Morbidity following dental treatment of children under intubation general anaesthesia in a day‐stay unit

Atan, Şenay Ünsal; Ashley, Paul; Gilthorpe, Mark S.; Scheer, Barry; Mason, Carol; Roberts, Graham

doi:10.1111/j.1365-263x.2004.00520.x

Cited by 86 publications

(109 citation statements)

References 11 publications

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“…[25][26][27] There is not a clear explanation for this difference in gender distribution, but it has been suggested that a higher prevalence of neuropsychiatric disorders among boys could explain the predominance of males. 22 It has been reported that in hospital settings, the frequency of DGA is concentrated in patients affected with cardiac problems, asthma, physical and emotional disabilities.…”

Section: Discussionmentioning

confidence: 94%

Dental Treatment under General Anesthesia in Healthy and Medically Compromised/Developmentally Disabled Children: A Comparative Study

Loyola-Rodríguez

Zavala-Alonso

Gonzalez-Alvarez

et al. 2009

Journal of Clinical Pediatric Dentistry

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Aim: To compare the type, number of procedures and working time of dental treatment provided under dental general anesthesia (DGA) in healthy and medically compromised/developmentally disabled children(MCDD children). Design: This cross-sectional prospective study involved 80 children divided into two groups of 40 children each. Group 1 consisted of healthy and Group 2 consisted of MCDD children. Results:Healthy children needed more working time than MCDD children, the means being 161±7.9 and 84±5.7 minutes, respectively (P= 0.0001). Operative dentistry and endodontic treatments showed a significant statistical difference (P= 0.0001). The means of procedures were 17±5.0 for healthy children and 11±4.8 for MCDD children (P= 0.0001). Conclusions: Healthy children needed more extensive dental treatment than MCDD children under DGA. The information from this sample of Mexican children could be used as reference for determining trends both within a facility as well as in comparing facilities in cross-population studies.

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Section: Discussionmentioning

confidence: 94%

Dental Treatment under General Anesthesia in Healthy and Medically Compromised/Developmentally Disabled Children: A Comparative Study

Loyola-Rodríguez

Zavala-Alonso

Gonzalez-Alvarez

et al. 2009

Journal of Clinical Pediatric Dentistry

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“…At 24 hr, the median (interquartile range [IQR]) NRS in both groups was 0 [1]. The NRS scores at 24 hr are shown in Figs.…”

Section: Resultsmentioning

confidence: 98%

Effect of dexamethasone on postoperative morbidity after dental rehabilitation in children

McIntyre

Hardcastle

Eng

et al. 2011

Can J Anesth/J Can Anesth

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Purpose Dexamethasone reduces postoperative morbidity after adenotonsillectomy, strabismus surgery, and third molar extraction. Our hypothesis was that dexamethasone would reduce pain and other morbidity in children undergoing dental surgery for up to 24 hr postoperatively. Methods A triple-blinded, randomized, controlled trial was carried out on 200 children undergoing prolonged dental rehabilitation under general anesthesia. Subjects were randomized into two groups: group D, given dexamethasone 0.3 mgÁkg -1 ; group S, given normal saline. The primary outcome measure was pain over 24 hr as evaluated by a parental 0-10 numerical rating scale (NRS). Key secondary outcomes included oral intake on a four-point scale at 24 hr and the overall incidence of postoperative vomiting (POV). Analysis for the primary outcome consisted of comparison of means in the NRS with the Wilcoxon rank sum test and for occurrence of POV with Fisher's test. Results After eliminating 22 subjects for protocol violations and withdrawals, 178 subjects were analyzed. There was no significant difference in pain scores (NRS) at 24 hr or the worst NRS experienced over the preceding 24 hr. There was no difference in the quality of oral intake between the groups. There was a significant difference in the percentage of patients who vomited during the first 24 hr: eight of 91 in group S and one of 87 in group D. Therefore, 7.74% more vomited in group S (P = 0.045), with a 95% confidence interval of 0.32 to15.16 for the difference in percentages. Conclusions Dexamethasone, 0.3 mgÁkg -1 , did not reduce pain over 24 hr in healthy children undergoing dental rehabilitation under general anesthesia. The quality of oral intake was also unaffected by dexamethasone at 24 hr. Dexamethasone did produce a significant reduction in postdischarge vomiting, beyond the incidence found with ondansetron alone. RésuméObjectif La dexame´thasone diminue la morbiditeṕ ostope´ratoire apre`s une intervention chirurgicale pour ade´no-amygdalectomie, strabisme et extraction de la troisie`me molaire. Nous avons formule´l'hypothe`se que la dexame´thasone pouvait diminuer la douleur et d'autres morbidite´s chez des enfants subissant une chirurgie dentaire jusqu'a`24 heures apre`s l'intervention. Méthodes Une e´tude randomise´e, contrôle´e, a`triple insu a e´te´mene´e chez 200 enfants subissant une restauration

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“…In response to this sobering report, studies have attempted to measure postoperative morbidity 5 and local anesthesia has been looked upon favorably as a potential technique to improve outcomes with varying levels of success. 2 Jurgens et al 6 could not find a statistically significant difference in self-reported postoperative pain between children treated with local anesthetic compared with those treated with systemic analgesics (intravenous fentanyl and paracetamol [acetaminophen] either alone or in combination) for dental extractions, but subjectively determined that the children appeared ''more settled'' in recovery. Atan et al 2 reported that the odds of experiencing pain at the operation site were reduced by local analgesia by an odds ratio of 0.39, but these children were more likely to report dizziness.…”

mentioning

confidence: 99%

“…2 Jurgens et al 6 could not find a statistically significant difference in self-reported postoperative pain between children treated with local anesthetic compared with those treated with systemic analgesics (intravenous fentanyl and paracetamol [acetaminophen] either alone or in combination) for dental extractions, but subjectively determined that the children appeared ''more settled'' in recovery. Atan et al 2 reported that the odds of experiencing pain at the operation site were reduced by local analgesia by an odds ratio of 0.39, but these children were more likely to report dizziness. Two other studies found a significant benefit to intraligamental injection but only at one isolated time in the immediate postoperative period (5 minutes).…”

mentioning

confidence: 99%

“…1 Although benefits of general anesthesia for dentistry include safe and efficient delivery of dental care, the procedure is not without morbidity or mortality. 2 A well-documented phenomenon in medicine is the undertreatment of pain in children. Pain has been undertreated across all age groups due to misunderstandings about analgesic use and concerns over addiction, and, in young children, the mistaken belief of no pain perception.…”

mentioning

confidence: 99%

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The Effect of Local Anesthetic on Quality of Recovery Characteristics Following Dental Rehabilitation Under General Anesthesia in Children

Townsend

Ganzberg

Thikkurissy³

2009

Anesthesia Progress

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This study is a randomized, prospective, double-blind study to evaluate the effects of the combination of local anesthetics and an intravenous nonsteroidal anti-inflammatory drug ( NSAID) vs NSAID alone on quality of recovery following dental rehabilitation under general anesthesia (GA ). Twenty-seven healthy children aged 3^5.5 years underwent dental rehabilitation under GA. Fifteen children in the experimental group received oral infiltration of local anesthetic in addition to intravenous ketorolac tromethamine, while 12 children in the control group received intravenous ketorolac tromethamine alone for postoperative pain management. Pain behaviors were evaluated immediately postoperatively using a FLACC scale and 4 hours postoperatively by self-report using various scales. Parents reported perception of child pain and comfort and any occurrences of postoperative cheek biting. The use of intraoral infiltration local anesthesia for complete dental rehabilitation under general anesthesia for children aged 3^5.5 years did not result in improved pain behaviors in the postanesthesia care unit (PACU), nor did it result in improved pain behaviors 4^6 hours postoperatively as measured by the FLACC scale, FACES scale, and subjective reports of parents or a PACU nurse. Those children receiving local anesthesia had a higher incidence of negative symptoms related to local anesthetic administration, including a higher incidence of lip and cheek biting, which was of clinical importance, but not statistically significant. Infiltration of local anesthetic for dental rehabilitation under general anesthesia did not improve quality of recovery in children aged 3^5.5 years.

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Morbidity following dental treatment of children under intubation general anaesthesia in a day‐stay unit

Abstract: Pain following dental GA was the most prevalent and long lasting symptom of postoperative morbidity in this study. Reductions in operating time and improvement in pain control have the potential to reduce reported morbidity following dental GA.

Cited by 86 publications

References 11 publications

Dental Treatment under General Anesthesia in Healthy and Medically Compromised/Developmentally Disabled Children: A Comparative Study

Dental Treatment under General Anesthesia in Healthy and Medically Compromised/Developmentally Disabled Children: A Comparative Study

Effect of dexamethasone on postoperative morbidity after dental rehabilitation in children

The Effect of Local Anesthetic on Quality of Recovery Characteristics Following Dental Rehabilitation Under General Anesthesia in Children

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