General Anaesthetic

Question 1

Name 3 inhaled anaesthetic agents.

Answer 1

Nitrous oxide
Sevoflurane
Halothane
Isoflurane
Des fluorine

Question 2

Name 2 IV anaesthetic agents.

Answer 2

Propofol

Midazolam

Question 3

What factors influence the choice of anaesthetic agent?

Answer 3

Length & type of procedure
Patient preferences
Medical history
Previous GA experience
Anaesthetists recommendations
Equipment
Staff & other resources

Question 4

What are the indications for GA?

Answer 4

Belief that the child is too: Young, anxious, uncooperative
Dentist need pt to be completely still
Operation is complex

Question 5

What are the contraindications for GA?

Answer 5

Risks outweigh the benefits
Rare risks of death, not waking up again, brain damage
Risks are increased if child is medically compromised

Question 6

What are some risks of GA?

Answer 6

Damage to mouth/oropharynx from intubation
Minor allergic reactions
Slow recovery from anaesthetic
Prolonged apnoea after muscle relaxant
Laryngospasm
Coughing/moving during procedure

Question 7

Who can consent for children?

Answer 7

Mother automatically
Father if married to mother at time of birth (Eng/Wales) or conception (Scot) or subsequently
Unmarried father if named on birth certificate after 04/05/2006
Adoptive parents if legally adopted
Etc.

Question 8

What are the four conscious levels of anaesthesia?

Answer 8

1. Induction
2. Excitement
3. Surgical Anaesthesia
4. Respiratory Paralysis/Overdose

Question 9

What type of consent is required for GA?

Answer 9

Written consent

Question 10

What medical conditions require careful work for GA?

Answer 10

Sickle cell disease, Down’s syndrome, bleeding disorders, cardiac conditions, renal disease, diabetes, liver disease, cystic fibrosis, severe asthma, epilepsy

Question 11

What is the discharge criteria for after GA?

Answer 11

Fully conscious, able to maintain clear airway & exhibits protective reflexes
Satisfactory oxygenation & respiration
CVS stable - no unexplained irregularities, no persistent bleeding, pulse & BP acceptable, adequate peripheral perfusion
Pain, nausea & vomiting controlled
Normal temperature
Eaten, drunk, been to toilet

Question 12

What should be included in a GA referral letter?

Answer 12

Patient name & address
Patient/parent contact numbers
Medical history
GP details
Parental responsibility
Justification for GA
Proposed treatment plan
Previous treatment details
Recent radiographs