General Anesthesia

General Anesthesia
Pediatric Maxillofacial
Surgery
Dr.Emir Bayandurov
8th Semester
Koorosh Arshi
Ahmad alhabeshneh
Indications
● Children who have physical, mental & medical disability.
● Extremely uncooperative, fearful, anxious, or uncommunicative
child(e.g. needle phobia)
● Local anesthesia is ineffective sometimes because of acute infection,
anatomic variations, or allergy.
● Multiple carious and abscessed teeth in multiple quadrants in very
young children.
● Severe facial cellulitis
● Extensive orofacial or dental trauma
● Extensive procedures such as face and jaw reconstruction and TMJ
surgery.
Contraindications
● Abnormal airway
● Active respiratory tract infection
● Chronic obstructive pulmonary disease (e.g. Asthma; poorly controlled)
● Apnea
● Known allergy & Hypersensitivity
● Respiratory failure
● Cardiac failure
● Neuromuscular disease (e.g. epilepsy)
● Hematologic disorders (e.g., Hemophilia)
Anesthetic preparation of child
 Preoperative anesthetic assessment:
● medical history;
Syndromes, Cardiac disease, Respiratory disease, Neurological disease,
Endocrine and metabolic disorders, Gastrointestinal problems, Hematological,
Neuromuscular disorders.
● Allergies (latex allergy)
● Medications
 Fasting:
6 hours from solids and milk
4 hours from breast milk
2 hours from clear fluids
 Premedication:
Some children may require oral medicine such as paracetamol or midazolam.
Phases of General Anesthesia
● Pre-anesthetic Phase: is to ensure that the patient arrives in the operating room in
a relaxed manner, without compromised breathing or impaired cardiovascular
status. (e.g., sedatives, analgesics)
● Induction Phase: General anesthesia can be induced with either inhalation or
intravenous (IV) medications. Mostly the volatile anesthetic agents are preferred in
children, Inhalation induction begins with the patient inhaling, through a face mask,
which is usually mixed with nitrous oxide.
● Maintenance Phase: child should be asleep, unaware of pain, and homeostatically
supported. Anesthesia is usually maintained with nitrous oxide, an inhalational
anesthetic, and a narcotic for intraoperative analgesia (benzodiazepine).
● Reversal Phase: The volatile inhalation agents rapidly leave the lungs during
ventilation and thus do not require other products to reverse their actions.
Types of anesthetic agents
1) Intravenous (IV) anesthetics

2) Inhalational anesthetics
3) Synthetic opioids
4) Neuromuscular blocking drugs
IV Anesthetic Agents
● Anesthesia can be induced and maintained with boluses or continuous
infusions.
● Barbiturates are commonly administered to pediatric patients for premedication
and induction of anesthesia. Thiopental, the most commonly used barbiturate.
 Advantages:
● IV anesthetic agents induce anesthesia more rapidly than inhaled products
and with fewer complications.
 Disadvantages:
● It is important to note that the barbiturates do not provide analgesia.
● depresses respirations, induces apnea, and can cause hypotension in the
hypovolemic patient.
● IV line must be placed.
Opioids
● Opioids are widely used in the practice of pediatric anesthesia and pediatric
perioperative medicine.
● Morphine and fentanyl are the most commonly used opioids in pediatric
anesthesia.
● Fentanyl has a shorter duration of activity and a more stable hemodynamic
profile than morphine.
 Advantages:
● They provide analgesia for painful procedures and decrease the incidence of
postprocedural pain.
 Disadvantages:
● They induce apnea, and respiratory depressants, their use must be monitored
closely.
● Because morphine can cause bronchospasm, it should be used cautiously in
children who suffer from asthma.
Neuromuscular Blocking Agents
● The neuromuscular blocking agents are used primarily as an adjunct to general

anesthesia to facilitate endotracheal intubation and to maintain muscle relaxation
during surgery.
● It is important to note that neuromuscular blocking agents have no known effect on
consciousness or pain threshold.
● side effects, including bradycardia, bronchoconstriction, and salivation.
Volatile Inhalation Agents
● Commonly used inhalation anesthetics in children include Nitrous oxide

(NO), Isoflurane, Desflurane, and Sevoflurane.
 Advantages:
● Rapid onset, rapid offset, and convenient route of delivery.
● Volatile anesthetics provide analgesia.
 Disadvantages:
● All of these products (in varying degrees) are airway irritants and can cause
laryngospasm, breath holding, coughing, and salivation in children.
● All of the volatile inhalation agents depress ventilation and dilate constricted
bronchial musculature.
● These anesthetics are not routinely used in children younger than 6 months.
Techniques of inhalation anesthesia
● Techniques of inhalation anesthesia vary with the type of equipment used , they
range from open or nonbreathing systems & semi open systems, semi closed
systems, closed systems.
● An oral laryngeal mask airway or endotracheal tube may or may not give the
dentist the access they require, as it interfere with the work area, this is a useful
technique for less extensive dental work, such as extractions of primary teeth after
trauma.
● Nasotracheal intubation with a nasal RAE (Ring, Adair & Elwyn) tube provides
good access for the dentist and a secure airway for the anesthetist. A throat pack is
usually used and it is extremely important to ensure the removal of a throat pack at
the end of the case.
● A face-mask-only technique may be used for simple extractions. The mask is
removed for a short time while the extraction is performed.
Face-mask-only Technique Nasotracheal Intubation
Oral laryngeal mask or Endotracheal tube

Complications of GA
● Postoperative Nausea and Vomiting (PONV)

● Confusion or memory loss, dizziness, urinary retention
● Oral trauma: insertion or removal of the endotracheal tube can irritate & cause
nasal bleeding or edema, abrasion; laceration of the tongue, lips, or mucosa,
dental trauma ,sore throat.
● Thermoregulation issues: malignant hyperthermia
● Cardiorespiratory complications: arrhythmias, laryngospasm, tooth avulsion
or aspiration, compromised airway.
● Dislodged or obstructed endotracheal tube
Post anesthesia care
 Monitoring blood pressure, heart rate, respiratory rate, body temperature.

 Prescriptions may be written for :
 pain control agents (e.g., acetaminophen with hydrocodone, ibuprofen
suspension)
 antibiotics (e.g., amoxicillin, clindamycin)
 antiemetics for nausea (e.g., prochlorperazine, ondansetron [Zofran])
The End

General Anesthesia

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General Anesthesia

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General Anesthesia

1) Intravenous (IV) anesthetics

● The neuromuscular blocking agents are used primarily as an adjunct to general

● Commonly used inhalation anesthetics in children include Nitrous oxide

Oral laryngeal mask or Endotracheal tube

● Postoperative Nausea and Vomiting (PONV)

 Monitoring blood pressure, heart rate, respiratory rate, body temperature.

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