By Dr. Ali Abdel Fattah

TREATING CHILDREN

under G.A

The Makkah Development 2020.flv

The Makkah Development 2020.flv

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1- PT UNABLE TO COOPERATE WITH A CERTAIN

PHYSICAL, MENTAL, OR MEDICALLY

COMPROMISSING DISABILITY .

2- EXTREMELY

uncooperative , FEARFUL, ANXIOUS ,

PHYSICALLY RESISTANT .

3 - FOR WHOME THERE IS NO EXPECTATION THAT THE

BEHAVIOR WILL SOON IMPROVE .

4 - PT WHO HAVE SUSTAINED EXTENSIVE OROFACIAL OR

DENTAL TRAUMA &/OR REQURE SIGNIFICANT SURGICAL

PROSEDURE ( (e.g oral BURN )

INDICATIONS

CONTRAINDICATIONS

PT with a medical

contraindication to G.A : -

Healthy

Cooperative PT with minimal

dental needs

اللهم احسن خاتمتنا

عليك وكان عظيما فضل الله

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HOSPITALIZATION : -

IS A FREQUENT SOURSE OF

ANXIETY FOR CHILDREN .

20% TO 50% OF

CHILDREN DEMONSTRATE SOME DEGREE OF

BEHAVIOUR CHANGE AFTER SEPERATION

Separation OF THE CHILD FROM THE

PARENT APPEARS TO BE A SIGNIFICANT

FACTOR

PSYCHOICLOG EFFECTS OF HOSPITALIAZATION ON CHEILDRN

BETTER APPETITE

LESS

FUSS ABOUT

EATING, FEWER

TEMPER

TANTRUMS

BITING THE FINGERNAILS,

GETTING UPSET WHEN LEFT

ALONE , NEEDING MORE

ATTENTION & BEING AFRAID OF

THE DARK

POSITIVE CHANGES

(42.5%)

NEGATIVE CHANGES

(42.5%)

75% OF THE CHILDREN RECEVIG G.A EXHIBITED SOME TYPE OF BEHAVIOUR CHANGE

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Pharmacologic

al & / OR

non

pharmacologic

al management

?

Learn how to think …… not what to

think

NON EMERGENCY G .A

THE NEED OF G.A REPRESENTS THE FINAL SOULATION, WHEN DECIDING TO USE G . A THE clinician must look at the whole picture 1 - Is the treatment absolutely necessary? 2 -Has there been a history of emotional trauma associated with the dental pain? - 3- Medical histOry ?

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COMPONENTS OF THE DENTAL HISTORY &INTRAORAL EX. TO BE COMPLETED BEFORE

HOSPITALIZATION

CURRENTLY , MORE Than 70 % OF ALL

PEDIATRIC SURGICAL PROCEDUR ARE PERFORMED ON AN OUT PATIANT BASIS

( In hospital or out patient surgery center ) GOOD

PT SELECTION IS AN IMPORTANT CRITERION OF SUCCESSFUL OUT

PT SURGERY PROGRAM CANDIDATE

ARE :- class 1 OR

2 ON ASA class1:-normal healthy pt class 2 :- patient with mild systemic disease.

OUTPATIENT SURGERY

THE DENTIST WILL BE MORE

RESPONSIBLE FOR TEAM

COMMUNICATION, PHYSICAL

ASSESSMENT, MANAGEMENT, AND POST

OPERATIVE EVALUATION FOR

OUTPATIENT PROCEDURES UNDER G.A

THAN FOR INPATIENT PROCEDURES .

THE DENTIST RESPONSIBILTEY

-ALL PERSONS INVOLVED IN THE

CARE OF PATIENTS IN THE O. R

MUST FOLLOW OCCUPATIONAL

SAFTY& HEALTH

ADMINISTRATION

(OSHA) GUIDELINES.

OPERATING ROOM PROTOCOL

BEFORE INDUCATION, WHEN THE PT ENTERS

THE OPERATING ROOM , TIME OUT

PROTOCOL INITIATED BY :- THE

CIRCULATING NURSE

IDENTIFIES The PT ALLERGIES ,

PLANNED

MEDIACATIONS & PROPOSED TO THE DENTIST &

ANAESTHESIOLOGIST

TIME OUT PROTOCOL

PATIENT IS IN A STABLE ANESTHETIC CONDITION & READY FOR THE DENTAL

PROCEDURE

NASOTRACHEAL INTUBATION & SPECIAL EYE GUARD

OBTAINING DIAGNOSTIC RADIOGRPH (DIGITAL RADIOGRAPHS )

SPECIAL CARE MUST BE TAKING DURING PERIORAL CLEANING

PLACEMENT OF THE SURGICAL SHEET & TRIANGULAR

DRAPING OF THE ORAL CAVITY AREA THE NASOTRACHEAL TUBE MUST BE EXPSED

POSITIONING OF A MOUTH PROP SPECIAL CARE IS TAKEN NOT TO IMPINGE ON THE

LIPS OR THE TOUNG WITH THE PROP

PLACEMENT OF THE PHARYNGEAL THROAT PACK

THE USE OF QUADRANT ISOLATION WITH A RUBBER DAM (TOPICAL FLOURIDE SHOULD BE APPLIDE BEFORE THE REMOVABLE OF RUBBER DAM )

O.R POSITIONS OF THE STAFF WILL PERFORMING DENTAL TREATMENT (FROM LEFT) 1-

DENTAL ASSISTANT, 2-DENTAL SURGEON 3- ANAETHESIOLOGIST , 4- ASSISTANT DENTAL SURGEON & 5- CIRCULATING NURSE

RESTORATIVE DENTAL CAER

UNDER G. A INCREASES THE

QUALITY OR QUANTITY

OF DENTAL

CARE ?

CLINACAL HINT

RESTORATIVE DENTAL CARE UNDER G.A ALLOWS

EXELLENT PATIENT COMPLIANCE & EASY

ACHIEVEMENT OF A WELL – LIGHTED FIELD

INCREASES THE QUALITY & QUANTITY

OF DENTAL CARE

WHILE DECREASING THE

ANXITY LEVEL FOR THE CLINICAN & PATIENT

DURING DENTAL TREATMENT

RESTORATIVE DENTISTRY IN THE O.R

Calculate

time needed for each procedure :- e.g

1- RCT + SSCs ( 35 minutes ) 2 - Teeth

extractions + Suturing ( 25 minutes )

3- Restorations +fluoride app ( 20

minutes ) SO,THE TIME OF ANESTHEIA IS : 1.5 H

LENGTH OF ANESTHESIA

The dentist should notify anesthesiologist 10 minutes before the completion of the procedure. The recovery room personnel are notified that the child will soon be arriving . The end time out protocol is called by The circulating nurse to identify any patient safety concerns . The dentist should accompany the anesthesiologist to the recovery room

COMPLETION OF THE PROCEDURE

THE DENTIST :-

SHOULD INFORM THE NURSE STAFF OF ANY SPECIAL REQUESTS / INSTRUCATION

THE PARENTS :-

SHOULD BE INFORMED OF THE TIME

TO MEET THE CHILD IN THE

RECOVERY AREA.

POSTANETHESIA CARE UNIT RECOVERY ROOM ( R R )

Post Operative Orders & The Operative

Note For The Staff Should Be

Completed By The Dentist & Recorded

In The Medical Chart While The Child

Is In The Recovery Room.

How Many People In The Recovery

Area ?

POST OPERATIVE CARE

BEST OUTCOMES FOLLOWING REHABILITATION

UNDER G.A MAY RESULT FROM :-

1 -AGGRESIVE TREATMENT OF

CARIES . 2 - ACTIVE FELLOW-

UP & EDUCATION OF PARENTS & CAREGIVERS .

( THE DENTAL HOME ? )

REASONS FOR REPEAT DENTAL TREATMENT UNDER G.A FOR THE HEALTHY CHILD

The researchers concluded that more aggressive preventive therapies required for children that was treated under G.A . BEHIVOUR MANAGEMENT is one of our key stone even during hospitalization

KEY TONE OF SUCESS

B.M

PREVENTATION

QUALIFIED DENISTST

OUT PATIENT SURGERY CENTER

KEY STONE OF SUCESS

1- THE DENTAL HOME

2- BREAK THE CYCLE

3- ARREST CARIES

4- MICRO

DENTISTRY

5- SEDATION & / PHYSCIAL RESTRAINT

6- G.A

7- BEHAVIOUR MANAGEMENT & PERVENTATION

ALL THE TIME ALL THE LIFE

FINAL

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