• Dental GA
    • Problems
      • Patient factors
        • Frequently children - adenotonsilar hypertrophy, epilepsy, reflux, uncooperative etc.
        • Needle phobic
        • High levels of autonomic activity
      • Surgical factors
        • Shared airway
        • Soiling of airway
        • Trigeminal nerve stimulation can lead to arrhythmias
    • Local anaesthesia
      • 2% lignocaine (3mg/kg) or with adrenaline (7mg/kg)
      • Prilocaine 3% (6mg/kg)
      • Articaine 4% - useful for penetrating into mandibular bone (7mg/kg)
    • Conscious sedation
      • Inhaled
        • N₂O commonly used with clinical monitoring of colour, respiration and pulse
      • IV
        • TCI propofol
        • Midazolam
      • Oral
        • Midazolam
        • Temazepam
    • Assessment
      • Consider LA, explain risks
      • Premedication
        • EMLA
        • Short acting BDZ
      • Monitoring
        • Observe monitoring standards
      • Induction
        • Inhalational, IV or IM all used. Full face mask for induction but may be swapped to nasal mask (Goldman and McKesson)
      • Airway
        • LMA, nasal mask or ETT can be used with consideration for nasal tube.
      • Maintenance
        • TIVA or inhalational
      • Positioning
        • Sitting now rare, more are slightly head up tilt
        • Head down and lateral for LMA or ETT removal with removal of packs.
      • Recovery
        • As per any GA must have suitable area and skilled staff
      • Analgesia
        • Paracetamol, dexamaethasone, NSAID, local by surgeon, short acting opiates.
    • General anaesthesia
      • Simple extractions ('dental chair') commonly in 4-10 year olds with learning difficulties
      • Day case for extraction of permanent molars or minor oral work
      • In-patient anaesthesia for more complex work
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/5/3/71.full.pdf