Time and Cost Analysis: Pediatric Dental Rehabilitation with General Anesthesia in the Office and the Hospital Settings

Abstract Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board–approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36–60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P < .001). The average total time (anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance.

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Pediatric Dental Surgery Under General Anesthesia: Uncooperative Children

Anesthesia Progress ◽

10.2344/anpr-65-03-04 ◽

2018 ◽

Vol 65 (4) ◽

pp. 225-230 ◽

Cited By ~ 3

Author(s):

Robert L. Campbell ◽

Navin S. Shetty ◽

Kaavya S. Shetty ◽

Herbert L. Pope ◽

Jeffrey R. Campbell

Keyword(s):

General Anesthesia ◽

Recovery Time ◽

Pediatric Patients ◽

Dental Treatment ◽

Age Groups ◽

Pulmonary Complications ◽

Dental Practice ◽

Dental Surgery ◽

Dental Rehabilitation ◽

Sedative Agents

Dental treatment of young pediatric patients can be confounded by lack of cooperation for dental rehabilitation procedures and even examination and/or radiographs. With the recent US Food and Drug Administration warning applied to many anesthetic/sedative agents for children less than 3 years old, a retrospective review of general anesthesia (GA) cases from 1 private pediatric dental practice was studied for age, gender, body mass index, anesthetic duration, airway management used, extent of dental surgical treatment, recovery time, and cardiac/pulmonary complications. For the 2016 calendar year, 351 consecutive GA cases were identified with patients aged 2–13 years. Of these, 336 underwent nasal endotracheal intubation. Forty-six of 351 patients (13%) were younger than 3 years. Median anesthesia duration was approximately 1.7 hours for all age groups. Dental treatment consisting of 8–9 teeth including crowns, fillings, and extractions was most frequently encountered. One hundred sixty-eight patients (48%), however, required care for 10–18 teeth. There were no episodes of significant oxygen desaturation. The overall complication rate was 1.1%, with 2 cases of postextubation croup, 1 case of mild intraoperative bronchospasm, and 1 case of intraoperative bradycardia. Complications did not correlate with children being overweight or obese.

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Is Neuromuscular Blocker Necessary in Pediatric Patients Undergoing Laparoscopic Inguinal Hernia Repair with Percutaneous Internal Ring Suturing?

European Journal of Pediatric Surgery ◽

10.1055/s-0036-1587329 ◽

2016 ◽

Vol 27 (03) ◽

pp. 263-268 ◽

Cited By ~ 1

Author(s):

İlker İnce ◽

Elif Ahiskalioglu ◽

Akgun Oral ◽

Mehmet Aksoy ◽

Murat Yiğiter ◽

...

Keyword(s):

Hernia Repair ◽

General Anesthesia ◽

Muscle Relaxant ◽

Airway Pressure ◽

Recovery Time ◽

Pediatric Patients ◽

Operating Conditions ◽

Peak Airway Pressure ◽

Neuromuscular Blocker ◽

Internal Ring

Purpose The aim of this study is to evaluate operating conditions during general anesthesia with or without neuromuscular blocker (NMB) in patients undergoing percutaneous internal ring suturing (PIRS). Materials and Methods In this study, 40 patients, with American Society of Anesthesiologists I and II between the ages of 1 and 12 years, were randomly assigned to two groups to receive muscle relaxant with endotracheal tube (ETT) (ETT group) or without muscle relaxant with supreme laryngeal mask airway (sLMA) (LMA group). Anesthesia was maintained with sevoflurane in oxygen (Fio 2 0.3–0.5), thiopental sodium, fentanyl, and rocuronium in ETT group. In LMA group, same protocol was used without rocuronium. Heart rate, blood pressure, peak airway pressure, end-tidal carbon dioxide (EtCO2), and Spo 2 were recorded before and during pneumoperitoneum maintained at a pressure of 8 to 10 mm Hg. Duration of surgery, recovery time, anesthetic time, and grade of quality view were also recorded. Airway problems (cough, hoarseness, laryngospasm, and aspiration) were recorded. Results In LMA group, there was a statistically significant reduction in recovery time versus ETT group (11.6 ± 4.08 vs. 17.15 ± 5.32 minutes; p = 0,001). There were no statistically significant differences grade of quality view between the two groups (p = 0.548). There were no statistically significant differences in oxygen saturation (Spo 2), peak airway pressure, and EtCO2 between the two groups before or during insufflation (p > 0.05). Postoperative airway complications were significantly more prevalent in the ETT group. There was no case of inadequate ventilation, regurgitation, or aspiration recorded. Conclusion sLMA is safe and suitable alternative to ETT and NMB is not necessary in general anesthesia with sLMA, pediatric patients undergoing laparoscopic hernia repair with PIRS.

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Comprehensive Dental Care of Pediatric Patients Treated Under General Anesthesia in a Hospital Setting in Saudia Arabia

The Journal of Contemporary Dental Practice ◽

10.5005/jcdp-7-1-79 ◽

2006 ◽

Vol 7 (1) ◽

pp. 79-88 ◽

Cited By ~ 4

Author(s):

Manal Ibrahim Al-Malik ◽

Maha Abdulla Al-Sarheed

Keyword(s):

General Anesthesia ◽

Dental Care ◽

Behavior Management ◽

Pediatric Patients ◽

Dental Treatment ◽

Hospital Setting ◽

Oral Rehabilitation ◽

Main Indication ◽

Restorative Treatment ◽

The Mean

Abstract The aims of this study were to determine the characteristics of patients and type of dental treatment carried out using dental general anesthesia (DGA) during two years in a following three year period. A total of 182 patients received treatment between 1999 and 2001. The mean age was 4.9 years. The main indication for DGA was behavior management problems. Complete oral rehabilitation including complex restorative treatment and extractions was provided under DGA at a single visit. Failure to return for recalls was common; 83% of patients returned for the post-operative recall but only 26% after a three year period. Most of the patients requiring further treatment accepted it in the dental chair. Only one patient received a second DGA during the three years following treatment. Citation Al-Malik MI, Al-Sarheed MA. Comprehensive Dental Care of Pediatric Patients Treated Under General Anesthesia in a Hospital Setting in Saudi Arabia. J Contemp Dent Pract 2006 February;(7)1:079-088.

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Medical Diagnoses of Pediatric Dental Patients Treated under General Anesthesia: A 19 Year Review

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.33.4.0g1011377763254n ◽

2009 ◽

Vol 33 (4) ◽

pp. 343-345 ◽

Cited By ~ 5

Author(s):

Michael Roberts ◽

Michael Milano ◽

Jessica Lee

Keyword(s):

North Carolina ◽

General Anesthesia ◽

Dental Care ◽

Dental Treatment ◽

Steady Increase ◽

Medical Diagnoses ◽

Children's Hospital ◽

Dental Patients ◽

Children’S Hospital ◽

The University

Objective: The objective of this study was to examine the records of pediatric dental patients treated under general anesthesia to determine if there had been any significant change in preoperative diagnoses between 1990-99 and 2000-08. Study Design: The records of 3298 pediatric dental patients treated in the operating room under general anesthesia at the University of North Carolina (UNC) Children's Hospital were examined and medical diagnoses recorded. The number of cases treated by calendar year was obtained. Results:The results of this study did not find any significant differences in percentage frequency of medical diagnoses between the years of 1990-99 and 2000-08. There has been a steady increase in the number of cases treated under general anesthesia over the period of the study. Conclusions: 1. Dental care under general anesthesia remains an important treatment option. 2. The medical diagnoses of children provided dental treatment under general anesthesia has not changed significantly over the past nineteen years at the UNC Children's Hospital. 3. The demand to provide dental care for children under general anesthesia has continued to increase.

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Methemoglobin Levels in Generally Anesthetized Pediatric Dental Patients Receiving Prilocaine Versus Lidocaine

Anesthesia Progress ◽

10.2344/0003-3006-60.3.99 ◽

2013 ◽

Vol 60 (3) ◽

pp. 99-108 ◽

Cited By ~ 9

Author(s):

Lauren L. Gutenberg ◽

Jung-Wei Chen ◽

Larry Trapp

Keyword(s):

General Anesthesia ◽

Local Anesthetic ◽

Dental Treatment ◽

Pearson Correlation ◽

Dental Patients ◽

Time To Peak ◽

Dental Rehabilitation ◽

Group 3 ◽

Group 2 ◽

Group 1

Abstract The purpose of this study was to measure and compare peak methemoglobin levels and times to peak methemoglobin levels following the use of prilocaine and lidocaine in precooperative children undergoing comprehensive dental rehabilitation under general anesthesia. Ninety children, 3–6 years of age, undergoing dental rehabilitation under general anesthesia were enrolled and randomly assigned into 3 equal groups: group 1, 4% prilocaine plain, 5 mg/kg; group 2, 2% lidocaine with 1 : 100,000 epinephrine, 2.5 mg/kg; and group 3, no local anesthetic. Subjects in groups 1 and 2 were administered local anesthetic prior to restorative dental treatment. Methemoglobin levels (SpMET) were measured and recorded throughout the procedure using a Masimo Radical-7 Pulse Co-Oximeter (Masimo Corporation, Irvine, Calif, RDS-1 with SET software with methemoglobin interface). Data were analyzed using chi-square, one-way analysis of variance (ANOVA), and Pearson correlation (significance of P < .05). Group 1 had a significantly higher mean peak SpMET level at 3.55% than groups 2 and 3 at 1.63 and 1.60%, respectively. The mean time to peak SpMET was significantly shorter for group 3 at 29.50 minutes than that of group 1 at 62.73 and group 2 at 57.50 minutes. Prilocaine, at 5 mg/kg in pediatric dental patients, resulted in significantly higher peak SpMET levels than lidocaine and no local anesthetic. In comparison to no local anesthetic, the administration of prilocaine and lidocaine caused peak SpMET levels to occur significantly later in the procedure.

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Incidence of Acute and Chronic Post-Thoracotomy Pain in Pediatric Patients

Children ◽

10.3390/children8080642 ◽

2021 ◽

Vol 8 (8) ◽

pp. 642

Author(s):

Giuliano Marchetti ◽

Alessandro Vittori ◽

Fabio Ferrari ◽

Elisa Francia ◽

Ilaria Mascilini ◽

...

Keyword(s):

General Anesthesia ◽

Pediatric Patients ◽

Pain Syndrome ◽

Intercostal Nerve ◽

Anesthetic Technique ◽

Intercostal Nerve Block ◽

Thoracic Epidural ◽

Burning Pain ◽

Significant Difference ◽

Group B

We studied acute and chronic pain in pediatric patients who underwent thoracotomy for benign disease with a follow-up of at least three months. A telephone interview investigated about the presence of pain and the analgesic therapy in progress. The results were compared with the anesthetic technique, postoperative pain and the adequacy of pain therapy, both during the first week after surgery and at the time of interview. Fifty-six families consented to the study. The mean age of the children at surgery was 2.9 ± 4.5 years, while at the time of the interview was 6.5 ± 4.4 years. We performed different anesthetic strategies: Group A: general anesthesia (36 pts); Group B: general anesthesia and thoracic epidural (10 pts); Group C: general anesthesia and intercostal nerve block (10 pts). During the immediate postoperative period, 21 patients (37.5%) had at least one painful episode. At the time of interview, 3 children (5.3%) had moderate chronic neuropathic (burning) pain on surgical scar. There was no statistically significant difference between the type of anesthesia and the incidence and severity of acute post-operative pain. Despite its limitations, this study confirms the low incidence of chronic post-thoracotomy pain syndrome in children.

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Comparison of laryngeal mask airway, cuffed and uncuffed tracheal tubes in pediatric patients during general anesthesia

Indian Journal of Health Sciences and Care ◽

10.5958/2394-2800.2020.00048.6 ◽

2020 ◽

Vol 7 (3) ◽

pp. 122-129

Author(s):

Suresh Kumar Singhal ◽

Vandna Arora ◽

Shilpa Khanna ◽

Pushpa Yadav

Keyword(s):

Laryngeal Mask Airway ◽

General Anesthesia ◽

Pediatric Patients ◽

Laryngeal Mask

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Trends and Characteristics of Pediatric Dentistry Patients Treated under General Anesthesia

Journal of Clinical Pediatric Dentistry ◽

10.17796/1053-4628-42.4.12 ◽

2018 ◽

Vol 42 (4) ◽

pp. 303-306 ◽

Cited By ~ 4

Author(s):

Maxwell N Rudie ◽

Michael M Milano ◽

Michael W Roberts ◽

Kimon Divaris

Keyword(s):

General Anesthesia ◽

Pediatric Dentistry ◽

Continuing Care ◽

Administrative Claims ◽

Care Needs ◽

Special Health Care ◽

Chapel Hill ◽

Dental Rehabilitation ◽

Tests Of Association ◽

System Information

Purpose: The aims of this study were to describe the demographic characteristics of pediatric dentistry patients undergoing dental rehabilitation under general anesthesia (DRGA) at UNC-Chapel Hill during the last 13 years and identify factors associated with multiple (1 versus 2 or more) DRGA visits during that timeframe. Study design: Administrative claims data were used to identify children and adolescents (age <18 years) who underwent DRGA between 1/1/2002 and 12/31/2014 at the UNC Hospitals system. Information on children's age, sex and all treatment-associated CDT codes were collected. Descriptive statistics and bivariate tests of association were used for data analyses. Results: There were 4,413 DRGAs among 3,973 children (median age=4 years 8 months, males=55%) during the study period. The annual rate of DRGAs increased over time, peaking (n=447) in 2013. Overall, 9% of children had ≥2 visits with repeat rates up to 18%. There was no association between children's sex and receipt of one versus multiple DRGAs; however, craniofacial cases were more likely (p<0.0005) to have multiple DRGAs compared to non-craniofacial ones. Conclusion: DRGAs are on the increase—with the exception of craniofacial and special health care needs patients, multiple DRGAs may be reflective of sub-optimal adherence to preventive and continuing care recommendations.

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