Introduction
This section will attempt to answer some of the questions that you might have concerning general anesthesia. Of course, I would be happy to answer further questions that you might have regarding anesthesia either by phone or email. Your dentist/surgeon has determined that your child/teenager needs general anesthesia for the dental or surgical procedure scheduled and we will do what we can to make this as comfortable an experience for you as we can.
General anesthesia, in simple terms is a state of unconsciousness where the patient is unaware of the dental surgical procedure that they are undergoing. The unconscious state requires close and continuous monitoring of the patient’s blood pressure, heart electrical activity, breathing, oxygen levels and temperature. Dentist anesthesiologists are trained to vigilantly monitor these parameters as well as to administer medications which keep patients at a safe level of anesthesia. In the very unlikely event of an emergency, such as cardiac arrest, dentist anesthesiologists are trained and prepared to manage these situations that may arise. General anesthesia is tightly controlled by the California Dental Board and only issues permits to those individuals who meet the qualifications set forth by the Board (E.g., completed residencies). Therefore, general anesthesia is safe as long as the individual providing the anesthesia is knowledgeable, the medical health history is accurate, and preoperative instructions are followed exactly as prescribed.
If general anesthesia is suggested for your child/teenager, you will be asked to fill out a medical history form and read an informed consent document which details the risks, benefits, as well as alternatives to general anesthesia. The medical history form will be sent to Dr Krall who will review the information and determine if your child/teenager is a candidate for office-based general anesthesia. Dr Krall will call you several days before the appointment and review the history with you and answer any questions that you might have concerning the appointment. In some situations where there is uncertainty on the medical diagnosis, Dr Krall may request that your child/teenager be seen by their primary care physician (or other specialist) for consultation before the surgery appointment.
Preoperative Instructions
Adult Escort:
A responsible adult must accompany the patient to the office and remain there during the procedure and escort the patient home after the patient has met discharge criteria. Also, a responsible adult must stay with the child throughout the remainder of the day.
Clothing:
A loose fitting, short sleeved shirt is appropriate for the appointment. If the weather is cold, please dress the patient in layers to keep the extremities warm. Cold extremities result in small veins which make it difficult to start an intravenous line. Please bring an older blanket which will be used to keep your child/teenager warm during the procedure. If appropriate, have your child wear a diaper and bring an extra one. Please remove any cosmetic makeup on the day of surgery, including nail polish as this affects the reliability of certain monitors.
Eating and drinking:
It is extremely important that patients undergoing general anesthesia have an empty stomach on the day of treatment. Vomiting and subsequent aspiration of stomach content during anesthesia may be life threatening. In the case of a child, an adult must supervise the child constantly on the day of the appointment. In most cases, violation of fasting guidelines necessitates rescheduling the dental surgery for another day.
6 years of age OR younger
- Solids- no food up to 6 hours before the appointment
- Liquids- clear liquids (no pulp) such as water, apple juice, and gatorade are allowed up to 2 hours before the appointment
Older than 6 years of age
- Solids- no food up to 8 hours before the appointment
- Liquids- clear liquids (no pulp) such as water, apple juice, and gatorade are allowed up to 2 hours before the appointment
Illness:
If your child/teenager develops a cough, nausea, or fever, please call the office. In most cases we will cancel the appointment and reschedule in 2-4 weeks.
Medications:
If your child/teenager takes any prescribed medication, Dr Krall will discuss with you whether or not this medication should be continued. Most medications should be taken on the day of surgery. Oral medications should be taken with a couple of teaspoons of water. Nebulized or inhaled medications should be taken as directed on the day of surgery without concern.
Pregnancy:
Studies in the past have indicated that approximately 4% of females between the ages of 15 and 19 will become pregnant. Animal studies have shown that general anesthetic medications and radiation (x-rays) exposure during procedures have resulted in brain cell death. Therefore, general anesthesia is to be avoided during pregnancy for elective procedures. Dr Krall requests that you inform him of the potential for pregnancy on the anesthesia medical history form. Dr Krall strongly recommends pregnancy testing before the appointment if there is a risk of pregnancy.
Vaccinations:
If your child has recently had a vaccinations such as MMR or DPT, Dr Krall may advise rescheduling the dental appointment under general anesthesia for a a couple of days or weeks depending on the vaccination. The rationale for this is that the vaccine administered often causes adverse events such as pain, fever and irritability and may be confused as an anesthesia-related complication.
Day of Appointment
On the day of appointment, please arrive 15-30 minutes early. Dr Krall will review the medical history, confirm that fasting guidelines have been adhered to, and review the risks, benefits, and alternatives to general anesthesia. After answering all questions, taking preoperative vitals (including weight), and completing a physical exam (heart, lung, and airway assessment), induction of general anesthesia is initiated.
The induction of anesthesia in younger children is usually accomplished by an intramuscular injection (upper arm or calf) of medication that will result in the rapid onset of unconsciousness. Once the patient is asleep, the child will be taken to the treatment room where monitors will be applied and an intravenous line will be placed. Your child will not feel or remember the placement of the intravenous line. Older children and teenagers usually accept the placement of an intravenous catheter without undue anxiety.
Your child/teenager will be able to go home when all post-operative vitals such as room air oxygen levels and blood pressure have returned to near normal baseline values and the patient is able to follow commands.
Postoperative Instructions
Eating and Drinking
Limit oral intake to liquids for the first few hours. Begin with water and follow with sweet liquids such as sports drinks, clear juice, and soda as tolerated. If teeth were extracted, do not use a straw. Food can be consumed once liquids are tolerated. Suggestions include scrambled eggs, applesauce, yogurt, mashed potatoes, and soups. If your child/teenager is not hungry, do not force him/her to eat, but encourage as much liquid as tolerated.
Activities
Do not allow your child/teenager to swim, bike, skate or play until the following day. Observe them closely throughout the day and place a blanket on the floor for them to sleep and rest.
Pain or Fever
Muscle aches and a sore throat may occur similar to the flu following anesthesia. These symptoms are very common and will usually disappear within 24 to 36 hours. Medications such as Tylenol and Advil are usually very effective and should be taken at the first sign of pain. For children, a fever of up to 101 degrees Fahrenheit may develop for the first l2 hours. Tylenol Elixir every 3 to 4 hours with plenty of liquids will tend to alleviate this condition as well as treat any post-operative discomfort.
Seek Advice
If vomiting occurs and persists beyond 8 hours, if temperature remains elevated beyond 24 hours, or if you have other serious concerns following anesthesia, please contact: Dr. Krall on his cell (909) 835-7940 0r home (909) 824-3464. In the event of a serious medical emergency, please call 911.
Financial Information
Insurance coverage for dental procedures under anesthesia is quite variable. Most dental and medical insurance plans do not cover anesthesia services for dental procedures. However, some medical plans cover dental procedures in certain patient populations (age < 7, special needs etc). Therefore, it is important to check with your insurance representative to see if anesthesia is a covered expense. If dental insurance covers anesthesia services, the cost of the treatment often exceeds the yearly plan maximum and therefore, the patient would be responsible for the balance.
The estimated anesthesia fee is based upon the dentist/surgeon’s estimated procedure time, plus the time for induction and recovery from anesthesia. Depending on how much time the dentist/surgeon actually takes to complete the procedure, the actual charge may be greater than or less than the estimate. Your treating dentist/surgeon will give you his/her best estimate on the time necessary for treatment. If the fee is less than the estimate, you will be promptly refunded the balance. If the treatment time goes over the estimate, the balance will be collected at the end of the procedure.
Because insurance usually does not pay for anesthesia services, Dr Krall does not directly bill medical or dental insurance. Dr Krall will generate a detailed Anesthesia Services Billing Statement at the conclusion of the procedure, if requested. This form has the necessary coding to submit to your insurance for reimbursement and Dr Krall will be happy to help you complete the insurance form if necessary.
Scheduling Information
Dr Krall does not provide dental treatment and therefore coordinates with dental colleagues to provide the dental care. After contacting your dentist/surgeon and scheduling an appointment in their office, the office will contact Dr Krall directly to schedule a date and time that works for all.
Patient Related Forms
Please use the following links to download patient forms.
