Non-intubated, total intravenous anaesthesia proposed as a safe method for paediatric dentistry in a rural area
More details
Hide details
Anaesthetic Department, ‘Dobra’ Medical Centre, Dobra, Poland
Department of Paediatric Dentistry, Pomeranian Medical University, Szczecin, Poland
Clinic of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland
Clinic of Neurosurgery and Children’s Neurosurgery, Pomeranian Medical University, Poland
Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland
Surgery Department, Medimel, Szczecin, Poland
J Pre Clin Clin Res. 2016;10(1):34–38
General anaesthesia can reduce child stress associated with occasionally very unpleasant dental treatment. However, general anaesthesia with endotracheal intubation is commonly used with dental procedures despite the fact that endotracheal tubes obstruct good access to molars, especially in very small children. In this article we would like to contribute to changes in anaesthetic methods to those less harsh for patients.

Material and Methods:
At our dental practice, located at a rural area, total intravenous anaesthesia with propofol infusion, without endotracheal intubation, has been used for more than 10 years as standard procedure for the dental treatment of children. Retrospective analysis of medical records of 614 children was performed, including search for perioperative critical incidents.

There were two adverse events. In the first, a boy (age 10.5 years with a history of tricuspid valve regurgitation) developed severe bradycardia, with no conjunction with any desaturation. Atropine was given and heart rhythm returned to normal values. The second incident occurred during the recovery of a 4-year-old girl who developed laryngospasm after the procedure, and the decision to use rescue intubation was made. The child recovered and was extubated shortly afterwards without any further problems. These two cases account for the total perioperative critical incident rate of 0.33% (95% confidence interval ~0 to 1.3%).

General anaesthesia without endotracheal intubation has been safe for paediatric dental treatment at our practice. Patients should be guided to follow strict fasting rules, and a throat pack and efficient suction are essential. The anaesthesiologist should be present during the intraoperative period until the child is safely discharged.

Ljungqvist O, Søreide E. Preoperative fasting. Br J Surg. 2003; 90(4): 400–406.
Smith I, Kranke P, Murat I, Smith A, O’Sullivan G, Søreide E, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011; 28(8): 556–569.
Wang Y-C, Lin I-H, Huang C-H, Fan S-Z. Dental anesthesia for patients with special needs. Acta Anaesthesiol Taiwan. 2012; 50(3): 122–125.
Good Practice: A guide for departments of anaesthesia, critical care and pain management. 2006. the-good-practice-guide (access: 2013.11.20).
Law AK, Ng DK, Chan K-K. Use of intramuscular ketamine for endoscopy sedation in children. Anaesthesia. 2003; 45(2): 180–185.
Malviya SS, Voepel-Lewis TT, Eldevik OPO, Rockwell DTD, Wong JHJ, Tait ARA. Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes. Br J Anaesth. 2000; 84(6): 743–748.
Peña BM, Krauss B. Adverse events of procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med. 1999; 34(4 Pt 1): 483–491.
El-Seify ZA, Khattab AM, Shaaban AA, Metwalli OS, Hassan HE, Ajjoub LF. Xylometazoline pretreatment reduces nasotracheal intubation-related epistaxis in paediatric dental surgery. Br J Anaesth. 2010; 105(4): 501–505.
Kim YCY, Lee SHS, Noh GJG,Cho SY, Yeom JH, Shin WJ, et al. Thermosoftening treatment of the nasotracheal tube before intubation can reduce epistaxis and nasal damage. Anesth Analg. 2000; 91(3): 698–701.
Mahajan R, Gupta R, Sharma A. Nasotracheal Intubation in Children. Anesthesiology. 2007; 107(5): 855–856.
Costa LR, Costa PS, Brasileiro SV, Bendo CB, Viegas CM, Paiva SM. Post-Discharge Adverse Events following Pediatric Sedation with High Doses of Oral Medication. J Pediatr. 2012; 160(5): 807–813.
Cravero JP, Blike GT, Beach M, Bendo CB, Viegas CM, Paiva SM, PhD5 et al. Incidence and Nature of Adverse Events During Pediatric Sedation/Anesthesia for Procedures Outside the Operating Room: Report From the Pediatric Sedation Research Consortium. Pediatrics. 2006; 118(3): 1087–1096.
Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH. The incidence and nature of adverse events during pediatric sedation/ anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg. 2009; 108(3): 795–804.
Todd DW. A comparison of endotracheal intubation and use of the laryngeal mask airway for ambulatory oral surgery patients. The Lancet. 2002; 60(1): 2–4.