A study into morbidity related to general anaesthesia given to children

Key Points

• Extractions under GA cause distress in children.

• Initial problems include bleeding, vomiting, headaches and pain.

• Longer term, less common effects include nightmares, bad memories and fear of future treatment.

• GA must be reduced in the primary care setting.

Abstract

Objective To describe the morbidity related to general anaesthesia provided in general dental practices for the extraction of teeth in school children.

Design Observational study supported by structured questionnaires and interviews.

Setting Three general dental practices in a Lancashire health district and children's homes.

Subjects 80 children aged 5–15 years undergoing extractions under general anaesthesia.

Main outcome measures Observed demeanour of the children prior to, during and immediately after the surgical procedures. Reported morbidity during the following 24 hours and 1 month later.

Results 92% of the children complained of symptoms associated with the surgery under general anaesthesia. Distress was noted in 16 (20%) patients during the induction of 26 (33%) during recovery. Continued crying was reported for 24 (39%) during the journey home and for 23 (37%) once home had been reached. Other symptoms included nausea, vomiting, sickness and prolonged bleeding. Six reported psychological trauma 1 month after; three had nightmares, two had continuing bad memories and one was depressed for several days.

Conclusion Morbidity following extractions under general anaesthesia in general dental practice is common and has distressing consequences for the young patients and their carers.

Main

An investigation of the effects on children of tooth extraction under general anaesthesia in general dental practice C M Bridgman, D Ashby and P J Holloway Br Dent J 1999; 186: 245–247

Comment

This is a particularly timely paper in the light of the recent recommendations by the General Dental Council restricting the administration of dental general anaesthesia (DGA). It addresses the research recommendations of the 1995 Clinical Standards Advisory Group report on General Anaesthesia for Dentistry.

The assessment of morbidity following DGA usually relates to the more serious complications which may arise during or following anaesthesia. These would include defective venepuncture technique, trauma to the jaw or soft tissues or rare atypical reactions such as hyperpyrexia or hepatotoxicity of Halothane.¹ These are not included within the remit of this study, which focusses on some of the more trivial, but no less distressing sequelae to DGA. Since they are easily observed and recorded, they tend to become an unpleasantly vivid reminder of the experience, well into later life. The subjective, verbatim, comments of the children collected in the second part of the study amply illustrates this.

The great majority of children experienced some degree of morbidity. It is therefore surprising to read that 38% of children had received a previous DGA. Parents may believe that there are no alternative methods of treatment and be insufficiently aware of techniques for home preventive care. It should make us question whether the dental health team place enough emphasis on health promotion and prevention for this at-risk group.

The administration of DGA in North West England increased from 11 per 1,000 to 13 per 1,000 persons between 1993 and 1997.² No doubt this will now decline rapidly as the new GDC recommendations are implemented. However, children in these unfluoridated areas, and particularly those from socially disadvantaged groups, will continue to experience a high caries susceptibility and require extensive treatment.

One of the few benefits of DGA is that it rapidly achieves a state of dental fitness for the child at one visit. If deciduous teeth which were formerly extracted under GA could be restored, it will be important to assess the reaction of both child and parent to a longer course of treatment, possibly involving many visits and a high degree of compliance and child cooperation. Since there was no control group in this study, there will be a need for further studies to measure similar criteria of morbidity following treatment under local anaesthesia, with or without sedation.