A Guide for Parents

1. What is a General Anaesthetic (GA)?
2. When is a general anaesthetic indicated?
3. What can happen if the treatment is not done under GA?
4. How do I prepare for admission?
5. What do I do if my child is not well on the day?
6. What happens on the day of admission?
7. What is Pre-medication (‘pre-med’)?
8. What is local anaesthetic cream used for?
9. What happens when your child is in theatre?  
10. What happens in the recovery room?
11. When do we go back home?
12. What pain relief can we use?
13. Is there a need for follow up?

1. What is a General Anaesthetic (GA)?

General anaesthetic is given to ensure that your child is not conscious and free of pain during an operation or procedure.

2. When is a general anaesthetic indicated?

It is recommended for highly anxious or very young children who are not likely to co-operate while the procedure is performed with local anaesthesia. AGA is also needed during complex dental treatment. Certain pre-existing medical conditions and children with different abilities may also need a GA to facilitate dental treatment.What are the risks from general anaesthesia? Most research places the risk of a serious reaction to GA in the range of 1 in 25,000 to 1 in 200,000, far better than the assumed risk of even driving a car daily. You can rest assured that a GA is given only when it is necessary and when the benefits of the treatment will have been deemed to outweigh the risks.The anaesthetist is a fully qualified medical doctor and specialist, who will administer the anaesthetic and look after your child throughout the whole procedure and while he/she is waking up.

3. What can happen if the treatment is not done under GA?

The indicated treatment would be difficult to perform. This would probably necessitate multiple appointments, cause severe anxiety and sometimes pain. The child might need to be held firmly leading to both emotional and/or physical discomfort while their dental treatment is completed.The risks of avoiding treatment all together include tooth pain, infection, swelling, the spread of new decay, damage to their developing adult teeth and possible life threatening hospitalisation from a dental infection and death.Can | help my child to prepare for the procedure? The best time to give information depends on the age of your child. Pre-school children probably only need to know the day before. However, older children may need more time. Unless your child is very young, you should try to explain:That they are going to hospital to get their teeth healthy again.
That they might be given a balloon having a funny smell to blow and might make feel them feel a bit dizzy.

4. How do I prepare for admission?

The hospital will contact you to confirm the date and time of your pre-op appointment with an educational nurse for assessment and information.It is very important that anaesthesia is administered on an empty stomach. You should stop giving food and drinks to your child as follows:

• Solid food up to 6 hours before
• Breast milk/formula milk up to 4 hours before
• No more than 100 mis water up to 2 hours before

This is extremely important to reduce the danger of vomiting and inhaling stomach contents into the lungs while asleep.If your child is taking regular medication, please give it at the usual time with a small amount of water if necessary, up to half an hour before. Please bring your child’s medication with you.Your child should not wear nail polish, lipstick or jewellery to the hospital. He/she should wear loose and comfortable clothing. It is always a good idea to bring an extra change of clothing for your child. If your child wears diapers or pull-ups make sure they are fresh and that you bring some extra on the day of the procedure.The accompanying parent or guardian should be able to devote their full attention to the child receiving treatment and should not have other children with them if possible.

5. What do I do if my child is not well on the day?

Please phone us at Camilleri Dental Clinic if your child develops a fever, significant cough or cold, or diarrhoea or vomiting within a few days of the operation. It may be best to delay the operation until they are better.

6. What happens on the day of admission?

An anaesthetist will visit you before the procedure to discuss your child’s anaesthesia. This is a good time to talk about any concerns you have about the anaesthetic.The anaesthetist will ask you about your child’s previous experiences with anaesthetics or injections. He/she will talk to you about the way in which anaesthesia will be administered. Sometimes there are medical reasons as to why things must be done in a certain way.

7. What is Pre-medication (‘pre-med’)?

This is the name for medications that are given before a general anaesthetic to help your child to relax and make them sleepy. Pain relief drugs may also be given with the pre-med. Such pre-meds are given usually given as liquid medicines to swallow.

8. What is local anaesthetic cream used for?

Nearly all children will have ‘magic cream’ put on the back of their hands. It takes about 60 minutes to work. This cream reduces the pain of the injection when a cannula is placed in your child’s hand or forearm. This cannula maybe inserted before or after the child is anaesthetised depending on the clinical indication.A cannula is a thin plastic tube that is gently inserted into a vein under the skin, usually on the back of the hand. A needle is used to put the cannula in, but the needle is removed immediately, leaving only the soft, very small plastic “straw” in place. It will be left in place for a few hours so that drugs and fluids can be given, if needed.

9. What happens when your child is in theatre?

A nurse from the ward will accompany you and your child to the operating theatre. Your child will be able to take a toy or comforter with them. Only one parent/guardian will be allowed in the theatre.The anaesthetic may start being administered while your child is lying on a trolley. Smaller children may be anaesthetised while sitting on your lap. Staff would then help you lift him/her on to the trolley.The anaesthetist will use either gas or an injection through a cannula to start the anaesthetic. If a cannula is used, your child will normally sleep very quickly indeed. The anaesthetist will then use a mask to continue administering the anaesthetic.If the initial anaesthetic used is gas, the anaesthetist generally uses a mask, or he/she may use his cupped hand placed gently over your child’s nose and mouth. It normally takes 1-2 minutes for the anaesthetic to take effect. Most prepared children will be very willing to blow the balloon! However, it is normal for the child to become restless at some point while he/she is becoming sleepy. Usually they do not recall much of it. Staff will help you hold your child gently but firmly. When anaesthetised, your child will be floppy and he will be positioned on the operating table.You will then be asked to leave the operating theatre while the anaesthetist is busy looking after your child and all the team is ready to start the procedure.Some parents feel upset and overwhelmed; there is nothing to be ashamed of. We understand. A member of staff will be with you as you leave.

10. What happens in the recovery room?

After the procedure your child will be taken to the recovery room while the anaesthetic wears off. The anaesthetist is close by and can help if needed. Each child is cared for by a specialist nurse who makes sure your child is comfortable. Do not worry, you will be called to be with your child as soon as he/she wakes up.Many children show some signs of confusion and/or agitation when they wake up. This is more likely in younger children. They may cry and roll about or wave their arms and legs. This behaviour may last around 30 minutes. The recovery room nurses are experienced at looking after children at this time. They will advise you on how best to comfort and reassure your child.

11. When do we go back home?

Your child will be given drinks and soft foods a short time after and will be able to go home after your child has drank, eaten and passed urine. Very rarely we may feel it is necessary for your child to stay in hospital overnight. Most children resume their daily activities on the following day. It is important that the child stays safe at home during the first day. You should take care that your child does not fall while going upstairs and from high chairs. They should not go swimming, running around or to parties.The anaesthetic might affect balance and reaction times for several hours. You should also inform the anaesthetist of any other sedative medications that he is on.

12. What pain relief can we use?

Pain relieving drugs are given along with the anaesthetic to ensure that your child wakes up as comfortable as possible. If you agree, the anaesthetist might ask the nurse to administer pain relieving medications as suppositories, while the child is anaesthetised. He/she will let you know about this.The type of pain relief will depend on the procedure being performed. You will be advised as to what pain relief to give your child when you go home, if at all necessary.

13. Is there a need for follow up?

We recommend a review appointment with our children’s dentist Dr Audrey Camilleri in 3 months time at Camilleri Dental Clinic. We would like to thank you for choosing our services and we would like to remind you that we are ready to help you and your child, with any questions that you might have.