General anaesthesia for dentistry

Abstract

Although general anaesthesia is used to reduce the pain and anxiety associated with dental treatment, most dental procedures can be managed with good local anaesthesia, with or without conscious sedation. Since the 1960s there has been a progressive fall in the use of general anaesthesia for dentistry and in the mortality associated with it. However, between 1996 and 1999, eight people died as a result of dental anaesthesia, five of them were children. Investigations and inquiries into these deaths were critical of the standard of care provided in areas such as preoperative assessment, perioperative monitoring, resuscitation and transfer to a critical care facility. In response to these concerns, the General Dental Council (GDC), the Royal College of Anaesthetists (RCA) and the Department of Health (DOH) have issued closely linked guidelines for standards of care in dental general anaesthesia. Since 1 January 2002, general anaesthesia for dentistry has been confined to a hospital setting with critical care facilities. This article summarizes the guidelines, with particular reference to the status of the anaesthetist, the indications for general anaesthesia, patient referral and assessment, the definition of a hospital setting, peroperative monitoring and resuscitation, and management of the emergency; it also reviews the technique of dental anaesthesia in current use.