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Anesthesiology/nasal intubation in dentists office


My daughter, who turns 3 next month, is going to need extensive dental work under IV sedation with an anesthesiologist in the dental office. I've spoken to two separate anesthesiologists from different pediatric dental practices and have to make a decision as to who I prefer for my daughters treatment. One uses nasal intubation, and starts the procedure with nitrous and then IV sedation using sevoflourane (sp?), nitrous and propofol. He says that this combination uses less propofol and makes them less groggy and they will have less recovery time. The other anesthesiologist first gives a shot of ketemine followed by the IV sedation using propofol. He doesn't use intubation.

My daughter has a complicated medical history. She is deemed healthy and normal now but she was born with fetal hydrops and she developed hydrocephalous as a result. She also needed a blood transfusion as a result of thrombocytopenia. The hydrocephalous resolved on its own and she has been given a clean bill of health.

I'm not sure if this is relevant to intubation but she gags when she cries and sometimes she wakes up in the night coughing but never during the day. She's also a chronic nose picker. Every once and a while there will be dried blood on her nose from picking but shes never gotten a gushing bloody nose.

I'm just wondering what person would be more appropriate for my daughter given the circumstances. I'm not sure why the first one is intubating. Does that mean my daughter will be in an even deeper state of sedation? And why do some anesthesiologists intubate and others do not? Thank you, very much for taking the time to read this and to hopefully ease an over worried mother's mind! :-)

Ultimately, the decision to intubate a patient is based on many factors, including an examination of the patient and familiarity with the surgeon--in this case dentist--and how he will proceed with his treatment, etc.  I tend to favor the intubation route myself for almost all "extensive" dental cases, but without knowing the details it is hard to state that a Ketamine sedation is not a good choice here.  I'd recommend talking to each anesthesiologist a bit more to get details as to why they've chosen what they have.  Intubating the patient would be considered a general anesthetic.  The use of ketamine without intubating your child would likely be a deep sedation.  Given only what you've told me, and knowing no other details at all, I'd say go with the intubation/general anesthetic.


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JM Starkman, MD


Over twenty-five years of adult and pediatric, inpatient and outpatient clinical anesthesia practice--some private, some group.

American Association of Physicians and Surgeons. My county medical society.

[not a researcher]

American medical school graduate. Board Certified. Fellowship trained Cardiovascular and Pediatric anesthesia subspecialist.

Past/Present Clients
Over 20,000 anesthetics, the majority of which have been personally managed, with less than 5% consisting of supervising nurse anesthetists or in-training resident physicians.

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