Simple extractions ('dental chair') commonly in

4-10 year olds with learning difficulties Frequently children - adenotonsilar

hypertrophy, epilepsy, reflux, uncooperative
etc.
Day case for extraction of permanent molars General anaesthesia
or minor oral work Patient factors
Needle phobic

In-patient anaesthesia for more complex work

High levels of autonomic activity
Problems

Shared airway
Consider LA, explain risks

Soiling of airway
Surgical factors
EMLA
Premedication Trigeminal nerve stimulation can lead to
CEACCP
Short acting BDZ arrhythmias

Observe monitoring standards Monitoring

2% lignocaine (3mg/kg) or with adrenaline (7mg/kg)
Inhalational, IV or IM all used. Full face mask Dental GA
for induction but may be swapped to nasal Induction
mask (Goldman and McKesson) Prilocaine 3% (6mg/kg)
Local anaesthesia

LMA, nasal mask or ETT can be used with Articaine 4% - useful for penetrating into
Airway mandibular bone (7mg/kg)
consideration for nasal tube. Assessment

TIVA or inhalational Maintenance

N₂O commonly used with clinical monitoring of
Inhaled
colour, respiration and pulse
Sitting now rare, more are slightly head up tilt

Positioning
TCI propofol
Head down and lateral for LMA or ETT
removal with removal of packs. IV
Conscious sedation
Midazolam
As per any GA must have suitable area and
Recovery
skilled staff
Midazolam
Oral
Paracetamol, dexamaethasone, NSAID, local
Analgesia Temazepam
by surgeon, short acting opiates.
/Dental GA/CEACCP
http://ceaccp.oxfordjournals.org/content/5/3/71.full.pdf