Introduction: Local anaesthesia injection is widely accepted as the gold standard for pain management during various dental procedures. Intra-oral topical anaesthesia not only reduces the pain of injection prick but also several minor dental procedures can be carried out under topical anaesthetic. Study aimed to determine the usage, type & effectiveness of various topical anaesthetics used for minor dental procedures in pediatric patients. Material and Methods: A self-structured, closed ended questionnaire was emailed to 100 private dental practitioners in the tricity and were asked to fill and mail it back. Results: 59% dentists responded, out of them 70.7% routinely used topical anesthetic. 64.8% used Lidocaine gel for administration of local anesthesia. 24.1% used topical anesthetic for extraction of nearly exfoliating deciduous teeth. 42.6% responded that the effect of topical anesthetic was achieved between 30 seconds to 1 minute. Conclusion: All the dentists were aware of using topical anesthetic and the most preferred delivery system was gel.

Awake tracheostomy in a child with respiratory distress is an emergency life-saving procedure when risk of airway loss after induction of general anaesthesia is greater due to difficult anatomy. A 10-year-old boy presented three days after removal of a foreign body in the throat under general anaesthesia. Over the subsequent days, the patient had a progressively increasing visible swelling in the neck, stridor and respiratory distress. An urgent X-ray and computed tomography scan of the neck revealed a retropharyngeal abscess compressing the trachea. Due to anticipated difficulty in airway management under general anaesthesia, we decided to perform an awake tracheostomy. The child and the parents were counselled regarding steps of awake tracheostomy, as well as the benefits and possible risks associated with it. Topicalisation was achieved by administering glycopyrrolate, nebulisation with lidocaine 4%, and the skin was prepared with lidocaine 2% with 1:200,000 adrenaline. After the awake tracheostomy was successfully performed, general anaesthesia was induced and the retropharyngeal abscess was drained. Effective communication and building rapport is essential for safe awake tracheostomy in a child with respiratory distress when impending airway loss may occur at any moment.

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