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Safe Settings for Administering General Anesthesia to Pediatric Dental Patients
Anesthesia Progress – Seeing the dentist can cause anxiety at any age, especially when undergoing treatment for dental caries or other conditions that require oral surgery. Dental anxiety is not relegated to adults, and children often experience increased stress and fear when undergoing oral procedures. For procedures requiring general anesthesia (GA) for children, how does a parent or caregiver ensure the child is receiving treatment in a safe venue?
To assess the safety of administering GA to pediatric patients in an ambulatory surgery center (ASC) compared with a hospital operating room (H-OR), researchers from private practice, Seattle Children’s Hospital, and the University of Washington in Seattle, Washington, and from the University of Missouri–Kansas City recently published a retrospective study in the current issue of Anesthesia Progress. Lead author Peter Douglas, DDS, MSD, and colleagues aimed to “describe the differences between types of pediatric patients who can safely receive dental GA in [an ASC] setting versus those that require [an H-OR] setting.”
A total of 1148 case reports of patients, most aged 3 to 8 years, who underwent GA at an ASC (n = 635) or H-OR (n = 513) were analyzed. Researchers evaluated the overall health and wellness of the patient, including any comorbidities that could increase the risk of adverse events. Researchers used the American Society of Anesthesiologists (ASA) classification to determine increased risk factors as follows: ASA I, a normal healthy patient; ASA II, a patient with mild systemic disease; ASA III, a patient with severe systemic disease; and ASA IV, a patient with severe systemic disease that is a constant threat to life. The need for preoperative or postoperative admission and combined dental and medical surgeries were also studied. The researchers found that of the pediatric patients treated at an ASC, 78% were ASA I and 21.3% were ASA II. Patients classified as ASA IV were treated exclusively at the H-OR, and only about 0.8% of ASA III patients were treated at an ASC. Preoperative (4.6%) or postoperative (25.7%) admission occurred solely from procedures done at the H-OR; there were no postoperative admissions from the ASC setting. Very few combined medical and dental procedures were done in the ASC setting (0.9%), whereas 22.8% of cases performed at the HOR were combination procedures.
The results show that both the ASC and H-OR settings can serve as safe venues for administering GA to pediatric patients undergoing dental procedures. Still, overall health plays a vital role in determining which venue is most appropriate. Douglas et al. concluded that “this study highlights the benefits of having a ‘multivenue model’ in comparison to a hospital-only model. As part of the multivenue model, an ASC can offer a more efficient experience for healthy patients and decrease the number of patients waiting for elective treatment in the H-OR. For providers, a multivenue model offers options to provide patients with safe and efficient care. And for the community, it increases access to care for dental patients who require treatment under GA. This is demonstrated by the two-venue model’s treatment of 240% of the number of patients treated in the hospital-only model.”
Full text of the article, “Comparison of Pediatric Dentistry Under General Anesthesia in a Surgery Center vs a Hospital,” Anesthesia Progress, Vol. 69, No. 4, 2022, is now available at https://doi.org/10.2344/anpr-69-02-07
About Anesthesia Progress
Anesthesia Progress is the official publication of the American Dental Society of Anesthesiology (ADSA). The quarterly journal is dedicated to providing a better understanding of the advances being made in the science of pain and anxiety control in dentistry. The journal invites submissions of review articles, reports on clinical techniques, case reports, and conference summaries. To learn more about the ADSA, visit: http://www.adsahome.org/.
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