1. Survey of Dental Out-Patient Anaesthesia in Scotland 2013 Neal Willis ST 7 Anaesthesia NHS Tayside

2. Background Previous survey in 2007 New guidance published in August 2011 http://www.apagbi.org.uk/publications/guidelines-other-organisations-0

6. Results SPAN mailing list 36 responses 16 locations countrywide

8. Results SPAN mailing list 36 responses 16 locations countrywide 100% perform DOPA 83% aware of the APA sponsored document

9. And so the Results…

11. Recommendation 5 Unless there is an urgent clinical need for treatment, assessment should ideally be undertaken at a separate appointment.

12. Recommendation 9 Children…should be managed in a child- centred, family-friendly hospital setting. This should provide the space, facilities, equipment and appropriately trained personnel required to enable resuscitation and critical care to be…undertaken.

13. Recommendation 10 Children…should receive the same standard of care as children admitted for any other procedure under general anaesthesia, including access to registered children's nurses and/or play specialists. 69% 78%

14. Recommendation 13 Children undergoing general anaesthesia for dental extractions shouldbemanaged by staff who have received appropriate training, and who are competentin paediatric anaesthesia and paediatric resuscitation.

15. Recommendation 14 Whenever general anaesthesia is to be administered to a child, clinical observation should be supplemented by minimum standards of monitoring.

16. Intra-operative Monitoring

17. Recommendation 15 Topical local anaesthetic cream should be applied preoperatively to potential sites for venepuncture, where appropriate.

18. Recommendation 15 Topical local anaesthetic cream should be applied preoperatively to potential sites for venepuncture, where appropriate. 89% 11%

19. Recommendation 18 NSAIDs and/or paracetamol should be used to provide analgesia. Opioids are not routinely required for uncomplicated extractions.

20. Non-Opioid Analgesia

21. Opioid Analgesia 2 / 3 use opioids at least ‘sometimes’ Fentanyl Dihydrocodeine Codeine: IM and oral Alfentanil: IV and as part of TIVA Tramadol: IV and oral

22. Recommendation 20 The standards of recovery and discharge following general anaesthesia for dental extractions in children should be the same as following general anaesthesia for any other procedure.

23. Recovery Monitoring

24. Recommendation 23 Discharge of the patient should be based on specified criteria, irrespective of the time taken to achieve these.

25. Time to Discharge

26. A Final Thought

27. Questions?