Download - 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.
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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