GA

Question 1

Uncommon side effects + complications of GA

Answer 1

• Breathing difficulties
• Damage to teeth, lips, and/or tongue
• Worsening of an existing medical condition
• Awareness during anesthesia

Question 2

Rare or very rare complications of GA

Answer 2

• Damage to eyes
• Allergic rxns to drugs
• Death
• Brain damage
• Equipment failure

Question 3

Pre-surgical NPO guidelines + pre-surgical dietary precautions

Answer 3

• Clear liquids
  
  • 6-36mo: 2hr
  • >36mo: 2hr
• Breast milk
  
  • 6-36mo: 4hr
  • >36mo: NA
• Formula
  
  • 6-36mo: 6hr
  • >36mo: NA
• Solids/milk
  
  • 6-36mo: 6hr
  • >36mo: 8hr

Question 4

ASA Classification

Answer 4

• ASA I – Normally healthy patient w/ no organic, physiologic, biochemical or psychiatric disturbance or disease
• ASA II – Mild to moderate systemic disturbance or disease
• ASA III – Severe systemic disturbance or disease
• ASA IV – Severe life-threatening systemic disease or disorder
• ASA V – Moribound patient who is unlikely to survive w/o the planned procedure
• ASA VI – Declared brain-dead patient whose organs are being removed for donor purposes

Question 5

In office GA

Answer 5

• Follow state dental board regulations
• Facility must be inspected to obtain an Anesthesia + Sedation Facility Certificate
• Anesthesia administration by a state licensed Physician Anesthesiologist, Certified Nurse Anesthetist, or dentist who holds an anesthesia and sedation permit

Question 6

Mallampati Scoring

Answer 6

Airway evaluation; visual assessment used to predict ease of endotracheal intubation

• Class I – Soft palate, uvula, fauces, pillars visible
• Class II – Soft palate, uvula, fauces visible
• Class III – Soft palate, base of uvula visible
• Class IV – Only hard palate visible

High score (Class III + IV) associated w/ more difficult intubation + higher incidence of sleep apnea

Question 7

Brodsky Grading Scale

Answer 7

Tonsillar size; based on percentage of oropharyngeal airway occupied by tonsils

• Grade 1 – ≤25%
• Grade 2 – 25-50%
• Grade 3 – 50-75%
• Grade 4 – ≥75%

Question 8

Post-GA orders

Answer 8

• Maintain IV (Lactated Ringer’s or D5W) until patient is stable
• Compute IV rate (mL/hr) using the 4:2:1 rule for replacement fluids:
  
  • 1st 10kg x 4mL
  • 2nd 10kg x 2mL
  • Remaining kg x 1mL each
    
    • Example: 25kg child would receive 40+20+5 = 65mL/hr
• D/c IV fluids once child is fully awake, alert, and has taken PO fluids
• Monitor for any oral bleeding
• Encourage PO intake of fluids once patient is alert + awake
• PO intake may be delayed if EXT + OS were performed
• Clear liquids are most commonly ordered
• Pain medications if none were given intra-operatively
• Vital signs

Question 9

GA Indications

Answer 9

• patients who cannot cooperate due to a lack of psychological or emotional maturity and/or mental, physical, or medical disability
• Patients for whom local anesthesia is ineffective because of acute infection, anatomic variations, or allergy
• Patients who are extremely uncooperative, fearful, or anxious
• Patients who are precommunicative or non-communicative child or adolescent
• Patients requiring significant surgical procedures that can be combined with dental procedures to reduce the number of anesthetic exposures
• Patients for whom the use of general anesthesia may protect the developing psyche and/or reduce medical risk
• Patients requiring immediate, comprehensive oral/dental care (e.g., due to dental trauma, severe infection/cellulitis, acute pain)

Question 10

GA Contraindications

Answer 10

• a healthy, cooperative patient with minimal dental needs
• a very young patient with minimal dental needs that can be addressed with therapeutic interventions (e.g., ITR, fluoride varnish, SDF) and/or treatment deferral
• patient/practitioner convenience
• predisposing medical conditions which would make general anesthesia inadvisable.

Question 11

GA documentation

Answer 11

• rationale for use of general anesthesia
• informed consent
• instructions provided to the parent
• dietary precautions
• preoperative health evaluation