General anaesthesia and my child

General anaesthesia means that your child is fully asleep. Due to the increased demands in safely monitoring for such a procedure, this anaesthetic is carried out in a hospital environment as a day-stay procedure. Children with airway problems including sleep apnoea, loud snoring, large tonsils, adenoids, retruded (small mandibles) or children with obesity have an increased risk of side effects during conscious sedation. Children below 24 months of age also have a higher risk to sedation in a dentist chair. Consequently, some of these children are better treated under general anaesthesia.

General anaesthesia and my child

Fasting is an important part of dental sedation. Certain foods may alter your child's reaction to conscious sedation procedures. This food may 'compete' with the sedative agent being administered, and delay/alter the desired effect. In the case of general anaesthesia, not fasting may compromise and endanger the recovery of your child post-operatively.

Children easily perceive anxiety on others (especially from anxious parents). Please assist us by reassuring your child pre- and post- operatively. Do not mention words such as needle, pain, injection, etc… The dentist will explain your child step by step on the day of appointment.

Numbness of the mouth, especially a lower lip can be an unusual experience for many children. Please remind your child not to bite or pinch the numb lip (or tongue). In the event that your child does bite the lip/tongue, an ulcer will develop and this should heal on its own in 7-10 days.

Side effects of oral sedatives. The "angry child syndrome" is a rare side effect that is self-limiting once the drug wears off. Depending on the severity of this reaction, treatment may be abandoned.

Please do not bring other siblings or children at the sedation appointment. Your sedated child will require your full attention. Please also be aware that your child will require close supervision after the procedure (conscious sedation & general anaesthesia). Avoid outdoor activities (e.g. running around or swimming) on this particular day.

Dental treatment involving fillings and simple tooth removal can often be carried out using injections to numb the child's mouth. It is also possible to add sedation, which makes the child feel drowsy, and helps to relax children who are anxious or afraid.

For some children however, especially the very young, a general anaesthetic may be the only option. You may have some concerns and questions about general and the following information is designed to help you.

If you would like further information then please ask our dentist, nurses and your anaesthetists. They will be happy to help.

What is a general anaesthetic?

General anaesthesia is a state of controlled unconsciousness and freedom from pain.

Anaesthetics are the drugs (gases and injections) that are used to start and maintain anaesthesia.

When the operation is finished the anaesthetic is stopped and your child regains consciousness ('wakes up').

Who gives the anaesthetic?

General anaesthetics are given by anaesthetists. They are doctors with specialist training and are experts at looking after patients when they are anaesthetised. The anaesthetist stays with your child all the time during the operation and carefully monitors him or her.

What should I tell my child about the anaesthetic?

This will depend on the age of your child and how much you judge they can understand. We have found that children as young as five may have fears about going to sleep for an operation and about feeling pain afterwards.

It may be enough to explain that some of their teeth are poorly and need to be removed. You can explain that the doctor will give them some medicine which will make them go to sleep while their teeth are removed. The doctor will look after them while they are asleep and will help them wake up at the end of the operation. They will also be given medicine to make sure they don't feel too sore afterwards. Older children may want to know more. Do encourage your child to talk about the operation. Books, games and stories can help. You may be able to visit the department/operating theatre before the procedure and speak to the staff (only one parent is allowed).

What should I do if my child is unwell?

If your child has a cough, cold or a running nose or is otherwise unwell it may not be possible to go ahead with the anaesthetic and operation.

If you have any doubts please contact your anaesthetist for advice before attending the operation.

Why is it important for my child not to eat or drink before the anaesthetic? ('nil by mouth')

If there is food or liquid in your child's stomach during the anaesthetic, it could come up into the back of the throat and then go into his or her lungs. This would cause choking, or serious damage to the lungs, and so is very dangerous. Your local hospital will give instructions about when your child must stop eating and drinking (call the hospital the day before the operation to obtain this information).

Please do not let your child have sweets or chewing gum as these fill the stomach with saliva and increase the risk of vomiting.

The Anaesthetic

How will my child be given the anaesthetic?

Your child can either have:

Anaesthetic gas to breathe through a face-mask, or a small mask placed over the nose.

An injection through a cannula. (A cannula is a thin plastic tube placed, using a needle, into a vein on the back of the hand or the arm. Once the cannula is in place, the needle is removed.)

Anaesthetic cream is commonly placed on a child's hand or arm to make the skin numb and reduce the pain when the cannula is put in.

The cream takes up to an hour to work, so please make sure it is not removed.

Can I choose how the anaesthetic is given?

The final decision is usually made by the anaesthetist, after discussing the options with you and your child. Nothing will happen unless you understand and agree with what has been planned.

If your child has had an anaesthetic before and would like to 'go to sleep' in the same way, or alternatively, has had an unpleasant experience, please tell the anaesthetist.

Can I stay with my child while the anaesthetic is given?

We encourage a parent, adult relative or guardian to stay with the child. Your child will usually become unconscious on the operating table or trolley in the anaesthetic room. If your child is unhappy to leave you, it is usually possible to start the anaesthetic with your child on your lap and then transfer him or her to the operating table when unconscious.

Once your child is unconscious you will be asked to return to the waiting room. The anaesthetist will stay with your child throughout the operation.

How long will my child be unconscious for?

This will depend on the length of the operation.

Simple removal of teeth may only take one or two minutes.

Recovery will occur quickly, usually within about five minutes.

If the operation takes longer then your child will receive more anaesthetic and recovery will take a little longer.

However, your child will usually be conscious within fifteen minutes of the end of the operation.

Will pain relief medicine be given?

Yes, most children receive one or more of:

A pain relief medicine to swallow beforehand.

A pain relief suppository during the operation.

A pain relief medicine injected into their cannula.

Local anaesthetic injected by the dentist near to the teeth being treated. This is done while your child is anaesthetised.

Your dentist or anaesthetist will tell you more about what is planned for your child. If they still feel pain when they wake up, more pain relief will be available.

Can I be there when my child regains consciousness?

Once the operation is completed your child will be taken to the recovery room. A trained recovery nurse will look after your child and once he or she is responding to the nurse's voice you will be able to be with your child again.

What will my child feel like?

When your child first wakes up he or she is likely to be a bit confused and may cry for a short time. Some children are upset by the taste of blood in their mouth. If local anaesthetic has been given, they may not like the numb feeling in their mouth. They may also feel some pain, in which case more pain relief medicine will be given. Most children settle quickly and can soon have a drink.

Afterwards

How soon will I be able to take my child home?

After very short operations children can usually go home after one hour. For longer operations recovery will take longer but most children will be able to go home within two hours.

Will my child have any after-effects?

It is common for children to:

feel dizzy and a bit sick for a few hours

be sick occasionally, especially if they have swallowed a little blood

have some pain or discomfort for a few hours.

You can help by giving your child pain relieving medicine regularly as prescribed rather than waiting for him or her to complain.

If you have any concerns about your child when you get home, you should our surgery and or the phone number your dentist has supplied you with.

Should I keep my child away from school?

You will have to be guided by how your child feels. Some children still don't feel quite right the following day and may need to stay off school.

Your dentist will advise you about when your child can safely take part in vigorous exercise or sports.

Risk and Safety

Why does my child have to go to hospital to have a general anaesthetic?

Government regulations state that general anaesthesia for dental treatment may only be given in hospital where all the appropriate safety facilities are available. General anaesthetics cannot be given at your dentist's surgery.

How safe is general anaesthesia for dental treatment and what are the risks?

With modern anaesthesia, serious problems are uncommon. Risk cannot be removed completely but when a patient is fit and healthy and the operation is a small one, as many dental operations are, the risk of a life-threatening problem is about 1 in 400,000. This risk is considerably less than that of your child being seriously injured in a road accident.

My child has learning disabilities or has special medical problems. Are there any extra risks with the anaesthetic?

Yes, there may be a small increase in risk but this risk should be outweighed by the benefits of your child's treatment. Each child is different and will be carefully assessed before their operation so that their treatment can be tailored to their needs.

Sometimes children with serious medical problems who need a general anaesthetic for their dental treatment need to be admitted to hospital rather than go home the same day. This allows full preparation for their operation and the anaesthetic and a longer recovery period afterwards.

Questions you may like to ask your Anaesthetist:

Who will give my child's anaesthetic?

Is this the only type of anaesthetic possible for dental treatment?

Have you often used this type of anaesthetic?

What are the risks of this type of anaesthetic?

Dose my child have any special risks?

How will my child feel afterwards?