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?