Preanesthetic medication of outpatient children: Efficacy of sedation of ambulatory children prior to general anesthesia for dental surgical procedures

Abstract

I have attempted to evaluate the efficacy of premedication for ambulatory children undergoing general anesthesia for dental surgical procedures in an outpatient environment. This article is primarily a report based on a study conducted at the Hebrew University School of Dentistry in Jerusalem, Israel. On the basis of knowledge learned from this experience and from subsequent work at the Forsyth Dental Infirmary, the routine practice of sedation of outpatient children prior to general anesthesia is recommended. Successful preanesthetic medication depends upon the judicious selection of premedicants, an understanding of the pharmacologic properties of the drugs employed, and a recognition of the uniqueness of drug dosage for sedation of children. The practical problems encountered in managing premedicated children under outpatient conditions can be resolved by intelligent office design, trained auxiliary personnel, and prudent parent counselling. Reluctance to provide sedation for outpatient children is rooted in traditional dental practice which tends to support the criticism that an office type of practice is not conducive to premedication of ambulatory children. Notwithstanding, there appears to be little justification for declining to prescribe sedation for a child on the grounds that he is not hospitalized, because careful preanesthetic preparation is as significant for the outpatient child as for the hospitalized child. In the final analysis, if general anesthesia is indicated for a particular child in a dental clinic or private office, then, by the same logic, premedication is likewise indicated for this child. The virtues of preanesthetic medication are impressive. It is hoped that this endorsement of premedication may help encourage those clinicians who hesitate to prescribe sedation for outpatient children prior to general anesthesia to give it a fair trial. The rewards can be most gratifying.