In December 2016, the US Food and Drug Administration (FDA) issued a warning regarding general anesthesia or sedation for children under the age of 3. According to the FDA, exposure to sedatives or anesthesia in a young child may affect brain development, especially for prolonged periods of time (more than 3 hours). This warning has a significant impact on pediatric dentistry, as many young children require oral sedation if small amounts of dental work are needed or general anesthesia to complete major dental procedures.
Given the implications of this new FDA warning, a study was published in the current issue of Anesthesia Progress that retrospectively reviewed 1 year of pediatric dental procedures performed under general anesthesia at a private dental practice with anesthesia support from dentist anesthesiologists.
Between January 1 and December 31, 2016, the researchers identified 351 of 3,661 (9.6%) cases in which dental procedures were performed under general anesthesia in their clinic. The children in the identified cases were grouped according to age—46 under 3 years, 216 from 3 to 6 years and 89 from 6 to 13 years—and data pertaining to physical characteristics including height, weight, sex, and body mass index were also considered. The researchers found that the average anesthesia time was 1.77 hours and the average number of teeth worked on was 9 in each of the 3 age groups. The recovery time ranged from 25 to more than 65 minutes, and age was not a factor in recovery time.
The case analysis found an overall complication rate in 4 of 351 (1.1%), in which all complications were easily treatable and not severe. There were two cases of mild post-operative breathing problems, treated immediately and successfully, one case of intraoperative mild asthma treated with a nebulizer and an incident of lowered heart rate in a 12-year-old child with Down syndrome, which normalized quickly and was not unexpected due to the underlying condition. There was no instance of prolonged oxygen desaturation (more than 30 seconds or less than 92%).
In the retrospective review of their cases, the researchers found that 13.1% of patients fell within the FDA warning criteria of being under 3 years of age during general anesthesia. Of these children, none experienced prolonged sedation times (more than 3 hours), nor were any severe complications reported. Overall, all cases in all age groups were treated successfully in one visit, and no additional anesthesia needed to be administered for a return visit. Currently, several other studies are being conducted to evaluate the specifics of the FDA warning regarding general anesthesia and sedation; however, anesthesia during pediatric dental procedures does not appear to fall into the high-risk category for concern.
Full text of the article, “Pediatric Dental Surgery Under General Anesthesia: Uncooperative Children,” Anesthesia Progress, Vol. 65, No. 4, 2018, is now available here: anesthesiaprogress.org.