Anesthesia for Children: Dental Procedures
Dr. Einstein strives to give his pediatric patients a safe, non-traumatic experience. Children are not to be frightened by restraints or inhumane treatment at any age or any size. Good communication and anesthetic technique minimizes any unpleasantness. Appropriate treatment and monitoring insure safety and comfort.
Children are just as intelligent as adults, but they process information differently. They have less life experience, and are more distrustful of new experiences, especially if they think they will be unprotected by their parents. They probably do not understand the rationale for needed medical or dental care. Parents and doctors need to communicate honestly with them in a soothing reassuring manner that is appropriate for them. Each child needs a unique approach to safely and comfortably give him or her the dental care that is needed.
A routine visit to the dentist should be fun and interesting. Most dentists that care for children, especially pediatric dentists, make their younger patients feel very comfortable, and are skilled at doing minor procedures or fillings with the use of topical and carefully administered local anesthetics.
However, some children who have already had a difficult medical or dental experience will not enter a dentist’s office without crying, or even trying to run away. It is impossible to do even a basic oral exam or obtain a routine dental x-ray.
Some children have numerous cavities that need filling, or several deeply rooted teeth that need to be extracted. Obtaining adequate anesthesia, and keeping these children cooperative for a prolonged time, is very difficult.
Other children have developmental, behavioral or underlying medical problems that interfere with usual dental treatment.
Some dentists or parents hope that some type of mild sedation by liquid, pill, or gas will make it possible to do a procedure. Quite often, the opposite occurs. The children are slightly sleepy, but when they are challenged with anything unpleasant, they feel out of control and are even more frightened, and less cooperative than when they were fully awake.
Before each procedure, Dr. Einstein obtains a medical history and discusses the case with the parents, to assess the initial approach.
Anesthesia patients should have an empty stomach before surgery. This minimizes the risk of aspiration pneumonia that can occur when food particles are sucked into the lungs. Dr. Einstein discusses diet guidelines for each patient with the parents.
Dr. Einstein recommends parents dress their children comfortably. Long legged pants, a short sleeved shirt, and a long sleeved loosely fitting sweater jacket are ideal. Sleeping clothes are also fine! Of course, patients can bring their favorite toy or blanket. Dr. Einstein usually uses a warming unit for comfort throughout the stay.
For most pediatric patients, Dr. Einstein prefers to prescribe some topical anesthetic cream that the parents can apply one to two hours before the dental appointment. This minimizes any actual discomfort when the intra-venous (IV) catheter is placed, for the IV anesthesia.
Dr. Einstein prefers IV anesthesia for all his patients because it is extremely safe, easily controlled, and has few side effects. The side effects are predictable and usually easy to treat. Nausea is extremely rare.
Some children are more fearless than most adults. They cooperate for placement of monitors, local anesthesia for intravenous (IV) placement, and then drift off to sleep easily with the IV anesthetic. They wake up promptly and go home quickly after their procedures.
Many children are so fearful of an IV, that this approach is not adequate. They are given liquid syrup sedative that is effective in fifteen to thirty minutes. In occasional cases, Dr. Einstein prescribes a sedative to be given by the parents before arrival at the office.
In the extremely rare situation where a patient is completely uncooperative for even oral medication, an intramuscular sedative injection is given with a small needle together with local anesthetic to minimize pain of injection. This is usually effective within five minutes. With the sedation, the patients are calm, and have little or no memory of subsequent events at the dental office.
The drawback to oral or intramuscular sedatives is that they last longer than IV medications, so, even though children are awake and safe to go home, they tend to be cranky and emotional for some time after they go home.
In some settings, an anesthetic gas can be used to do a mask induction. The children hold a mask and breath pure oxygen mixed with a powerful anesthetic gas called sevoflurane. When the child is completely asleep, an IV line is place, and the anesthetic is completed with IV medication. In some cases this is very easy, but quite often patients require sedation before mask induction. Otherwise, they are very frightened when they feel a mask with a stinky gas is being forced over their face. Dr. Einstein routinely gives these patients strong anti-nausea medication to avoid this common complication of inhaled gas anesthesia. A rare (one in 10,000 to one in 50,000) reaction called malignant hyperthermia can be triggered by gas anesthesia. This reaction is life threatening, but treatable. Since it is an inherited illness, Dr. Einstein asks his patients if there is any family history of life-threatening reactions to anesthesia.
In all cases Dr. Einstein monitors pediatric patient very closely throughout their procedures. He uses his eyes and ears to observe respiratory function and effort, and electronic monitors to measure each breath, heartbeat, and blood pressure. Additionally, Dr. Einstein uses a BIS monitor to help measure depth of anesthesia. A special sensor strip is placed on the forehead and connected to a monitor that measures brain activity. This helps minimize the amount of anesthesia that is given, while at the same time helping to insure that the patient remains comfortable and unaware.
As with adult patients, intra-operative pain control is key to a good anesthetic experience. Local anesthesia is placed wherever possible so that the patients don’t have pain while they are asleep, and don’t wake up with pain when the procedure is completed. As a bonus, patients with good pain control require much less IV anesthetic, so they wake up faster. Dr. Einstein gives anti-inflammatory medications with the anesthetic, and recommends anti-inflammatory treatments for most patients after dental and oral surgery.
Fortunately, pediatric patients are much more resilient than adults. They usually heal faster and bounce back very quickly. Parents will receive written and verbal instructions from the surgical doctor and Dr. Einstein. Dr. Einstein will remain available post procedure for any patient care questions.
These are all general guidelines. Remember each patient is unique. If you have any questions, Dr. Einstein can be contacted by email at einstein@einsteinanesthesia.com.