiology to consider during GA
- Increased incidence of periodic breathing and apnoeas
- Ventilatory response to CO2 is more readily depressed by opiates
- Immature neuromuscular junction leads to increased sensitivity to muscle relaxants
Most common drugs used to induce a GA
- IV
- Inh
- IV: propofol
- Inh: NO/sevoflurane
Name the 4 stages of anaesthesia
- induction
- excitement
- surgical anaesthesia
- resp paralysis/overdose
Indications for a child to have a GA
- child is too anxious / too young to co-op
- too unco-op for treatment
- patient won’t sit still
Contra-indication to GA
-risk of procedure outweighs benefits
Major risks of GA
- death
- brain damage
- malignant hyperpyrexia
Minor risks of GA
-standard risks of dental treatment
- sore head / throat
- drowsiness
- fear of hospitals
- nausea / vomiting
- upset
- damage to oropharynx during intubation
- allergy
- laryngospasm
-risks of treatment: pain/swelling/bleeding/bruising/visible restorations/failure of treatment/stitches/loss of space
Important aspects of GA consent
-in what form must GA consent be obtained
- aware of other options (IS/IVs)
- risks vs benefits
- advise that 1st appt: treatmetn plan & info
-Written form
Medical conditions that need careful work up for GA
- Down syndrome
- epilepsy
- bleeding syndrome
- renal disease
- diabetes
- liver disease
- cardiac conditions
- cystic fibrosis
- sickle cell disease
- severe asthma
Discharge criteria for GA
Discharge Criteria
Fully conscious, able to maintain clear airway, exhibits protective
reflexes
Satisfactory oxygenation and respiration
2-5yrs 24-30 breaths/min
5-12yrs 20-24 breaths/min
CVS stable- no unexplained cardiac irregularities, no persistent
bleeding, pulse and BP acceptable, adequate peripheral
perfusion
Heart rate 2-10yrs mean 80 beat/min
BP for 1-10yrs= 90+ 2xage in yrs
Pain, nausea and vomiting controlled
Temperature in normal limits
Eaten, drunk, been to toilet
Referral letter information required
Referral letter should state:
- Patient name
- Patient address
- Patient/ Parent contact numbers- landline and mobile
- Patient medical history
- Patient GP details
- Parental responsibility
- Justification for GA
- Proposed treatment plan
- Previous treatment details
- SPECIAL INV: Rgs
