Intra-operative Local Anesthesia and Anesthesiologist Intervention During Pediatric Dental Surgery

Objective: To evaluate the use of intra-operative local anesthetic (LA) in pediatric outpatient dental surgery using general anesthesia (GA), vital sign fluctuation (end-tidal CO2, heart rate, and respiratory rate) and subsequent anesthesiologist intervention.

Methods: Twenty-three children with a mean age of 4.1 years (range 2.9 years-6.4 years) were included in this randomized parallel-design pilot study. Following collection of baseline vital signs, patients were either given local anesthesia before dental treatment (rubber dam clamp placement, pulpotomy, cementation of stainless steel crown, and extraction) or not. Vital sign change was noted 30 seconds after each procedure. A mixed model analysis was used with each subject as their own control and Tukey-Kramer pair-wise adjustment was done to examine intra-subject variance. Chi-square and Fisher exact tests were used to evaluate association between anesthesiologist intervention and local anesthesia use.

Results: When intra-operative local anesthesia was not used, a mean increase in heart rate of 25.3 bpm was noted with extractions which was statistically significant from the local anesthesia group (p=0.0279). The change in respiratory rate (p=0.0419) and end-tidal volume (p=0.0045) were also statistically significant with all procedures, although clinical significance was minimal. There was a statistically significant relationship between local anesthetic use and anesthesiologist intervention (p=0.001). Odds ratios revealed an anesthesiologist was 25 times more likely to intervene due to vital sign fluctuation on patients where no local anesthesia was administered.

Conclusion: Patients who were not given intra-operative local anesthesia were more likely to experience vital sign fluctuation that required anesthesiologist intervention.