Pediatric Dental Restoration Under GA

Patient phenotype

Children unable to tolerate awake dental work — young (< 5), severe caries (early childhood caries), special needs (autism, behavioral). Often have dental abscesses.

Procedure

Off-floor (often in dental clinic with anesthesia or hospital OR). Multiple restorations + extractions. ~1-2 hours. Throat pack used to protect airway from blood/debris.

Anesthetic plan

GETA with nasal RAE tube (preferred) or oral RAE. Inhalational induction. Throat pack — REMOVE before extubation. Multimodal pain (acetaminophen + ibuprofen + local).

Setup

·Pediatric circuit, warmed
·Nasal RAE ETT (or oral RAE)
·Throat pack + reminder visible
·Pediatric LMA backup
·Dex + ondansetron for PONV
·Local anesthetic injected by dentist

Biggest concerns by phase

Pre-op

Off-floor anesthesia readiness

If in dental office: confirm O₂, suction, monitors, drugs, defib all available + tested. Limited backup.

Induction

Inhalational induction

Sevoflurane mask. PIV after asleep. Nasal intubation (often with red rubber catheter dilation first if narrow nares).

Intra-op

Throat pack management

Pack placed by dentist or anesthesia. Document placement. Visible reminder + remove before extubation. Aspiration risk if forgotten.

Intra-op

Local anesthetic toxicity

Multiple injections in small child = risk of LAST. Lidocaine max 4.5 mg/kg (7 mg/kg with epi). Bupivacaine 2 mg/kg. Calculate total; communicate with dentist.

Emergence

Bleeding + emergence delirium

Bleeding from extraction sites — suction, gauze, position lateral. Emergence delirium common (pediatric + sevo) — dex 0.5 mcg/kg before emergence helps. Awake extubation after suctioning.

Mock-defense scenarios

Practice answering these out loud. The probes show what an examiner is listening for.

5-yo with severe early childhood caries, autism, uncooperative for outpatient. Multiple restorations + extractions in dental clinic with anesthesia. Plan?

What an examiner probes for

▹Off-floor anesthesia readiness
▹Nasal RAE intubation
▹Throat pack with reminder
▹Local anesthetic dose tracking
▹Emergence delirium prevention

Sources

Coté Peds Anesthesia 6e Ch 30
AAPD Anesthesia Guidelines

Anatomy reference

Sourced reference images. 4 matches for "mouth teeth oral facial".

OpenStax · CC BY 4.0

OpenStax · CC BY 4.0

OpenStax · CC BY 4.0

Wikimedia · Public domain

Browse the full image library →

Education only — anesthetic plans vary by patient, institution, and provider judgment. Use as a starting point, not a substitute for clinical reasoning.