Introduction
In order to make the treatment as pleasant and painless as possible for the patient, the dentist has various anaesthetic options. They range from local anaesthesia by injection to sedation and narcosis. General anesthesia, where the patient is not aware of the treatment, is used by the dentist very rarely and only in exceptional cases.
General anesthesia at the dentist
Under general anesthesia (also called intubation anesthesia) not only pain perception, but also reflexes, consciousness and the ability to move are switched off. The patient “sleeps” and must be ventilated and closely monitored. Therefore, general anesthesia is used during operations and under the supervision of an anesthesiologist.
A normal dental practice is usually not equipped for this. In almost all cases, dental treatment does not require general anesthesia, especially since ventilation makes access to the mouth difficult. Sedation is more common.
The patient is in a “twilight sleep“, not really awake, but still responsive. Under sedation one can breathe normally and respond to prompts, but does not remember the procedure. Sedation also relieves anxiety.
In order to prevent pain transmission at the same time, analgosedation is used. It can be performed in the dental office and does not require the presence of an anesthetist. The dentist needs further training to be able to offer sedation.
In Germany, sedation with midazolam via an intravenous approach is widespread, while in English-speaking countries, nitrous oxide sedation is popular. General anesthesia for dental procedures is an exception that must be strictly justified. The condition is that treatment under local anesthesia is not possible.
Examples of possible indications are extensive dental restorations in the case of a lack of willingness to cooperate psychological disorders that prevent the patient from cooperating mentally handicapped physical preexisting conditions infants The dentist must decide whether treatment is only possible under general anesthesia or whether sedation is an option, and consult with the patient’s family doctor and anesthesiologist.
- Extensive restoration of dentition in case of lack of willingness to cooperate
- Mental disorders preventing the patient’s cooperation
- Mental disability
- Pre-existing physical illness
- Infants
The anaesthetist is responsible for the implementation and monitoring of general anaesthesia in children during dental procedures (also in outpatient treatment). Children under 12-16 years of age are usually not sedated, but treated under general anesthesia if local anesthesia is not sufficient or if the child is not cooperative.
This may be the case with toddlers or disabled children. General anesthesia, as with adults, should only be used when necessary, as there are risks involved. After waking up from anesthesia, patients often complain about
- Nausea,
- Headaches and
- Confusion.
- Children sometimes suffer from diarrhea after anesthesia.
