8
General Anaesthesia
Indications for General Anaesthesia
General anaesthesia (GA) carries risks of morbidity and mortality. It should only be considered when treatment using local analgesia or a combination of local analgesia and sedation has failed or is inappropriate. Factors to consider before choosing GA are: the ability of the child to cooperate, the child’s degree of anxiety, anticipated surgical trauma, complexity of the procedure (e.g. extractions in multiple quadrants, severe dento-alveolar trauma), presence of acute dental infection, past dental history and medical history of the child (Table 8.1).
Table 8.1 Medical conditions requiring consideration when planning treatment under GA.
| Medical condition | Examples |
| Cardiac | Congenital heart disease, cardiomyopathies and dysrhythmias |
| Respiratory | Asthma, croup, cystic fibrosis |
| Haematological | Haemophilia, Von Willebrands, thrombocytopenia, aplastic anaemia, haemoglobinopathies |
| Immunocompromised | Primary (e.g. asplenia) and acquired (e.g. HIV, chemotherapy) |
| Endocrine | Diabetes, hypothyroid, hyperthyroid |
| Metabolic | Malignant hyperthermia, suxamethonium sensitivity |
| Gastrointestinal | Reflux, difficulty swallowing or feeding |
| Neurological | Epilepsy, cerebral palsy |
| Renal | Renal failure, nephrotic syndrome |
| Liver | Hepatitis, biliary atresia, alpha-1 antitrypsin deficiency |
| Neuromuscular | Muscular dystrophy |
| Syndromes | Down, DiGeorge, Williams |
| Difficult airways | Pierre Robin, sleep apnoea, obesity, cleft palate, micrognathia |
| Allergies | Latex, penicillin, elastoplast, EMLA, Ametop |
Planning Treatment under GA
Treatment should be planned with the aim of ensuring all treatment is provided unde/>
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