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Survey of Dental Out-Patient Anaesthesia in Scotland 2013
Neal WillisST7 Anaesthesia
NHS Tayside
Background
• Previous survey in 2007• New guidance published in August 2011
• http://www.apagbi.org.uk/publications/guidelines-other-organisations-0
Results
• SPAN mailing list• 36 responses• 16 locations countrywide
Results
• SPAN mailing list• 36 responses• 16 locations countrywide• 100% perform DOPA• 83% aware of the APA sponsored document
And so the Results…
Recommendation 5
• Unless there is an urgent clinical need for treatment, assessment should ideally be undertaken at a separate appointment.
Recommendation 9
• Children…should be managed in a child-centred, family-friendly hospital setting. This should provide the space, facilities, equipment and appropriately trained personnel required to enable resuscitation and critical care to be…undertaken.
Recommendation 10
• Children…should receive the same standard of care as children admitted for any other procedure under general anaesthesia, including access to registered children's nurses and/or play specialists.
69%78%
Recommendation 13
• Children undergoing general anaesthesia for dental extractions should be managed by staff who have received appropriate training, and who are competent in paediatric anaesthesia and paediatric resuscitation.
Recommendation 14
• Whenever general anaesthesia is to be administered to a child, clinical observation should be supplemented by minimum standards of monitoring.
Intra-operative Monitoring
Recommendation 15
• Topical local anaesthetic cream should be applied preoperatively to potential sites for venepuncture, where appropriate.
Recommendation 15
• Topical local anaesthetic cream should be applied preoperatively to potential sites for venepuncture, where appropriate.
89% 11%
Recommendation 18
• NSAIDs and/or paracetamol should be used to provide analgesia. Opioids are not routinely required for uncomplicated extractions.
Non-Opioid Analgesia
Opioid Analgesia
• 2/3 use opioids at least ‘sometimes’• Fentanyl• Dihydrocodeine• Codeine: IM and oral• Alfentanil: IV and as part of TIVA• Tramadol: IV and oral
Recommendation 20
• The standards of recovery and discharge following general anaesthesia for dental extractions in children should be the same as following general anaesthesia for any other procedure.
Recovery Monitoring
Recommendation 23
• Discharge of the patient should be based on specified criteria, irrespective of the time taken to achieve these.
Time to Discharge
A Final Thought
Questions?