Preoperative screening of the pediatric patient will be simpler as most will have an uncomplicated medical history. Laboratory testing is rarely indicated in these patients. Of special interest is a medical history of asthma or recent upper respiratory infection, as both these conditions may predispose toward respiratory complications during anesthesia. Upper respiratory tract infections are notoriously common in school‐age and younger children, and adverse airway effects have been noted by some to persist for several weeks after the resolution of acute symptoms [20]. Parents should be asked about any cough, sore throat, or “runny nose,” and the procedure should be rescheduled if there is any doubt about the child's condition.
Management of anesthetic complications in children is similar to that of adults with a few differences. The pediatric advanced life support protocol (PALS) mirrors the ACLS protocol for adults, except that PALS guidelines recommend beginning chest compressions for children with significant bradycardia (<60 bpm) and signs of hypoperfusion. Oxygen face masks (bag masks), ETs, laryngoscopes, oral and nasal airways, and LMAs of appropriate size should be available for use with pediatric patients. A frightened child may become increasingly uncooperative and inadvertently injure themselves at various stages during ambulatory anesthesia. Additional staff members may be required to be present during ambulatory anesthetic procedures to calm and distract the child at the start of the procedure and assist during recovery.
Postoperative monitoring of the pediatric patient is similar to that of adults. Children benefit from a prompt reunion with a parent or caregiver and effort should be made to have parents present in the postoperative recovery area as soon after the procedure as possible. Having a parent or family member present can help to calm an anxious child and may aid in the management of any postoperative drug‐induced agitation.
In conclusion, anesthesia in outpatient settings for OMS procedures has a documented track record of safety, and recent advances in the field have increased its efficacy and reliability. Complications, though infrequent, do occur during ambulatory anesthesia, but with adequate knowledge and preparation many serious adverse events can be prevented or managed effectively.
CONCLUSIONS
In general, the oral and maxillofacial surgeon is capable of providing safe and efficient outpatient anesthesia delivery, but some complications still may occur. However, with proper patient assessment and anesthetic planning, regional anatomical knowledge, and experience, these complications can best be prevented, or minimized and managed effectively, if they do occur.
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2 Third Molar Surgery
Thomas Schlieve, DDS, MD, FACS
Raza A. Hussain, BDS, DMD, FACS
Michael Miloro,