paeds tx planning for xga Flashcards
What are some basic facts?
Tooth decay is the most common reason for GA (6-10yrs)
55000 admissions for extractions (under 19)
Over £40 million to NHS
What is the typical dental GA patient?
Mean age 5-6years
Up to 50% of pts are preschool
High rep from ethnic minorities (1/3)
Most are deprived
Caries for DGA pop is 5x normal
DGA pop has safeguarding concerns (>10%), don’t turn up (5-10%), don’t follow up (>50%)
Parents have little control/motivation
What is the ideal tx plan?
Individualised
Holistic
Flexible
Forward planning
Evidence based
Non authoritarian
Why is tx planning for GA so important?
Risk of death (1:100000)
Over 50% feel sick, dizzy, bleeding pain
Inconvenience for family
Psychological upset
Maximise efficiency and minimise cost (£1800 for each GA)
Need to minimise repeat!
What is the justification for GA?
1. Kids w management problems (<3yrs, learning difficulties)
2. Orofacial trauma
3. Surgery/multiple x
4. Acute facial swelling (LA doesn’t work, trismus)
5. Med history (haemophilia, esterase inhibitor deficiency)
6. Severe phobia, anxiety
What are the stages of tx planning?
1. History
2. Exam
3. Special investigation
4. Diagnosis
5. Further info
6. Tx plan
7. Informed consent, risks, preop instructions
GA
Why do we do a pre-GA assessment?
1. Sufficient time for full history and discuss options
2. Time for special tests, tx
3. Speak to GP, anaesthetist
4. Time for family to reflect
5. Pre op instructions and risks understood
6. Opp for behaviour management
7. Will run better on day
8. Less risk of serious incident
9. Less risk of repeat GA
10. Will reduce overall prescription of GA
What is in the history?
Who is with the child- do they fully understand?
HPC
PDH
MH- bleeding problems, allergies, previous GA, family (malignant hyper pyrexia)
SH- ease of attendance
What do we consider in the examination?
EO- pyrexia, swelling, trismus
IO- caries, restorations, erosion, trauma, ortho, soft tissue mobility, tongue ties, mobility, missing teeht
What special investigations do we need?
Radiographs- bitewings can pick up 8x more carious lesions that clinical (or sectional OPT, PAs, USO, pan oral, CBCT
BMI- height and weight (increased=increased risk- longer post op monitoring, 24% were above)
Bloods- (10% of non white european may have Haemoglobinopathy, 19% <6yrs were anaemic, multiple molar x may lose 15% blood volume)
What is the choice of GA?
Depends on facilities available, waiting lists, urgency, med status, tx required
Short dental GA- non intubated
Long dental GA- intubated
Shared GA- w other specialties
What are risk factors for repeat GAs?
1. Early caries
2. Poor attendance
3. Dysfunctional family
4. Poor compliance (diet, OH, bottle, child brushing own teeth)
What should be considered for consent?
1. Good pt-operator relationship
2. Written- time to reflect- invalid after 3 months
3. Itemise specific items of tx
4. Input of child sometimes
5. Understand risks and benefits
What are risks and preop instructions?
Bleeding, pain, bruising, fractured roots, damage to adj, space loss etc
Dizziness, sickness, fatality
Written and verbal + interpreter
No food for 6hrs prior but allowed sips of water
Preventative advice incorporated
What is important on the day?
Make sure tx plan clear and correct
Valid informed consent
All records available
Details of med status
Anaesthetist fully aware
Fasting time observed
Child is fit and well
Escort requirements known and observed
