4.13 GENERAL ANAESTHESIA
4.13.0 Introduction
The use of general anaesthesia in paediatric dentistry has a wide application, usually
for the extraction of teeth. Fortunately, referrals have reduced, due to both the
reduction in dental disease and to the use of sedation. Nevertheless, there will always
be a need for general anaesthesia in dentistry, especially for pre-co-operative children.
Key Points
- In the United Kingdom, general anaesthesia can now only take place in a hospital
setting, and be administered by a consultant anaesthetist. - Risk of general anaesthesia:
-mortality⎯~ 3 per million;
-morbidity⎯symptoms associated with the procedure, distress at induction and
during recovery, prolonged crying, nausea, sickness, and postoperative bleeding. - Referring dentists are obliged to:
-explain the risks of general anaesthesia;
-discuss the alternative treatment modalities;
-explain why the option of general anaesthesia has been selected;
-keep a copy of their referral letter;
-the referring dentist must be assured of the appropriateness of the care provided by
sedation or general anaesthetic service. - Indications for general anaesthesia
-the child is pre cooperative (too young to cope)
-uncontrolled fear
-complexity of procedure.
4.13.1 Type of anaesthesia
In dentistry, anaesthesia falls into three main groups:
(1) out-patient short-case 'dental chair' anaesthesia traditionally with a nose mask but
now more often with a laryngeal mask
(2) out-patient/day-stay 'intubation' anaesthesia;
(3) in-patient/hospital-stay 'intubation' anaesthesia.
Within these categories there are variations determined by anaesthetistic preference.
Anaesthesia for dental treatment requires the help of a consultant anaesthetist. The
organization of dental general anaesthesia lists, at least in the preliminary stages, is
performed by a dental surgeon who therefore must understand the type of anaesthesia
and the implications of any underlying medical condition.
4.13.2 Definition of anaesthesia
The state of anaesthesia is defined as: 'The absence of sensation artificially induced by
the administration of gases or the injection of drugs or a combination of both'. The
important feature of anaesthesia is that the patient is completely without the ability to
independently maintain physiological function, such as breathing and protective
reflexes, and is acutely vulnerable to the loss of any foreign bodies or fluids down the