General anaesthesia for dentistry

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General anaesthesia for dentistry
Anaesthesia &intensive care medicine
Volume 6, Issue 8, 1 August 2005, Pages 263-265
Dental/maxillofacial

Patricia J Flynn a, and Leo Strunin b
a -Patricia J Flynn is Consultant Anaesthetist at St BartholomewÌs and The London NHS Trust. Her interests include dental anaesthesia and sedation, and risk management.
b -Leo Strunin is Emeritus Professor of Anaesthesia at Queen MaryÌs School of Medicine and Dentistry, University of London. He is a past President of the Royal College of Anaesthetists and a past President of the Association of Anaesthetists of Great Britain and Ireland.

Available online 13 November 2006.

Abstract
Although general anaesthesia is used to reduce the pain and anxiety associated with dental treatment, most dental procedures can be managed with good local anaesthesia, with or without conscious sedation. Since the 1960s there has been a progressive fall in the use of general anaesthesia for dentistry and in the mortality associated with it. However, between 1996 and 1999, eight people died as a result of dental anaesthesia, five of them were children. Investigations and inquiries into these deaths were critical of the standard of care provided in areas such as preoperative assessment, perioperative monitoring, resuscitation and transfer to a critical care facility. In response to these concerns, the General Dental Council (GDC), the Royal College of Anaesthetists (RCA) and the Department of Health (DOH) have issued closely linked guidelines for standards of care in dental general anaesthesia. Since 1 January 2002, general anaesthesia for dentistry has been confined to a hospital setting with critical care facilities. This article summarizes the guidelines, with particular reference to the status of the anaesthetist, the indications for general anaesthesia, patient referral and assessment, the definition of a hospital setting, peroperative monitoring and resuscitation, and management of the emergency; it also reviews the technique of dental anaesthesia in current use.

FURTHER READING
Association of Anaesthetists of Great Britain and Ireland. for anaesthetic apparatus. 3, 2004.

Association of Anaesthetists of Great Britain and Ireland. Information and consent for anaesthesia. 1999 (under review).

Association of Anaesthetists of Great Britain and Ireland. Recommendations for standards of monitoring during anaesthesia and recovery. 3, 2000.

Department of Health., General anaesthesia for dental treatment in a hospital setting with critical care facilitieswww.doh.gov.uk/dental/consciousguidance2.htm (2001).

Resuscitation Council (UK)www.resus.org.uk.

Royal College of Anaesthetists. Good practice. A guide for departments of anaesthesia, critical care medicine and pain management. 2002.

Royal College of Anaesthetists. Guidelines for the use of non-steroidal anti-inflammatory drugs in the perioperative period. 1998.

Royal College of Anaesthetists. Standards and guidelines for general anaesthesia for dentistry. 1999.

Royal College of Anaesthetists. Guidelines for the provision of anaesthetic services. 1999.

Royal College of Anaesthetists. Guidelines on the provision of paediatric anaesthetic services. 2001.

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