General Anaesthetic for Children

Question 1

when was general anaesthesia in the primary care setting ceased?

Answer 1

December 2001

Question 2

most common reason for children to go to hospital

Answer 2

tooth decay

Question 3

what links have been made between children and caries?

Answer 3

deprived areas
ethnicities

Question 4

what form collects the data on ethnicities of patients?

Answer 4

FP17

Question 5

describe the 5 levels of priority rating for general anaesthetic use

Answer 5

1a - emergency - op needed within 24 hr
1b - urgent - op needed within 72 hr

2 - surgery can be deferred up to 4 week
3 - surgery can be delayed up to 3 month
4 - surgery can be delayed >3month

Question 6

what comes under class 1a priority rating for GA?

Answer 6

emergency - need op within 24 hr
- acute spreading infection with:
- airway compromise or
- severe trismus
- pain not resolving with analgesics

Question 7

what comes under class 2priority rating for GA?

Answer 7

surgery can be deferred up to 4 weeks

• regular or current pain on eating or sleeping
• pt is responding to analgesics
• more than one course of antibiotics
• current chronic infection

Question 8

what comes under class 3 priority rating for GA?

Answer 8

surgery can be delayed up to 3 months

• little or no pain
• no disturbance to eating or sleeping
• symptoms resolved with analgesics

Question 9

advantages of GA

Answer 9

don’t need behaviour management
extensive tx complete in one visit
complications are better controlled

Question 10

disadvantages of GA

Answer 10

patient risk - death
limited access - huge waiting lists
expensive
can be a traumatic experience
child may have - headache, sore throat, dizziness, sickness, allergic reaction

environmental - greenhouse gas - sevofluorane more potent than carbon dioxide
- the gases are not easily broken down
- sevofluorane - 14 yrs lifetime

Question 11

how do you manage the environmental effects of GA?

Answer 11

alternative anaesthetics - local or IV
recycling materials
education and policy changes
low flow anaesthesia

Question 12

what comes under the patient suitability assessment?

Answer 12

cooperation
- is patient able to cooperate
- any learning disabilities
- anxieties/phobias

medical history
- medical conditions
- risk to patient
- inpatient vs day case
- specialise management - multifactorial?

extent of treatment
- degree of surgical trauma
- complexity

Question 13

what three things come under the principles of treatment planning?

Answer 13

the treatment
- restorations must last until exfoliatilon
- intention is to reduce potential for further tx
- consider success rates
- consider bruxism

the tooth
- maintain the E
- less impact of D
- balance for C

the patient
- extent of disease
- medical condition
- engagement
- learning disabilities
- access to GDP
- parent expectation

Question 14

how would you discuss GA to the patient?

Answer 14

• the justification
• alternative options
• risks
• be aware of the waiting times
• if it emergency tx that is needed