IADR Abstract Archives
Prolonged General Anesthesia in a Pediatric Population
Objectives: Prolonged general anesthesia (GA), defined by the Food and Drug Administration (FDA) in 2016 as 3 or more hours of anesthetic exposure, may be a risk factor for cognitive defects, especially among pediatric patients under 3 years of age. The purpose of this study is to determine whether a difference exists in the proportion of pediatric dental cases with GA time 180 minutes pre-FDA to post-FDA warning and to utilize a root cause analysis (RCA) to identify factors that contribute to prolonged GA exposure of children undergoing dental rehabilitation.
Methods: A cross-sectional, retrospective chart review of pediatric dental cases completed between July 2011 and July 2020 was conducted. Variables collected included patient age, medical history, body mass index (BMI), ethnicity, time under anesthesia, intraoperative times, treatment conducted under general anesthesia, and provider level of experience. Characteristics of cases were compared using Student’s t-test or Pearson’s chi-squared test, as appropriate.
Results: We reviewed 114 cases; of these, 25 cases of prolonged general anesthesia were identified. There was no significant difference in the proportion of prolonged GA cases pre- and post-FDA warning (pre-FDA = 22.9%, post-FDA =21.9%). RCA identified potential variables that may contribute to prolonged GA including: (1) complex dental treatment plans, (2) non-dental complications, (3) additional services utilized during dental rehabilitation, and (4) provider level of training. Twelve percent of prolonged cases (n=3) had one of the above contributing factors, 68 % (n=17) experienced two contributing factors, 16% (n=4) experienced three, and 4% (n=1) experienced all four contributing factors.
Conclusions: The proportion of pediatric dental cases with prolonged GA time has not changed with the issuance of the FDA warning. Practitioners utilizing GA to complete dental rehabilitation on patients under 3 years must be cognizant of their case characteristics and procedure times to prevent exposure to prolonged GA.
Methods: A cross-sectional, retrospective chart review of pediatric dental cases completed between July 2011 and July 2020 was conducted. Variables collected included patient age, medical history, body mass index (BMI), ethnicity, time under anesthesia, intraoperative times, treatment conducted under general anesthesia, and provider level of experience. Characteristics of cases were compared using Student’s t-test or Pearson’s chi-squared test, as appropriate.
Results: We reviewed 114 cases; of these, 25 cases of prolonged general anesthesia were identified. There was no significant difference in the proportion of prolonged GA cases pre- and post-FDA warning (pre-FDA = 22.9%, post-FDA =21.9%). RCA identified potential variables that may contribute to prolonged GA including: (1) complex dental treatment plans, (2) non-dental complications, (3) additional services utilized during dental rehabilitation, and (4) provider level of training. Twelve percent of prolonged cases (n=3) had one of the above contributing factors, 68 % (n=17) experienced two contributing factors, 16% (n=4) experienced three, and 4% (n=1) experienced all four contributing factors.
Conclusions: The proportion of pediatric dental cases with prolonged GA time has not changed with the issuance of the FDA warning. Practitioners utilizing GA to complete dental rehabilitation on patients under 3 years must be cognizant of their case characteristics and procedure times to prevent exposure to prolonged GA.