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Child's General Anaesthetic:Child Protection - Parents 27/10/2008 12:44 Page 16
for dental treatment
Child's General Anaesthetic:Child Protection - Parents 27/10/2008 12:44 Page 1
• Information about general anaesthesia. 3
• Advice before attending for the general 5
• What happens during the general 9
a) When you arrive, 9
b) In theatre, 10
c) Recovery. 12
• What to expect after the general 13 anaesthetic appointment.
2 Child's General Anaesthetic:Child Protection - Parents 27/10/2008 12:44 Page 2 Your child’s general anaesthetic for dental treatment A dentist in the hospital outpatients’ department has now assessed your child. You (the person with parental responsibility) and the dentist have come to the decision that the child should have dental extractions carried out using general anaesthesia (your child will be asleep during the procedure and unaware of what is happening).
This will take place in the Day Procedure Unit (to the left of the main hospital entrance).
This booklet will explain about your visit to this unit, and inform you about what will happen before, during and after your appointment.
It is vitally important that you read this booklet before attending for your next appointment.
Information about general anaesthesia What is a general anaesthetic?
A general anaesthetic ensures that your child is fully asleep and free of pain during a test or operation. It consists of a combination of drugs given either as gas to breathe, or as an injection.
General anaesthetics are only given by anaesthetists.
Who are anaesthetists?
Anaesthetists are specialist doctors who look after children before, during and after surgery. Their 3 Child's General Anaesthetic:Child Protection - Parents 27/10/2008 12:44 Page 3 role is to ensure that children are asleep and safe throughout surgery and wake up comfortably at the end.
How safe is general anaesthesia, and are there any after effects?
Modern anaesthesia is very safe and complications are rare. The anaesthetist is an experienced doctor who is trained to deal with any complications. Risks 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.
Most children recover quickly and are soon back to normal after an anaesthetic, but a few may suffer some after effects. These can include headache, sore throat and dizziness. Some children may feel sick and/or vomit. This usually lasts for a short time and there are medicines available to treat this, if necessary.
Other complications may occur depending on your child’s medical condition, the type of surgery and anaesthetic used. If there are risk factors specific to your child, these will be discussed with you beforehand.
Why should my child not eat or drink before having a general anaesthetic?
It is important that your child's stomach is as empty as possible as this reduces the risk of vomiting during and after the operation.
No food or milk should be taken for six hours before surgery but water can be given up to two hours before surgery. This means that the patient attends for the appointment fasting.
To ensure that your child is fasted, please keep him/her off school on the day of admission.
For your child’s own safety, if your child has not fasted as advised, the procedure may need to be postponed.
Medication Normally, regular medication should be taken as usual before a general anaesthetic. The dentist may have given specific instructions regarding this at the assessment appointment. If you are still unsure about when to take your medication, please contact the assessment clinic in outpatients’ for advice.
If medication has been prescribed between the assessment and treatment appointments, please inform the dentist at the outpatients’ clinic (by phoning 028 7034 6297). If you cannot inform the dentist in advance, then please make sure that he/she is informed on the day of the procedure and before the general anaesthetic is administered.
Please bring inhalers, if used, to the hospital.
Pain relief To help reduce pain after dental extractions, it is advised that you give your child some paracetamol/Calpol before attending the Day Procedure Unit.
Your child should take the correct dose (corresponding to the age of the patient) as detailed opposite, at NOON on the day of their appointment.
A small glass of water can be taken with this. Do not give your child anything to eat with this.
Illness If the patient is sick (e.g. heavy cold, vomiting, temperature) in the days before the anaesthetic appointment, or if you are unable to attend, please telephone The Day Procedure Unit (028 7034 6102) to cancel the appointment, and arrange an alternative appointment.
Accompanying the patient A parent or person with parental responsibility MUST accompany their child to the general anaesthetic appointment. Adult patients must attend with another adult who can stay with them for 24 hours after treatment.
For your own comfort and safety, please do not bring other children with you to the DPU
- only bring the child who is attending for treatment.
Hygiene Make sure your child has a bath or shower in the morning before coming into hospital.
Attire Please dress your child in loose fitting clothing, (e.g. a track-suit) so that they are comfortable while in theatre and recovery beds. Pyjamas are not necessary.
Make-up Please ensure that all patients have make-up and nail varnish removed before coming into hospital.
Books/toys To help pass the time while your child is in the Day Procedure Unit, you might want to bring a favourite toy/game/book for your child to use.
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. It may be enough to explain that some of their teeth are poorly and need to be removed before they cause pain. You can explain that the doctor will give them some medicine which will make them go to sleep while their teeth are removed. Afterwards they will wake up.
Older children may want to know more. Do encourage your child to talk about the operation. Books, games and stories can help.
The Day Procedure Appointment
Please report to the reception, which is inside the Day Procedure Unit entrance. You will be greeted by a member of the reception staff, who will then inform the nursing and dental staff of your arrival.
An admitting nurse will come to reception and take you and your child to the appropriate area for a pre-operative check. The nurse will complete an assessment form, and ensure that the child is fit and well, and fasted. It is important that you inform the staff if you suspect or know that anything has been eaten after fasting has begun.
The treating dentist will re-examine your child’s teeth, to ensure that the treatment has not changed in the time since the assessment appointment, and will complete the day procedure consent form with you.
Why may I need to see an anaesthetist before the anaesthetic?
An anaesthetist may see you in the Day Procedure Unit to assess your child's general health and to discuss the anaesthetic.
The anaesthetist will ask you if your child has had an anaesthetic previously and whether he or she has any allergies, and will also discuss options for anaesthesia and pain relief medication.
You and the patient will then be taken to the waiting area where you will wait until the Theatre Nurse comes to take your child along to theatre.
One adult may accompany the child to theatre.
How will my child be given the general anaesthetic?
Your child will either have an anaesthetic gas to breathe, or an injection.
If your child is having anaesthetic gas, this takes a minute or two to work. The anaesthetist generally cups a hand over your child's mouth and nose, or uses a face-mask to give the anaesthetic gas. If your child is a toddler, it may be possible to give the anaesthetic while your child is sitting on your lap.
If your child is having an anaesthetic by injection, 'magic cream' is put on the hand about an hour before surgery by the admitting nurse. This numbs the skin so that a small plastic tube (cannula) and needle can be put into the vein.
The anaesthetic is injected through this cannula.
Will I be able to stay with my child while he/she goes to sleep?
If accompanying your child, you will be asked to stay with them while they are going to sleep in
theatre. Your child may wriggle a bit at this stage
- this is normal and can be eased by reassuring your child and holding their hand.
Once your child is fully asleep, you will be asked to return to the waiting area until their treatment is complete. Adult patients may request that another adult may accompany them into the theatre. This is perfectly acceptable.
What happens next?
Your child will now be “asleep” in the operating theatre. The anaesthetist will closely monitor your child's blood pressure, pulse, and breathing throughout the operation, ensuring that he or she is safe and fully asleep. The teeth will be extracted, and the patient will remain asleep until this is completed, and the tooth sockets have stopped bleeding.
Will my child be in pain?
While your child is asleep, pain relief is given to help make him or her as comfortable as possible after surgery. The type and strength of pain relief given depends on the procedure or operation and this will be discussed with you beforehand.
What type of pain relief medicines are available and do they have any side effects?
All drugs and treatments have potential complications but these methods are remarkably safe and are often used after children's surgery.
Suppositories: Some pain killers like paracetamol can be given rectally (into the bottom). These are given while your child is still
asleep and last several hours. Suppositories are also very good for pain relief when children cannot take drugs by mouth or are feeling sick.
Local anaesthesia: This is given by injection into the area around the wound to numb the site of the operation. It is given while your child is asleep and the effect usually lasts for a few hours.
When the operation is finished, your child will be transferred to the recovery room.
What is the recovery room?
This is a large room in the Day Procedure Unit where your child wakes up from the anaesthetic.
It is a child friendly environment equipped with a variety of toys.
A recovery nurse closely looks after each child in the recovery unit until he or she is awake and comfortable. You will be called, when appropriate, to sit with your child until he or she is recovered and ready to go home.
Your child will be moved into the second area of the recovery room when fully awake. Here the child will receive a drink and some toast or cereal when he/she feels ready for this.
Dental nurses will assist at this point, ensuring that the tooth sockets do not bleed excessively, and that your child is recovering adequately. The dentist and anaesthetist may also check the patient again at this stage.
You will be given verbal and written advice about care of the mouth over the next few days.
Your child’s suitability for discharge will be assessed, to ensure that it is safe for the child to leave the Day Procedure Unit - which is usually about an hour after waking up from the anaesthetic.
Travelling home A parent or a person with parental responsibility must accompany their child home after being discharged. You must not return home on public transport after having a general anaesthetic. Try to arrange an alternative (e.g. taxis, lift with friend/relative).
After the general anaesthetic treatment appointment It is normal for your child to feel a little disorientated after having a general anaesthetic.
The child may even experience some brief loss of memory of events surrounding the treatment.
The child should return home after treatment and rest for the remainder of the day. Do not return to work/school or partake in sports on the day of the procedure.
Parents should continue to supervise their child’s activities for 24 hours after their treatment, if the child is not recovered sufficiently to attend school the following day.
You will have been given written advice on caring for the mouth after an extraction.
The advice in this should be carefully followed.
Pain relief After the teeth have been removed, paracetamol can be given (only if required), every six hours to a maximum of 4 doses in 24 hours. Please wait until 6.00p.m. on the day of the general anaesthetic before giving the first post-operative dose. Occasionally, some children will be given additional pain relief at the recovery room stage.
In this instance, guidance will be given from staff as to when the next dose of paracetamol can be given.
doctor, dentist, or the relief-of-pain clinic (Telephone 0870 2411 437).
Rest and diet Your child should rest, avoiding exercise, only taking light meals for at least 24 hours.
Sickness If your child vomits, give them fluids only, and if vomiting continues, contact your own family doctor or doctor on call.
Review arrangements Any appointments necessary for wound management e.g. removal of stitches etc. will be explained before you leave the Day Procedure Unit.