Anesthesia for Dental Procedures in Children

Abstract

Dental procedures are the third commonest reason for general anesthesia in children. These procedures vary in duration from a few minutes for removal of a tooth, to a few hours for dental restoration procedures. Guidelines limit the degree of sedation during treatment in the dental chair, and complex work in anxious or young children is performed in a hospital under general anesthesia. Nasal endotracheal intubation is common for dental treatment. Nasal intubation can be more difficult to perform than oral intubation. The tube can be difficult to pass through the nose, it can be difficult to guide around into the oropharynx, and it can be difficult to align the tube with the glottic opening. Refinements in intubation technique allow successful nasal intubation. Some children with underlying cardiac disease require endocarditis prophylaxis before some dental procedures.

Review Questions

• 1. A 6 year old child is having restorative dental treatment under general anesthesia. A nasal endotracheal tube is required. What size tube will you use?

• 2. A 6 year old child with Trisomy 21 is having dental treatment which includes extractions and stainless steel crowns to four teeth. A nasal endotracheal tube is required. Past history includes a fully repaired atrio-ventricular septal defect during infancy. Does this child require endocarditis prophylaxis? What size tube will you use?