Pediatric dentists may recommend general anesthesia (GA) for anxious and young children who need long and complex treatments. They may also suggest GA for developmentally patients who are not able to get necessary dental treatments done in a normal dental office.
The American Academy of Pediatric Dentistry (AAPD), on its Policy on the Use of Deep Sedation and General Anesthesia in the Pediatric Dental Office, “recognizes that a population of patients, because of their need for extensive treatment, acute situational anxiety, uncooperative age-appropriate behavior, immature cognitive functioning, disabilities, or medical conditions, would benefit from deep sedation or general anesthesia.”
Our Specialist Pediatric Dentist Dr. Imneet Madan deep dive into the safety of general anesthesia for children with Dr. Nalla Natarajan, Specialist Anesthetist at Medcare Hospital.
“We face a lot of questions from parents whenever we propose GA as a treatment,” said Dr. Imneet. “This is why we invited Dr. Nalla, a specialist in anesthetics with over 25 years of experience in GA, to answer the most frequently asked GA questions by parents.”
Is general anesthesia safe for children?
Dr. Nalla: 100%. Anesthesia is a way to make a person sleep using medications. With GA, induced comfortable sleep are achieved with the use medications that are reversible and short acting. They work only for a specific period of time. Once the effect goes off, the person is awake. During the state of sleep or anesthesia, the patient is completely monitored with gadgets that check your pulse, your breathing, takes care of your brain and tells us what’s happening in your brain and your hemodynamics.
What kind of medications do you use to induce this deep sleep with our young patients?
Dr. Nalla: We use a balanced anesthesia in the sense that we use a cocktail of medications – one is to sedate, two, induce a state of amnesia that you do not remember what happened in the procedure, three we want the patient to be quiet, not to move (a state of paralysis) and four, to not feel any pain. All these dosages are tailored to the weight of the child and the requirement of the procedure. Once you give the anesthesia, the child sleeps and does not move, does not feel the pain thereby allowing the dentist to do the procedure. What I tell the parents is that GA in this case does not mean that there is a surgery, it is just a dental procedure. Coming out of a dental procedure is something different compared to when you come out of a surgery.
Does general anesthesia have an impact on the development of a young child’s brain? Does it have an impact on a child’s ability to learn?
Dr. Nalla: During the state of anesthesia, a patient may be subjected to certain conditions like when the saturation drops, or the oxygenation did not go well. This is what we call associated with anesthesia. Anesthesia medication does not cause anything to the brain. During GA, the patient is monitored all throughout the anesthesia. It is a very safe procedure.
Once we are done with the anesthesia, are there any residual effect of the medicines?
Dr. Nalla: It depends on the length of the procedure. Like I said, the maintenance of anesthesia is done through the inhalation of a gas. Similarly, the gas has to leave the body by exhalation. Which means your body breathes out the anesthetic gas through the lungs and get back to normal.
Why is there a need for the nasal tube while anesthesia?
Dr. Nalla: When you want to do a safe, controlled anesthesia especially when the dentist has a lot of things in the mouth and we are looking at the airway – it needs to be protected. The safest way to protect the airway is to pass it through the nose because you’re going to operate in the mouth. One, it allows the dentist to work in the mouth. Two, the nasal tube delivers the anesthesia and three, when you want to do any procedure in the mouth, you don’t want the patient to aspirate any secretions or blood getting into the lungs.
Does that explain why some patients experience vomiting after the procedure?
Dr. Nalla: Vomiting and nausea are side effects of narcotics and sedation. These side effects are nothing compared to the benefits patients receive. These side effects last for an hour or so and this is why we keep them in the recovery room, so we can observe the child, give anti-nausea medications if needed, then send them home. I’ve even heard from some parents that their child goes with them to them in the supermarket in the evening (of the procedure). It depends on the metabolism of the body.