PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

is selected to enable the anaesthetist to ventilate the patient artificially. These forms of

anaesthesia have a greater intrusion upon the patient's physiological state. However,

the use of a laryngeal mask instead of an endotracheal tube is gaining in popularity

because it avoids the use of the paralysing agent reducing postoperative muscle pain.

Nevertheless, the same principles of protecting the airways apply. In addition to the

tube, the throat will be packed with gauze. If conservation is required it is prudent to

use a rubber dam, as good isolation is essential for a high standard of operative

dentistry (158HFig. 4.13). For surgical procedures, local anaesthesia infiltration (2%

lignocaine with 1 : 80,000 adrenaline) reduces bleeding and aids visibility during

surgery while reducing the risk of cardiac dysrhythmias.

Once the treatment is complete the patient is placed in the recovery position and

wheeled to a recovery suite. The recovery from such extensive anaesthesia is such that

the patient may not be able to return home for several hours. Usually it is necessary to

have access to a car as the children are never quite as 'street fit' as those who have had

a short anaesthetic, so public transport is best avoided.

159H

Fig. 4.13 Rubber dam applied during

general anaesthesia.

4.13.5 In-patient/hospital-stay 'intubation' anaesthesia

Patients who are unfit for short or medium length general anaesthetics are usually in
ASA class III. These patients have a medical problem that constitutes a significant
increased risk, so anaesthetists advise that they are treated in a hospital operating
theatre, which is always close to the facilities of an intensive care unit. The dental
surgery is no more complex than that carried out for 'short-' and 'day-stay' anaesthesia,
but the underlying medical condition requires the increased level of care that may be
needed in the operating theatre environment and during post-operative recovery, and
even later on the ward.

Key Points

• There are different types of dental anaesthesia, dependent on the complexity and
  length of time for the planned dental procedure.


• Children with a medical condition may require hospital admission.

4.14 SUMMARY

1. Most patients can be treated using local anaesthesia and good behaviour
   management.


2. A significant minority of patients will require some form of sedation to enable them