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paeds 4th year > general anaesthesia for the child patient > Flashcards

general anaesthesia for the child patient Flashcards

1
Q

what is the definition of a general anaesthetic?

A

> the induction of a state of unconsciousness with the absence of pain sensation over the entire body, through the administration of anaesthetic drugs

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2
Q

what is the purpose pf general anaesthesia? (5)

A
  1. Analgesia (loss of response to pain)
  2. Amnesia (loss of memory)
  3. Immobility (loss of motor reflexes)
  4. Hypnosis (unconsciousness)
  5. Paralysis (skeletal muscle relaxation)
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3
Q

what are the two indications for use of GA in children?

A
  1. The child needs to be fully anaesthetized before dental treatment procedures can be
    attempted.
  2. The surgeon needs the child fully anaesthetized before dental treatment can be
    performed
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4
Q

what are the rules for giving GA to a child in the UK?

A

> Children undergoing general anaesthesia for dental extractions should receive the same standard of assessment and preparation as children admitted for any other procedure under general anaesthesia Hospital Appointment

> Can only take place in a hospital setting

> Can only be administered by a consultant anaesthetist

> Critical care unit must be available

> support by Specialist Paediatric nursing

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5
Q

based on the 2001 causewellow report, where are all GA carried out ?

A

> in a hospital setting

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6
Q

what must the dentist referring a child for GA decide on/ do?

A

> Decide that if a child requiring dental extractions is not manageable within general dental practice setting ,they make the appropriate referral

> Adhere to referral guidelines and make use of the recommended proforma

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7
Q

what are certain things you should condisider before offering a GA?

A

> Routine conservative treatment

> If child is cooperative consider LA +/-RA

> Single Extraction ? LA

> Preference of child

> Preferable in certain medical conditions

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8
Q

when is GA not justified?

A

> Caries is asymptomatic with no infection

> Orthodontic extractions

> Patient /parent request

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9
Q

when is a GA appropiatre to use?

A

> Dental extractions should only be performed under general anaesthesia when this is considered to be the most clinically appropriate method of management.

> Young child

> Special needs

> Anticipated distress from local anaesthetic (bad experience)

> Multiple extractions

> Surgical extractions

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10
Q

what are the duties of the referring dentist?

A

> Responsibility to explain the risk of GA
mortality is approx 3/1mill
- morbidity symptoms associated with the procedure/distress at induction/recovery/nausea post op bleeding

> Discuss the alternative treatment choice

> Explain why the option of GA has been chosen

> Keep a copy of the referring letter

> The referring dentist must be aware of the appropriateness of the care provided by sedation or GA service

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11
Q

after being referred by the GDP, the patient is assed by another dentist in the hospital setting, who are they and what should they be trained in?

A

> Ideally a specialist in paediatric dentistry Or equivalent ie with experience in Paediatric Dentistry
and trained in =

  • behavioral management of children, including
  • conscious sedation (particularly inhalational sedation).
  • planning and management of children requiring dental extractions under general anaesthesia
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12
Q

when should the assessment appointment take place?

A

> Assessment should ideally be undertaken at a separate appointment

> this gives enough time for consent

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13
Q

what happens at the assessment appointment?

A

> Decide if general anaesthesia required

> Preliminary anaesthetic assessment performed by assessing dentist

> Access to the opinion of ananaesthetist,

> The need for sedative premedication is decided

> Information sharing, discharge planning and an

> Explanation of fasting instructions together with an appropriate regimen for analgesia

> Verbal & written information provided

> Sufficient time should be provided to allow the parent / carer and child to arrive at considered opinion and to give informed consent

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14
Q

what are the Pre Op instructions for GA?

A

> Accompanied by responsible adult who can give consent

> If unwell before appointment to contact surgery/hospital for advice

> Fasting instructions

> Take medication as normal

> No nail varnish

> No School

> Lift home

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15
Q

who can give consent for GA?

A

> Mother can always give consent

> Father if name is on the birth certificate after April 2002

> Grandparents cannot give consent unless a court order has been sought

> Gillick Competent

> Social workers/Foster parents (if its been approved)

> Adoptive Parents

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16
Q

who administers the GA?

A

> GA will be administered BY an anaesthetic consultant who has undergone specialist training in pediatric anaesthesia

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17
Q

where does the GA procedure take place?

A

> Procedure will take place in an operating theatre, with a team trained in the care of children.

18
Q

is there a risk of catastrophe during a GA?

A

> There is a small but real risk of a catastrophe during GA.

> Agreement should be reached between the dental and anaesthetic teams concerning how and when anaesthetic risk is explained and documented.

19
Q

what are the 3 types of anaesthesia?

A

> Day Procedure short-case

> Day Procedure intubation anaesthesia

> In patient stay intubation anaesthesia

20
Q

what cases take place in day procedure?

A

> Severe pulpitis

> Sub mandibular abscess

> Surgical drainage

> Under 5 requiring multiple extractions

> Symptomatic teeth causing pain in
more than one quadrant

> Ankylosis extractions

> Extraction of 1st permanent molar

> Biopsy

> Debridement and suturing

> Allergy to LA

21
Q

what are the indication for intubation ?

A

> Restricted access to airway or whole patient (large swelling, or genetic malformations)

> Protection against contamination of airway from above /below

> Requirement for muscle relaxation

22
Q

what are the indication for treatment in day procedure intubation anaesthesia ?

A

> Greater than 15 minutes long

> Full mouth rehabilitation

> Dento alveolar surgery (buried canine)

23
Q

what are in indication for patients that need an in patient hospital stay?

A

> Medically compromised (eg patient with diabetes)

> These should be managed in collaboration with the child’s paediatrician.

> underlying medical condition in categories ASA III or ASA IV should be admitted to a paediatric ward and clinical care shared with a paediatric team

24
Q

what is the care pathway for GA?

A

> Multiprofessional (big team)

> Mandatory Criteria (carry out check list below) =

  1. Risk factors
  2. Pre-op assessment
  3. Pain relief
  4. Admission Assessment
  5. Pre-op checklist
  6. Anaesthetic chart
  7. Theatre Nursing
  8. Operation Note (what you do)
  9. Transfer from theatre to recovery
25
Q

who is part of the GA team?

A

> Anaesthetist

> Surgeon

> Dental Nurse

> Pre –op nurse

> Anaesthetic Nurse

> Auxiliary nurse

> Recovery Staff

26
Q

how is the GA administered?

A

> induction of anaesthesia is either via =

  1. inhalation anaesthetics

or

  1. injectable intravenous anaesthetics

> Most commonly the two forms are combined, with the injection given to induce anaesthesia and a gas used to maintain a state of unconsciousness.

27
Q

what is an example of commonly used inhalation anaesthetics?

A

> Desflurane isoflurane and sevoflurane are the most widely used volatile anaesthetics today.

> They are often combined with nitrous oxide.

28
Q

what is an example of commonly used injectable intravenous anaesthetics ?

A

> Propofol

> Etomidate

> Barbiturates such as methohexital and thiopentone

> Benzodiazepines such as midazolam

29
Q

what do anaesthetists prefer to use, IV or inhalation?

A

> Anaesthetists prefer to use intravenous injections as they are faster, generally less painful and more reliable than intramuscular or subcutaneous injections

30
Q

what is an anaesthetic machine?

A

> Allows composing a mixture of oxygen, anaesthetics and ambient air, delivering it to the patient and monitoring patient and machine parameters.

> Liquid anaesthetics are vaporised in the machine.

> All of these agents share the property of being quite hydrophobic (i.e., as liquids, they are not freely miscible /mixable—in water, and as gases they dissolve in oils better than in water).

31
Q

what dental equipment is present in theatre?

A

> +/- Local anaesthetic

> Mouth props

> Mouth packs

> Appropriate forceps

> Surgical drill

> Sutures

32
Q

after extractions pain is common, what is used to manage this?

A

> Unless contraindicated, non‐steroidal anti‐inflammatory drugs (NSAIDs) and / or paracetamol should be used for analgesia

> These drugs may be combined or given separately before,during or after surgery

33
Q

when does post op pain start and what causes this ?

A

> Pain after surgery usually starts after the antiesthetic drugs have worn off

> Result of unavoidable surgery trauma or pre existing infection

34
Q

what are the complications of General anaesthesia?

A

> Analgesia is usually suffice, however sometimes antibiotics are indicated

> Wound infection is uncommon and treatment should be guided by the pathogen

> Bleeding /Patients /parents should be given written and verbal instruction on how to care for their wounds

> bleeding, Downiness ,nausea, vomiting, headaches

35
Q

when are patients allowed to leave?

A

> approx 2 hours after

> patient should have stopped bleeding and nurses happy with post op

36
Q

why is recovery very important post GA extractions ?

A

> Airway obstruction can occur as the surgeon is operating around the airway and there is a risk of inhaling a foreign object

> Recovery period is the most dangerous time and it is VERY important to keep the airway clear

> Respiratory depression can result from the effects of the anaesthetic and ancillary drugs

37
Q

what should be kept on hand during the recovery period?

A

> Equipment and drugs for dealing with medical emergencies must be on hand

> suction should be available

38
Q

how should a patient be positioned during recovery?

A

> During recovery the patient should be laid on their side and their airway protected

39
Q

what is supplemented during recovery?

A

> Supplementary oxygen is given during recovery

40
Q

what post op instructions/ care should be given after GA extractions?

A

> Important instructions must be given preoperatively recorded in the case notes and reemphasized after discharge

> No rinsing

> No eating hard foods

> No active sports for 24hours

> Emergency contact number

> Ideally follow up appointment with hygienist

> Discharge letter to GDP

paeds 4th year (12 decks)

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