The document discusses guidelines and best practices for treating children with dental procedures under general anesthesia, including indications such as extreme uncooperativeness, requirements for hospitalization versus outpatient settings, pre-operative assessments, operating room protocols, recommended dental treatments, post-operative care, and the importance of preventative therapies and behavior management for successful outcomes. Proper patient selection, qualified dental staff, and outpatient surgery centers can help achieve the best results when using general anesthesia to deliver necessary dental care to children.

1. By Dr. Ali Abdel Fattah
Pedodontist
TREATING CHILDREN
UNDER G.A

2. ‫خاتمتنا‬ ‫احسن‬ ‫اللهم‬
‫عظيما‬ ‫عليك‬ ‫هللا‬ ‫فضل‬ ‫وكان‬
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3. 1.
1- PT UNABLE TO COOPERATE WITH A CERTAIN
PHYSICAL, MENTAL, OR MEDICALLY
COMPROMISSING DISABILITY .
2- EXTREMELY uncooperative , FEARFUL,
ANXIOUS , PHYSICALLY RESISTANT .
3 - FOR WHOME THERE IS NO EXPECTATION
THAT THE BEHAVIOR WILL SOON IMPROVE .
4 - PT WHO HAVE SUSTAINED EXTENSIVE
OROFACIAL OR DENTAL TRAUMA &/OR REQURE
SIGNIFICANT SURGICAL PROSEDURE ( (e.g oral BURN )
INDICATIONS

4. CONTRAINDICATIONS
 PT with a medical contraindication to G.A : -
Healthy Cooperative
PT with minimal dental
needs

6.  HOSPITALIZATION : -
IS A FREQUENT SOURSE OF ANXIETY
FOR CHILDREN .
20% TO 50% OF CHILDREN DEMONSTRATE
SOME DEGREE OF BEHAVIOUR CHANGE
AFTER SEPERATION
Separation OF THE CHILD FROM THE
PARENT APPEARS TO BE A SIGNIFICANT
FACTOR
PSYCHOICLOG EFFECTS OF
HOSPITALIAZATION ON CHEILDRN

7. BETTER APPETITE
LESS
FUSS ABOUT EATING,
FEWER
TEMPER TANTRUMS
BITING THE
FINGERNAILS,
GETTING UPSET
WHEN LEFT ALONE ,
NEEDING MORE
ATTENTION &
BEING AFRAID OF
THE DARK
POSITIVE
CHANGES (42.5%)
NEGATIVE
CHANGES (42.5%)
75% OF THE CHILDREN RECEVIG G.A
EXHIBITED SOME TYPE OF BEHAVIOUR CHANGE

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Pharmacological
& / OR
non
pharmacological
management ?

9. Learn how to
think …… not
what to think

10. NON EMERGENCY G .A
THE NEED OF G.A REPRESENTS THE FINAL
SOULATION, WHEN DECIDING TO USE G . A
THE clinician must look at the whole picture
1 - Is the treatment absolutely necessary?
2 -Has there been a history of emotional
trauma associated with the dental pain? -
3- Medical histOry ?
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11. COMPONENTS OF THE DENTAL HISTORY
&INTRAORAL EX. TO BE COMPLETED BEFORE
HOSPITALIZATION

12.  CURRENTLY , MORE Than 70 % OF ALL
PEDIATRIC SURGICAL PROCEDUR ARE
PERFORMED ON AN OUT PATIANT BASIS
( In hospital or out patient surgery center )
GOOD PT SELECTION
IS AN IMPORTANT CRITERION OF
SUCCESSFUL OUT PT SURGERY PROGRAM
CANDIDATE ARE :-
class 1 OR 2 ON ASA class1:-normal healthy pt
class 2 :- patient with mild systemic disease.
OUTPATIENT SURGERY

13.  THE DENTIST WILL BE MORE RESPONSIBLE
FOR TEAM COMMUNICATION, PHYSICAL
ASSESSMENT, MANAGEMENT, AND POST
OPERATIVE EVALUATION FOR OUTPATIENT
PROCEDURES UNDER G.A THAN FOR
INPATIENT PROCEDURES .
THE DENTIST RESPONSIBILTEY

15.  -ALL PERSONS INVOLVED IN THE
CARE OF PATIENTS IN THE O. R
MUST FOLLOW OCCUPATIONAL
SAFTY& HEALTH ADMINISTRATION
(OSHA) GUIDELINES.
OPERATING ROOM PROTOCOL

16.  BEFORE INDUCATION, WHEN THE PT
ENTERS THE OPERATING ROOM ,
TIME OUT PROTOCOL INITIATED BY :-
THE CIRCULATING NURSE
IDENTIFIES The PT ALLERGIES ,
PLANNED MEDIACATIONS & PROPOSED
TO THE DENTIST & ANAESTHESIOLOGIST
TIME OUT PROTOCOL

19. PATIENT IS IN A STABLE ANESTHETIC CONDITION &
READY FOR THE DENTAL PROCEDURE

20. NASOTRACHEAL INTUBATION & SPECIAL EYE GUARD

21. OBTAINING DIAGNOSTIC RADIOGRPH
(DIGITAL RADIOGRAPHS )

22. SPECIAL CARE MUST BE TAKING
DURING PERIORAL CLEANING

23. PLACEMENT OF THE SURGICAL SHEET
& TRIANGULAR DRAPING OF THE ORAL CAVITY AREA
THE NASOTRACHEAL TUBE MUST BE EXPSED

24. POSITIONING OF A MOUTH PROP SPECIAL CARE IS
TAKEN NOT TO IMPINGE ON THE LIPS OR THE
TOUNG WITH THE PROP

25. PLACEMENT OF THE PHARYNGEAL THROAT PACK

26. THE USE OF QUADRANT ISOLATION WITH
A RUBBER DAM (TOPICAL FLOURIDE SHOULD BE
APPLIDE BEFORE THE REMOVABLE OF RUBBER DAM )

27. O.R POSITIONS OF THE STAFF WILL PERFORMING
DENTAL TREATMENT (FROM LEFT) 1- DENTAL ASSISTANT,
2-DENTAL SURGEON 3- ANAETHESIOLOGIST ,
4- ASSISTANT DENTAL SURGEON & 5- CIRCULATING NURSE

28. RESTORATIVE DENTAL CAER
UNDER G. A INCREASES THE
QUALITY OR QUANTITY
OF DENTAL CARE ?
CLINACAL HINT

29.  RESTORATIVE DENTAL CARE UNDER G.A ALLOWS
EXELLENT PATIENT COMPLIANCE & EASY
ACHIEVEMENT OF A WELL – LIGHTED FIELD
INCREASES THE QUALITY & QUANTITY
OF DENTAL CARE
WHILE DECREASING THE ANXITY LEVEL FOR THE
CLINICAN & PATIENT DURING DENTAL TREATMENT
RESTORATIVE DENTISTRY IN THE O.R

30. 
Calculate time needed for each
procedure :- e.g
1- RCT + SSCs ( 35 minutes )
2 - Teeth extractions + Suturing ( 25 minutes )
3- Restorations +fluoride app ( 20 minutes )
SO,THE TIME OF ANESTHEIA IS : 1.5 H
LENGTH OF ANESTHESIA

31.  The dentist should notify anesthesiologist
10 minutes before the completion of the
procedure.
The recovery room personnel are notified
that the child will soon be arriving .
The end time out protocol is called by
The circulating nurse to identify
any patient safety concerns .
The dentist should accompany
the anesthesiologist to the recovery room
COMPLETION OF THE PROCEDURE

32.  THE DENTIST :-
SHOULD INFORM THE NURSE STAFF
OF ANY SPECIAL REQUESTS / INSTRUCATION
 THE PARENTS :-
SHOULD BE INFORMED OF THE TIME
TO MEET THE CHILD IN THE
RECOVERY AREA.
POSTANETHESIA CARE UNIT
RECOVERY ROOM ( R R )

33.  Post Operative Orders & The Operative
Note For The Staff Should Be Completed
By The Dentist & Recorded In The
Medical Chart While The Child
Is In The Recovery Room.
How Many People In The Recovery Area ?
POST OPERATIVE CARE

34. BEST OUTCOMES FOLLOWING REHABILITATION
UNDER G.A MAY RESULT FROM :-
1 -AGGRESIVE TREATMENT OF CARIES .
2 - ACTIVE FELLOW-UP & EDUCATION OF PARENTS &
CAREGIVERS . ( THE DENTAL HOME ? )
REASONS FOR REPEAT DENTAL TREATMENT
UNDER G.A FOR THE HEALTHY CHILD

35. The researchers
concluded that more
aggressive preventive
therapies required for
children that was
treated under G.A .
BEHIVOUR
MANAGEMENT is one
of our key stone even
during hospitalization
KEY TONE OF SUCESS

36. B.M
PREVENTATION
QUALIFIED
DENISTST
OUT PATIENT SURGERY CENTER
KEY STONE OF SUCESS

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