How to safely limit children’s anaesthesia exposure

Copyright: aigarsr / 123RF Stock Photo
Copyright: aigarsr / 123RF Stock Photo

Children who require both dental and non-dental medical procedures should have them completed under one general anaesthetic whenever possible, which is ideal for both the patient and family, according to research presented at this week’s Anesthesiology® 2016 annual meeting.

Vidya T. Raman is director of pre-admission testing at Nationwide Children’s Hospital and clinical associate professor at The Ohio State University Medical Center, Columbus. As lead author of the study discussed at the meeting, he explained that of the 55 children monitored who had a dental procedure combined with another non-dental medical procedure under one anaesthetic, virtually nine in 10 did not experience any complications.

Seven had complications such as vomiting and pain and of those, four required unplanned admission to the hospital. Most of those patients were at increased risk of hospitalisation because of severe systemic diseases, said Dr Raman.

Every year, millions of children require surgery for dental and non-dental medical procedures. Some children require general anaesthesia when undergoing restorative dental procedures, such as teeth extraction or capping.

The research suggests that, where possible, these procedures should be performed in combination with other surgical interventions requiring general anaesthesia, such as tonsil removal, insertion of ear tubes and diagnostic tests such as magnetic resonance imaging (MRI), which requires sedation to ensure the child does not move. This enables the child to undergo multiple procedures in one visit rather than over several weeks or months.

“While surgery and anaesthesia are safer than they’ve ever been, limiting exposure [to anaesthetic] is preferable, especially in children, because there may be sensitivities or a greater risk of anaesthesia-related complications,” said Dr Raman.

“In addition to improving patient safety, we believe combining procedures decreases costs and improves patient satisfaction.”

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  1. As a Paediatric dentist I always try to combine any other procedure that is required into the same general anaesthesia session. There are many barriers to this including surgeon availability, hospital cooperation and health fund limitations. BUPA will only reimburse the hospital for one procedure which is usually the medical procedure over dental. All the other funds have multiple procedure rules so the pay 100% for the first procedure, 33% for the second and 20% for subsequent procedures. Dental procedures are low in consumables but high in time cost compared to the medical procedure. Hospitals are placed in a compromised position as they want to do the best for the child but financially combining of procedures gives them an overall poor rebate. Many of my special needs patients require multiple procedures but the health funds do not take this into consideration. I am privileged to work with a select group of anaesthetists and surgeons who are incredibly generous with their time and a hospital administration that is open to trying to coordinate these multiple procedures. MRI is not a possibility as the expensive equipment is in high demand so occupying the room to complete an hour of dentistry is not a possibility. The equipment is not able to be moved around like a mobile X-ray machine.
    I would like to see a reform to the health fund rules and rebates which would facilitate more joint procedures and they would then be truly providing what is in the best interests of their members.


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