treating children under g.a 2016

By Dr. Ali Abdel Fattah

Pedodontist

TREATING CHILDREN UNDER G.A

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عليك وكان عظيما فضل الله

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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

CONTRAINDICATIONS

PT with a medical contraindication to G.A : -

Healthy Cooperative PT with

minimal dental needs

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

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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Pharmacologi

cal & / OR non pharmacological management ?

Learn how to think …… not what to

think

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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COMPONENTS OF THE DENTAL HISTORY &INTRAORAL EX. TO BE COMPLETED BEFORE

HOSPITALIZATION

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

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

-ALL PERSONS INVOLVED IN THE CARE OF PATIENTS IN THE O. R MUST FOLLOW OCCUPATIONAL

SAFTY& HEALTH ADMINISTRATION

(OSHA) GUIDELINES.

OPERATING ROOM PROTOCOL

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

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

NASOTRACHEAL INTUBATION & SPECIAL EYE GUARD

OBTAINING DIAGNOSTIC RADIOGRPH (DIGITAL RADIOGRAPHS )

SPECIAL CARE MUST BE TAKING DURING PERIORAL CLEANING

PLACEMENT OF THE SURGICAL SHEET & TRIANGULAR

DRAPING OF THE ORAL CAVITY AREA THE NASOTRACHEAL TUBE MUST BE EXPSED

POSITIONING OF A MOUTH PROP SPECIAL CARE IS TAKEN NOT TO IMPINGE ON THE

LIPS OR THE TOUNG WITH THE PROP

PLACEMENT OF THE PHARYNGEAL THROAT PACK

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

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

RESTORATIVE DENTAL CAER UNDER

G. A INCREASES THE QUALITY OR

QUANTITY

OF DENTAL CARE ?

CLINACAL HINT

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

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

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

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 )

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

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

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

B.M

PREVENTATION

QUALIFIED DENISTST

OUT PATIENT SURGERY CENTER

KEY STONE OF SUCESS

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