The use of inhalation sedation and local anaesthesia instead of general anaesthesia for extractions and minor oral surgery in children: a prospective study

Abstract

Summary. One hundred and thirty‐three children aged 4–17 years were treated to assess the viability of operating a regular inhalation sedation service for extractions and minor oral surgery in children. The study evaluated treatment success, assessed parents' and children's satisfaction, and compared the cost of inhalation sedation with that of existing general anaesthesia services. Eighty‐four per cent of the children had been referred for orthodontic extractions. Treatment was successfully completed for 120 of the patients; 201 permanent and 130 primary teeth were extracted and six minor surgical procedures were performed. Postal questionnaire assessment of the parents' and children's views showed that 97% were satisfied with the treatment provided. Of those parents who had previous experience of general anaesthesia, 79% stated that inhalation sedation was ‘better’ or ‘much better’ than general anaesthesia. It was estimated that the cost of providing treatment under inhalation sedation was considerably less than under general anaesthesia. It was concluded that it is viable to offer a regular inhalation sedation service for orthodontic extractions in children because it is clinically successful, acceptable to children and their parents, and cost‐effective. Résumé. Utilisation de la sédation par inhalation et de l'anesthésie locale au lieu de l'anesthésie générate pour extractions et chirurgie orale mineure: étude prospective Cent trente trois enfants, âgés de 4 â 17 ans, ont été traités, sous sédation par inhalation, pour extractions et chirurgie orale mineure. Cette étude a porté sur l'évaluation du traitement, la satisfaction des parents et des enfants, et a comparé le coût de la sédation par inhalation avec celui de l'anesthésie générale. Quatre‐vingt pour cent des enfants avaient été adressés pour des extractions d'indication orthodontique. Les interventions ont été réalisées chez 120 patients; 201 dents permanentes et 130 dents temporaires sont été extraites et six interventions de chirurgie orale mineure ont été réalisées. Un questionnaire adressé, par la poste, aux parents et à leurs enfants, a montré que 97% d'entre eux étaient satisfaits du traitement reçu. Pour les parents, qui avaient déjà eu une anesthésie générate, 79% d'entre‐eux ont trouvé que la sédation par inhalation était préferable ou de beaucoup préférable à l'anesthésie générale. Les estimations ont montré que le coût de l'intervention sous sédation par inhalation était moindre que celui sous anesthésie générate. La conclusion est qu'il est intéressant d'avoir un service de sédation par inhalation pour les extractions d'indication orthodontique pour les enfants car les résultats cliniques sont bons, les parents et les enfants satisfaits et le coût moindre. Zusammenfassung. Die Anwendung von Lachgas und Lokalanästhesie anstatt einer Vollnarkose für Extraktionen und kleine Chirurgische Eingriffe bei Kindern, eine propektive Studie 133 Kinder in Alter von 4 bis 17 Jahren wurden mit dieser Kombinationsmethode Lachgas und Lokalanästhesie behand...

Utilising a paediatric version of the indicator of sedation need for children’s dental care: a pilot study

“…When that significant association was further explored, it was found that the patients who were younger than 10 years were more likely to require general anaesthesia for their dental treatment. This is in agreement with previous studies which reported that children with mean age ranging from about 3 years to slightly above 7 years were referred to have their dental treatment under general anaesthesia (Shaw et al 1996;Alexopoulos. et al 2007;Wilson et al 2007).…”

“…This was in accordance with the studies by Crawford (1990) and Shaw et al (1996). However, these figures were higher than the work performed by Bryan (2002) where IHS was abandoned in 7.5% of the total study population.…”

“…Many studies have been conducted to assess the need for sedation with such studies utilising either a paper questionnaire posted to dental health care providers/general population or via telephone contact. The results of these studies revealed that clinicians felt that sedation for dental treatment should be available to all children (Crawford 1990;Shaw et al 1996;Hosey 2002). …”

Current sedation practice among general dental practitioners and dental specialists in Jordan: an example of a developing country

“…Further, IHS together with local anesthesia has also been recommended as an alternative to GA in children12,17–19 and in adults undergoing orthodontic extraction and minor oral surgical procedures 20. When comparing previous experiences of dental treatment under GA, the majority of children (80%) preferred IHS18 and showed less postoperative psychological distress when this form of sedation was used 21. The reduction of the number of local anesthetics used, the reduction of the appointment duration for each patient, and the increase in the efficacy of the treatment session were all noted features after using IHS.…”

The effects of a long wait for children's dental general anaesthesia

“…The availability of general anaesthesia (GA) in general dental practice and the Community Dental Service has been greatly reduced following the Department of Health's circular A Conscious Decision 1 . It was envisaged that other methods of pain control and the use of sedation could be employed to avoid the use of GA 2 . There still remain a number of children, however, who are extremely anxious or who need multiple extractions of grossly carious teeth, and GA is still required in the treatment of these individuals 3,4 .…”