General Anaesthesia For Dental Extractions Research Articles

Improving pain management for children having dental extractions under general anaesthesia.

Children provided with general anaesthesia for dental extractions at East Surrey Hospital were audited to determine the percentage of children who were prescribed adequate pain management in accordance with guidance published by the Association of Paediatric Anaesthetists of Great Britain and Ireland. Three audit cycles were completed. Data were collected retrospectively through case note review. The results from the first cycle showed that only 47% of children were prescribed with a recommended analgesic regimen. Implementation of change included the development of a protocol for analgesic delivery, which was disseminated to the anaesthetic and dental teams. Full compliance with the audit standards was then demonstrated in the second and third cycles. This audit demonstrates the importance of multidisciplinary collaboration in order to provide high standards of care for children undergoing dental extractions under general anaesthesia. The protocol developed could be applied to other surgical day case procedures for children to improve the patient experience.

Why has oral health promotion and prevention failed children requiring general anaesthesia for dental extractions?

Many children in the UK still require dental treatment under general anaesthesia (DGA). Why oral health promotion and prevention, in this cohort of children, has failed is poorly understood. By questioning the parents/carers of children undergoing DGA this study aimed to establish: 1 previous exposure to oral health education and promotion activities; 2 beliefs and behaviours about dental caries and prevention; and 3 what parents perceive useful in preventing dental caries. A cross-sectional questionnaire based study. Dental general anaesthetic centres in Wales, UK. 207 consecutively attending parents of children aged < 10 years requiring a DGA. In total, 150 (76%) parents/carers claimed to have received previous oral health advice and 103 (52%) had received toothbrushing instruction from a dentist. Only 18 (9%) reported the application of topical fluoride. Sixty seven (34%) believed "tooth decay runs in families" and 53 (27%) it was simply bad luck that their child had dental decay. The majority (89%) believed that information leaflets on oral health would be useful and 133 (67%) would find information on a website helpful. This study suggests that there is a significant scope for increasing the exposure of high risk children to fluoride. A sense of fatalism and erroneous beliefs were evident amongst some parents/carers of children needing DGA. These issues need to be addressed in the future design of oral health promotion/prevention activities.

Reasons for referral of children to a general anaesthetic service in Northern Ireland

To investigate, in a case-specific manner, dental practitioners' clinical and social reasons for referral of children for dental extractions under general anaesthesia and to relate these to separately obtained information. For each child referred to the community general anaesthetic dental extraction service, closed-ended questionnaires were completed by the referring practitioner, by the parent accompanying the child and by the assessing community dental officer. The study was undertaken in the Craigavon and Banbridge area of Northern Ireland. A total of 177 completed the study, representing an inclusion rate of 93%. The children ranged in age from 3 to 17 years (mean 6.8 years) and previous experience of general anaesthesia for dental extractions was seen in 55 (31%). The most common reasons for referral were the requirement for multiple extractions (63%), the patients' anxiety or fear of dental treatment (60%) and the young age of the patient (60%), and the specification of these reasons was found to be significantly related to separately obtained indicators. A poor record of co-operation for treatment in the past was indicated in almost a third of cases and this indication was significantly related to low levels of co-operation for restorations. It appears practitioners have considered a range of factors in their decisions to refer children and there is information which supports these reasons in most instances.

Bacteraemia following local anaesthetic injections in children.

To estimate odontogenic bacteraemia following three different types of local anaesthetic injections, namely: buccal infiltration analgesia (BIA), conventional intraligamental analgesia (CIA), and modified intraligamental analgesia (MIA). The bacteraemia-producing potential of three methods of injecting local analgesic solution was determined by taking blood samples, using aseptic technique, from 143 children, aged 1 year 11 months to 19 years 4 months, undergoing general anaesthesia for dental extractions. Of these 143 children, a subgroup of 50 had blood taken before any dentogingival manipulative procedures to provide a baseline level of bacteraemia. The injection methods were buccal infiltration, conventional intraligamental, and a modified intraligamental. The blood samples were taken 30 seconds after injection and cultured in aerobic and anaerobic broth cultures (Bactec) and from lysis filtration vials (Isolator). The percentage prevalence of bacteraemia was: baseline level 8%; buccal infiltration analgesia 16%; modified intraligamental analgesia 50%; and conventional intraligamental analgesia 97%. These values were statistically significantly different using the chi-squared test (P < 0.001). The mean value for colony forming units per millilitre (Isolator system) was 252 (sd = 646) for the intraligamental technique but zero for baseline, infiltration and modified intraligamental techniques. All local anaesthetic techniques studied were associated with bacteraemia which may have implications for antibiotic prophylaxis for dental treatment. The intraligamental techniques had statistically significantly greater percentage prevalence of bacteraemia compared with baseline. The modified intraligamental technique causes significantly less bacteraemia than the conventional intraligamental technique.

Iron‐deficiency anaemia in young children requiring dental extractions under general anaesthesia

The aim of the study was to determine the prevalence of iron-deficiency anaemia in children less than 6 years of age who attended for outpatient general anaesthesia for dental extractions. Pre- or peri-operative capillary blood samples were taken from 109 children (70 white Caucasian and 39 ethnic-minority children). The haemoglobin concentration (Hb), mean cell volume (MCV) and red cell porphyrin (RCP) value were determined for each subject. 19% of the children were found to be anaemic (Hb < 11 g/dl) and there was no statistically significant difference for mean Hb or prevalence of anaemia between white Caucasian and ethnic-minority children. A significantly greater proportion of the ethnic-minority children were iron deficient, as indicated by low MCV and high RCP. There were no statistically significant differences between anaemic and non-anaemic subjects with regard to sex or social class, but a significantly greater mean number of extractions were performed in the anaemic children.

The use of nitrous oxide-oxygen inhalation sedation with local anaesthesia as an alternative to general anaesthesia for dental extractions in children'

The use of nitrous oxide-oxygen inhalation sedation with local anaesthesia as an alternative to general anaesthesia for dental extractions in children'

The use of nitrous oxide-oxygen inhalation sedation with local anaesthesia as an alternative to general anaesthesia for dental extractions in children

The aim of this study was to determine whether children who were assessed to require the extraction of teeth under general anaesthetic could be treated using an alternative technique of nitrous oxide-oxygen inhalation sedation with local anaesthetic. Consent was obtained for 61 children to enter the study. Fifty-three children were treated successfully using inhalation sedation and local anaesthetic. It was evident that general anaesthetic facilities would still be required for a small proportion of children who could not cooperate adequately for treatment to be performed under sedation and local anaesthetic.

Pulse oximetry during general anaesthesia for dental extractions.

Pulse oximetry during general anaesthesia for dental extractions.

Serum amoxycillin levels following oral loading dose prior to outpatient general anaesthesia for dental extractions.

Serum amoxycillin levels were measured 4 h after oral administration of a 3 g loading dose given prior to outpatient dental treatment under general anesthesia. A mean level of 8.49 mg/l +/- (1 S.D.) 5.07 mg/l of amoxycillin was obtained, which is adequate at the time of bacteraemia to protect patients susceptible to bacterial endocarditis. A second identical dose of amoxycillin was given following recovery from anaesthesia (mean 18.7 min) and was tolerated by 97.6% of patients.