Abstract
The use of deep sedation and general anesthesia (DS/GA) to permit the completion of high-quality dental care for young children and patients with intellectual, emotional, or physical challenges is recognized as indispensable for a subset of these patients. The combination of behavioral techniques, minimal and moderate sedation, and even prolonged restraint, which some practitioners still provide, is not uniformly successful in achieving dental surgical goals. DS/GA can be safely provided in the dental office, ambulatory surgery center, or hospital provided that well-trained anesthesia providers are utilized. Airway management can include intubated, laryngeal mask airway (LMA) or natural airway techniques in any of these venues. Either dentist or physician anesthesiologists can be used; however, only dentist anesthesiologists have specific training requirements in office-based anesthesia management. In some states where it is legal, certified registered nurse anesthetists can also provide anesthesia in the dental office. It is critical for the pediatric dentist to understand what the pediatric anesthesia training is between these various providers and to ensure that emergency protocols are well thought out and prepared for by the anesthesia provider. Fortunately, the safety record of office-based anesthesia by well-trained dentist and physician anesthesiologists is exemplary allowing cost-effective care for these children with special needs.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Coté CJ, Wilson S. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Pediatr Dent. 2006;32(6):167–83.
Borgeat A, Wilder-Smith OH, Suter PM. The nonhypnotic therapeutic applications of propofol. Anesthesiology. 1994;80(3):642–56.
Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiology. 1994;81(4):1005–43.
Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorumski CF, Olney JW, Wozniak DF. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003;23(3):876–82.
Zou X, Patterson TA, Divine RL, Sadovova N, Zhang X, Hanig JP, Paule MG, Slikker Jr W, Wang C. Prolonged exposure to ketamine increases neurodegeneration in the developing monkey brain. Int J Dev Neurosci Off J Int Soc Dev Neurosci. 2009;27(7):727–31.
Brambrink AM, Evers AS, Avidan MS, Farber NB, Smith DJ, Zhang X, Dissen GA, Creeley CE, Olney JW. Isoflurane-induced neuroapoptosis in the neonatal rhesus macaque brain. Anesthesiology. 2010;112(4):834–41.
Slikker Jr W, Zou X, Hotchkiss CE, Divine RL, Sadovova N, Twaddle NC, Doerge DR, Scallet AC, Patterson TA, Hanig JP, Paule MG, Wang C. Ketamine-induced neuronal cell death in the perinatal rhesus monkey. Toxicol Sci Off J Soc Toxicol. 2007;98(1):145–58.
Wilder RT, Flick RP, Sprung J, Katusic SK, Barbaresi WJ, Mickelson C, Gleich SJ, Schroeder DR, Weaver AL, Warner DO. Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology. 2009;110(4):796–804.
Kalkman CJ, Peelen L, Moons KG, Veenhuizen M, Bruens M, Sinnema G, de Jong TP. Behavior and development in children and age at the time of first anesthetic exposure. Anesthesiology. 2009;110(4):805–12.
Hansen TG, Pedersen JK, Henneberg SW, Pedersen DA, Murray JC, Morton NS, Christensen K. Academic performance in adolescence after inguinal hernia repair in infancy: a nationwide cohort study. Anesthesiology. 2011;114(5):1076–85.
DiMaggio C, Sun LS, Li G. Early childhood exposure to anesthesia and risk of developmental and behavioral disorders in a sibling birth cohort. Anesth Analg. 2011;113(5):1143–51.
Stratmann G, May LD, Sall JW, Alvi RS, Bell JS, Ormerod BK, Rau V, Hilton JF, Dai R, Lee MT, Visrodia KH, Ku B, Zusmer EJ, Guggenheim J, Firouzian A. Effect of hypercarbia and isoflurane on brain cell death and neurocognitive dysfunction in 7-day-old rats. Anesthesiology. 2009;110(4):849–61.
Straiko MM, Young C, Cattano D, Creeley CE, Wang H, Smith DJ, Johnson SA, Li ES, Olney JW. Lithium protects against anesthesia-induced developmental neuroapoptosis. Anesthesiology. 2009;110(4):862–8.
Young C, Jevtovic-Todorovic V, Qin YQ, Tenkova T, Wang H, Labruyere J, Olney JW. Potential of ketamine and midazolam, individually or in combination, to induce apoptotic neurodegeneration in the infant mouse brain. Br J Pharmacol. 2005;146(2):189–97.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Ganzberg, S.I. (2015). Deep Sedation and GA. In: Wilson, S. (eds) Oral Sedation for Dental Procedures in Children. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46626-1_10
Download citation
DOI: https://doi.org/10.1007/978-3-662-46626-1_10
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-46625-4
Online ISBN: 978-3-662-46626-1
eBook Packages: MedicineMedicine (R0)