General anaesthesia for the child patient Flashcards
(63 cards)
Definition
the induction of a state of
unconsciousness with the absence of pain
sensation over the entire body, through
the administration of anaesthetic drugs.
It is used during certain medical and
surgical procedures
What is the purpose of general anaesthesia
Analgesia (loss of response to pain)
Amnesia (loss of memory)
Immobility (loss of motor reflexes)
Hypnosis (unconsciousness)
Paralysis (skeletal muscle relaxation)
Indications for the use of GA in children
The child needs to be fully anaesthetized
before dental treatment procedures can be
attempted.
The surgeon needs the child fully
anaesthetized before dental treatment can be
performed.
Key points for GA in children-
- 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
- Specialist Paediatric nursing
The responsibilities of the referring dentist in GA?
Since … GAs are carried out in a …
2001, hospital setting
- 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
What are other options beside GA
*Routine conservative treatment
*If child is cooperative consider LA +/-RA
*Single Extraction ? LA
Consider when looking at other options beside GA
*Preference of child
*Preferable in certain medical conditions
When is GA NOT justified?
*Caries is asymptomatic with no infection
*Orthodontic extractions
*Patient /parent request
Indications for GA?
Dental extractions should only be performed under GA 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
Duties of a referring dentist?
- 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
. Must be aware of the
appropriateness of the care provided by sedation or
GA service
The assessing dentist must be (professionally)
deally a specialist in paediatric dentistry Or
equivalent ie with experience in Paediatric Dentistry
and trained in…
The assessing dentist must be 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
The Assessment appointment for GA - when should it occur
Assessment should ideally be undertaken at a separate appointment. (called preliminary anaesthetic appointment and preformed by an assessing dentist).
The assessment appointment for GA- what do you need to decide?
Decide if general anaesthesia required
Whose opinion do you need in a GA assessment?
ananaesthetist
What information is provided?
Verbal and written
What is there a need for in GA assessment?
Sedative premedication
Information sharing
Discharge planning
Explanation of fasting instructions
An appropriate regimen for analgesia
What are the pre op instructions for GA in children?
- 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
Who can give consent for childrens GA?
Always mother
Father if name is on the birth certificate (since April 2002)
* Gillick Competent
* Social workers/Foster parents
* Adoptive Parents
Who cannot give consent in GA for children?
Grandparents unless a court order has been sought
Explanation of risk in GA?
Will be administered BY an anaesthetic
consultant who has undergone specialist training in pediatric anaesthesia
In an operating theatre, with
a team trained in the care of children.
There is a small but real risk of a catastrophe
Documentation of risk for explanation GA?
Agreement should be reached between the
dental and anaesthetic teams concerning how and when anaesthetic risk is explained and documented.
What are the types of anaesthesia?
*Day Procedure short-case
*Day Procedure intubation anaesthesia
*In patient stay intubation anaesthesia
What cases would result in short-case day procedure GA?
Severe pulpitis
Sub mandibular abscess
Surgical drainage
Symptomatic teeth causing pain in
more than one quadrant
