Anesthesia Progress Volume 59: Issue 4

Abstract

The purpose of this study was to test the null hypothesis that children with environmental tobacco smoke (ETS) exposure (also known as passive smoke exposure) do not demonstrate an increased likelihood of adverse respiratory events during or while recovering from general anesthesia administered for treatment of early childhood caries. Parents of children (ages 19 months–12 years) preparing to receive general anesthesia for the purpose of dental restorative procedures were interviewed regarding the child's risk for ETS. Children were observed during and after the procedure by a standardized dentist anesthesiologist and postanesthesia care unit nurse who independently recorded severity of 6 types of adverse respiratory events—coughing, laryngospasm, bronchospasm, breath holding, hypersecretion, and airway obstruction. Data from 99 children were analyzed. The children for whom ETS was reported were significantly older than their ETS-free counterparts (P = .03). If the primary caregiver smoked, there was a significantly higher incidence of smoking by other members of the family (P < .0001) as well as smoking in the house (P < .0005). There were no significant differences between the adverse respiratory outcomes of the ETS (+) and ETS (−) groups. The ETS (+) children did have significantly longer recovery times (P < .0001) despite not having significantly more dental caries (P = .38) or longer procedure times. ETS is a poor indicator of post–general anesthesia respiratory morbidity in children being treated for early childhood caries.

Abstract

Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board–approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36–60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P < .001). The average total time (anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance.

Abstract

For several decades, anesthetic gases have greatly enhanced the comfort and outcome for patients during surgery. The benefits of these agents have heavily outweighed the risks. In recent years, the attention towards their overall contribution to global climate change and the environment has increased. Anesthesia providers have a responsibility to minimize unnecessary atmospheric pollution by utilizing techniques that can lessen any adverse effects of these gases on the environment. Moreover, health care facilities that use anesthetic gases are accountable for ensuring that all anesthesia equipment, including the scavenging system, is effective and routinely maintained. Implementing preventive practices and simple strategies can promote the safest and most healthy environment.

Adrenergic agonists, 159

Adrenergic antagonists, 159

Amnesia, 62

Anesthesia, 82

Anesthetics local, 57

Anticholinergic drugs, 159

Asthma, 123

Autonomic drugs, 159

Biocompatibility testing, 57

Bronchospasm, 123

Buffering, 127

Cholinergic drugs, 159

Complication, 82

Cost analysis, 147

Deep sedation, 107

Demand for services, 3

Dental anesthesia, 147

Dental anesthesiologist, 3

Dental caries, 143

Dental treatment, 62

Dentist-anesthesiologist, 12

Dentistry, 90, 127

Dexmedetomidine, 62

Difficult airway management, 87

Drug actions, 28

Drug mechanisms, 28

Drug toxicity, 90

Dual bougie technique, 85

Endotracheal intubation, 82

Environmental pollution, 154

Epinephrine, 118

Facial nerve palsy, 22

Greenhouse warming potential, 154

Health economics, 147

Implant, 62

Have You Met Your Production Quota Today?

Effect of Passive Smoke Exposure on General Anesthesia for Pediatric Dental Patients

Abstract

Time and Cost Analysis: Pediatric Dental Rehabilitation with General Anesthesia in the Office and the Hospital Settings

Abstract

Environmental Implications of Anesthetic Gases

Abstract

Basic and Clinical Pharmacology of Autonomic Drugs

Abstract

Continuing Education Program

Author Index, Volume 59

Subject Index, Volume 59

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

A New ACLS Option for Anesthesia Providers

Single-Agent Total Intravenous Anesthesia With Remimazolam for an Elderly Man Undergoing Ambulatory Oral Surgery: A Case Report

General Anesthesia for a Child With a Living Donor Liver Transplant After Hepatoblastoma and Metastatic Lung Tumor Resection

Virtual Reality Distraction vs Nitrous Oxide for Reducing Anxiety and Injection Pain

Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery

Letter to the Editor

Monheim LM. Analgesia in dentistry now and in the future. Anesth Prog. 1971;18(5):100–106 and J Am Analg Soc. 1971:9:1(abstract).

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

Perfect Time for a Fresh Perspective