Quote:
> Hi Steve,
> Thanks for your reply about the enamel hyperplasia, very helpful. So
> we learned that my son needs a couple crowns and the dentist scheduled
> him for this week.
> The dentist offered to try conscious sedation. No chl{*filter*}hydrate, but
> he wants to use demerol, visatril and nitrous oxide while I hold him
> down.
> My son has had general anesthesia a few times for dental work but he
> has ever had conscious sedation or local anesthesia.
> Keep in mind that my son has multiple con{*filter*} cardiac issues,
> endocrine issues, neurological problems, etc. The dentist is aware of
> these things but I'm a bit nervous honestly. My son is a 1 in a
> 1,000,000 kind of kid.
> I do not know if GA in the hospital is safer than conscious sedation
> at the dentist's office. And for "just two crowns". But my gut
> instinct is that GA is safer, with the proper monitoring and whatnot.
> I'm not sure if the dentist thinks that I'm cost sensitive to GA (I'm
> not. I'd never put money over my son's well being), or if the dentist
> feels confident that they are trained to handle cardiac and
> respiratory problems there. At the same time I hate to subject him to
> GA over and over, what's the safest of the the two?
> Of course you cannot provide advice for us but in general, what would
> you advise someone in a similar situation at your practice? Liability
> aside, strictly for the kid's well being, GA or conscious sedation?
> We appreciate all the guidance you've given us for the past decade.
> We've made it this far!
> Richard
This is very much an individual judgment call--not because general
statements can't be made, but that the general statements are less
important than the particular patient in the particular clinical situation.
As a GENERAL rule, and for the normal healthy patient, and with good
monitoring, either is fine. For the patient with compromised health,
the less the depth of the anesthesia, the less the medication used, the
less the cardiorespiratory depression will occur. In a patient with
cardiorespiratory problems, this means that, ALL OTHER THINGS BEING
EQUAL, conscious sedation in and of itself can more easily be given than
general anesthesia for these patients.
But all things are NOT equal. Each state will differ on the amount of
anesthesiology training a dentist must get in order to provide it in
his/her office. And there should ALWAYS IMO be a trained person in the
room monitoring the sedation, regardless of the setting.
Because the primary determinant in risk is due to your son's medical
condition, I would recommend that you speak to your son's cardiologist.
It is possible that your dentist has already conferred with the
cardiologist, and if they have and the cardiologist gives his/her
consent, I'd tend to go with what the cardiologist says.
Of course, there is a third option that may be available--conscious
sedation instead of GA, in a hospital setting. This is often done on an
outpatient setting.
Some of this decision making process is done by the doctor. When I had
a colonoscopy I had sedation (I though I was asleep; it's possible I was
amnesic) in the doctor's office, with an anesthesiologist there. When I
went for endoscopy last year, this gastroenterologist chose to not do
ANY procedures requiring sedation in his office, so I had it at the
outpatient department of a hospital. Frankly, dealing with the
administrative BS at a hospital was a pain, but there's no doubt the
coverage was better.
One other thing--if you have to "hold him down" for a long procedure,
that would favor general anesthesia--it indicates you anticipate this
will be stressful for your son--and if it's stressful for him, it's
going to be stressful for you. In any case, I'd definitely discuss this
with your son's physician(s).
Hope this helps,
Steve
--
Mark & Steven Bornfeld DDS
http://www.***.com/
Brooklyn, NY
718-258-5001
Question for Steve about sedation