From the Guidelines
Dental procedures under general anesthesia are considered moderate risk due to the potential for complications associated with general anesthesia. The risk level is elevated due to several factors including the complete loss of consciousness, need for airway management, potential for cardiovascular depression, and possible respiratory complications, as noted in studies discussing the risks of general anesthesia 1. Patients undergoing general anesthesia for dental procedures require careful pre-operative assessment, including evaluation of medical history, current medications, and any existing conditions that might increase anesthetic risk. The American Society of Anesthesiologists (ASA) physical status classification system is often used to stratify risk, with most healthy patients being ASA I or II. However, the use of general anesthesia automatically increases the procedural risk regardless of the patient's baseline health status. Factors that further modify risk include the patient's age, presence of systemic diseases (particularly cardiac or respiratory conditions), obesity, sleep apnea, and the complexity and duration of the planned dental procedure. According to the 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery, procedures with higher bleeding risks, such as those involving general anesthesia, should be managed with careful consideration of the patient's anticoagulation status and the potential need for reversal agents 1. While general anesthesia provides optimal conditions for complex dental procedures and is beneficial for anxious patients or those with special needs, the moderate risk classification acknowledges that appropriate monitoring, equipment, trained personnel, and emergency protocols must be in place. Key considerations for managing patients undergoing dental procedures under general anesthesia include:
- Careful pre-operative assessment and risk stratification
- Appropriate management of anticoagulation and potential reversal agents
- Monitoring for cardiovascular and respiratory complications
- Availability of emergency protocols and trained personnel.
From the Research
Dental Procedure Under General Anesthesia
- The use of general anesthesia for dental procedures is a common practice, especially for patients with anxiety or special needs 2.
- General anesthesia is considered a safe environment for patients when administered correctly, with meticulous care to balance the patient's depth of sedation and level of responsiveness while maintaining airway integrity, ventilation, and cardiovascular hemodynamics 3.
Risk Factors
- Airway compromise is a significant contributing factor to anesthetic complications, and human error is a highly contributing factor to anesthetic mishaps 3.
- The risk of repeated dental treatment under general anesthesia is affected by factors such as nutrition, with patients who are tube-fed or receive pureed/liquid food being at higher risk 4.
Safety and Management
- Deep sedation and general anesthesia can be safely administered in the dental office with appropriate patient selection, selection of anesthetic agents, utilization of monitoring, and a highly trained anesthetic team 3.
- Optimization of patient care requires emergency management preparation, including decision-making, leadership, communication, and task management 3.