Anesthesia for dental procedures
If a dentist plans to restore a larger number of teeth and/or expects a longer duration of treatment in a child who is unable to tolerate the procedure even with the sedation they can provide, general anesthesia is chosen. This differs from other types of anesthesia mainly in the need for adequate premedication, which this algorithm aims to highlight.
Review
The algorithm comprehensively guides the management of a complicated pediatric patient prior to a dental procedure. It introduces new recommended practices both for preoperative fasting and for preparing the pediatric patient, including options for premedication and sedation before general anesthesia. It also describes the possibility of extending sedation if it proves insufficient, which is typical for this spectrum of pediatric patients, as sedation often needs to be approached in a highly individualized and sometimes sequential manner. The algorithm further addresses the situation of desaturation caused by bronchospasm, which may occur during light anesthesia and positioning of the endotracheal tube. One note here: in the case of bronchospasm, if deepening inhalational anesthesia and inhaled administration of beta-mimetics (salbutamol) are insufficient—and salbutamol is often not readily available in the operating theater—an alternative is nebulized administration of adrenaline (1 mg/5 ml via jet nebulization) or systemic administration of corticosteroids, preferably hydrocortisone, which has the fastest onset of action.
Sources
LARSEN, Reinhard. Anesteziologie. 11. Praha: Grada, 2023. ISBN 533582474.
VYMAZAL, Tomáš; MICHÁLEK, Pavel; MICHÁLEK, Pavel a KLEMENTOVÁ, Olga. Anesteziologie (nejen) k atestaci. 2. Praha: Grada, 2023. ISBN 978-80-271-3898-2.
Frykholm, P., Disma, N., Andersson, H., Beck, C., Bouvet, L., Cercueil, E., Elliott, E., Hofmann, J., Isserman, R., Klaucane, A., Kuhn, F., de Queiroz Siqueira, M., Rosen, D., Rudolph, D., Schmidt, A.R., Schmitz, A., Stocki, D., Sümpelmann, R., Stricker, P.A., Thomas, M., Veyckemans, F., Afshari, A. Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol. 2022 Jan 1;39(1):4-25. doi: 10.1097/EJA.0000000000001599.
Learning targets
2. The student knows how to manage a child's agitation before the procedure.
3. The student knows how to prepare for a difficult intubation.
4. The student knows how to manage bronchospasm during the procedure.
Key points
2. The first-choice premedication for children is midazolam, with additional options including ketamine and dexmedetomidine.
3. In dental procedures, airway management can be achieved using a laryngeal mask, orotracheal, or nasotracheal intubation.
4. Bronchospasm may present similarly to mucus plugging or a kinked orotracheal tube.
