throat.
4.13.3 Out-patient 'short-case' general anaesthesia
This is used for ASA class I or class II patients requiring short, 2-10 min, procedures
with rapid induction and early recovery, for example, dental extractions. Anaesthesia
is induced either by inhalation of an anaesthetic vapour in an oxygen-nitrous oxide
mixture using a face mask or by an intravenous injection for example, propofol.
Occasionally, the child is premedicated with a benzodiazepine. The parent commonly
accompanies the child to help them cope with the anaesthetic induction. Irrespective
of the induction method, anaesthesia is maintained by the anaesthetic vapour, for
example, sevofluorane, carried in a mixture of oxygen and nitrous oxide, and the face
mask is exchanged for a nose mask or a laryngeal mask (156HFig. 4.12 different sizes of
laryngeal masks). Following this, the oropharynx is packed with gauze to protect the
airway. This gauze is the reason why children sometimes later complain of a sore
throat. Monitoring for this type of anaesthesia usually consists of an
electrocardiograph, pulse oximeter, and a blood pressure cuff.
On completion of treatment, the gauze is removed and the patient turned into the
recovery position and removed to a quiet recovery room so that he/she can be
monitored during their final recovery. The child is discharged when he or she is able
to drink a glass of water without being sick and able to stand without swaying or
appearing dizzy. Although the child is deemed 'street fit', once he or she has arrived
home the combined effects of anxiety, the general anaesthetic, and the dental surgery,
make it necessary for the child to play 'quietly at home' for the rest of that day.
157H
Fig. 4.12 Different sizes of laryngeal
masks.4.13.4 Out-patient 'day-stay' general anaesthesia
This is usually reserved for ASA class I or class II patients who require dental
treatment that lasts more than 10 min, for example, removal of supernumeraries,
complex and compound odontomes, exposing and bonding impacted teeth, or
extensive conservative dentistry. Day surgery units commonly offer premedication
and pre-anaesthetic visits to facilitate the child's ability to cope with the visit.
Anaesthetic induction is similar to that for 'short case' anaesthesia but an endotracheal
tube is used, instead of a nose mask, either inserted through the nose (nasotracheal
tube) or through the mouth (orotracheal tube). To insert it, a short-acting
neuromuscular paralysing agent needs to be used, when this wears off the patient then
breaths spontaneously. Occasionally, a longer-acting neuromuscular paralysing agent