General Anesthesia Through IV (GAIV)

Most children are not able to easily tolerate having an IV started while they are awake.

After the anesthesiologist reviews your child’s medical history and completes a physical exam to ensure they are excellent candidates for in-office anesthesia care, the anesthesiologist will inject a combination of medicines typically into their shoulder (deltoid muscle, similar to an immunization) to start the anesthesia process. Therefore, your child will be able to fall asleep in your arms.

Once the anesthesiologist deems your child is ready, he/she will safely transport your child to the treatment room where they will immediately begin their monitoring, provide supplemental oxygen, and start the IV.

Most children are groggy after waking up, which may last for a few hours (1-2 hours) after anesthesia.

However, the sedative medications they use are all short-acting and do not return once your child wakes from anesthesia. While it is okay if your child sleeps once they are released to go home, we recommend they do so in a safe and well-monitored environment (like the living room couch as opposed to their bedroom).

Rest assured that we will closely monitor your child to ensure they are awake and stable before releasing them home.

Generally, yes patients are typically able to return to school and/or their normal routine the next day as long as any discomfort from the dental treatment is well controlled.

No, your child will never be left alone throughout their care in our office. The anesthesiologist and another provider (pediatric dentist, dental assistant, nurse) will always be with your child until they are returned to you.

The dentist anesthesiologist carefully monitors your child to ensure the proper depth of anesthesia is delivered, watching out for signs of inadequate or excessive anesthesia and adjusting the delivery of anesthetics as needed to keep your child asleep and comfortable.

Your child will be monitored by several methods including use of a standard anesthesia monitor, continuous observation, and a precordial stethoscope.

The anesthesia monitor assesses your child’s:

• Heart rate
• Breathing rate (respiratory rate)
• Blood pressure
• Oxygen saturation
• Carbon dioxide levels (capnography)
• Temperature.

Along with the patient monitor, the anesthesiologist visually monitors your child’s status throughout their care, looking for movement, breathing, and any other potential issues, as well as using a precordial stethoscope to continuously listen for appropriate breathing sounds as it sits above your child’s sternum.

Every child is different and there are many factors that impact the speed of waking up from sedation or general anesthesia. Because of this variability, your child will remain closely monitored until they are sufficiently awake.

It is very important for your child to have an empty stomach before sedation or general anesthesia to keep any food or liquid from getting into their lungs.

Patients are usually “back to normal” quite quickly due to the sedative medications being so short-acting, typically within a few hours.

Yes, a local anesthetic (numbing the mouth) is important to keep your child comfortable not only while they are under the procedure but also during their recovery period.

Your child may have the tendency to bite or chew their cheeks, or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas.

You can find post op instructions in “About the Procedure”, question 3.

We estimate approximately 3-4 hours total time to incorporate pre-operative time, the length of the dental procedure, and your child’s recovery time.

Yes, you will be able to be with your child as they are recovering from anesthesia (i.e., waking up), stable, and otherwise ready for you.

Yes, we highly recommend there be 2 adults present when you drive home so that one parent can sit next to your child. Your child may want to sleep on the way home and close supervision is recommended for the first few hours following anesthesia since your child may not be steady on their feet and may fall down.

Our office has established emergency protocols in place along with an emergency kit and equipment in addition to all of the emergency equipment brought by the dentist anesthesiologist. In the case of an emergency, our practitioners would activate the emergency protocol appropriate for the specific scenario.

The anesthesiologist and both pediatric dentists in our office are trained in Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Cardiopulmonary Resuscitation (CPR). The anesthesiologist and pediatric dentist would provide care for your child during an emergency until EMS arrives to transport your child to the hospital for additional care and support.

Yes, and while sedation and general anesthesia carry inherent risks, the current pediatric medical and dental literature places the risk of a complication somewhere around 1 in 150,000. As a comparison, this risk rate is better than the risk of getting in a car accident or trauma from a household injury.

Initially, your child will likely be drowsy and will need to be watched very closely. Keep your child away from areas of potential harm.

Grogginess may last for a few hours (1-2 hrs) afterward for your child. It is okay if your child sleeps once they get home. We will monitor your child to determine when they are able to be released home.

It is important for your child to be well hydrated afterward. Encourage drinking at home as this is the very best thing for your child immediately following their care.

Although your child was likely given medications to prevent nausea and vomiting, drinking large quantities quickly or eating too early can increase their risk for nausea and vomiting. First, give your child small sips of clear liquids (water, apple juice, Sprite, etc.) to help prevent this.

Most children are not that hungry for several hours following sedation or general anesthesia. You do not need to force your child to eat if they are not hungry.

Your child's first meal should be something light and easily digestible (mashed potatoes, rice, yogurt, milkshake, etc).

If your child vomits, slowly reintroduce clear liquids before trying more solid food. If your child can’t tolerate/keep down clear liquids- please call the office or contact the dentist anesthesiologist directly.

Because we use local anesthetic to numb your child’s mouth during the dental procedure, your child may have the tendency to bite or chew their lips, cheeks, or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas.

Prior to leaving our office, you will be given a detailed list of "Post-Op Instructions" and your doctor's personal cell phone number along with a separate sheet detailing post-anesthesia instructions and contact information for the dentist anesthesiologist.

Please call our office for any questions or concerns that you might have.

Your child will remain in recovery for ~30-60 minutes or until they are awake, respond appropriately, and are otherwise stable. Responding appropriately means opening their eyes upon command, talking, or crying.

Dr. Kyle Kramer is a licensed, board-certified dentist anesthesiologist who is solely responsible for safely delivering anesthesia to your child and monitoring them throughout the entire procedure.

A dental anesthesiologist is a dentist who specializes in providing sedation and general anesthesia services for dentistry. They must complete a credentialed residency program in dental anesthesiology after dental school and pass all exams.

A dentist anesthesiologist can administer sedation and general anesthesia for dental and oral surgery procedures. They must be actively licensed and have a permit from the Indiana State Dental Board to provide their services in a dental office.

In addition, dentist anesthesiologists have extensive training in treating children as part of their residency requirements and they achieve board certification upon passing the rigorous American Dental Board of Anesthesiology examination process.

This is common among children for many reasons. Some dental procedures require your child to lie completely still, there may be extensive treatment needed, or the noises/sensations of dental treatment are intolerable for some children to cooperate.

The goal is always to provide the safest treatment in a comfortable manner.

The short answer is no. This is a highly manageable amount of work to have done in 1 appointment.

Even under the worst-case scenario where every tooth has to be repaired, the amount of time your child is under anesthesia is typically less than many other medical procedures.

Additionally, since your child is under anesthesia, it is important to minimize the times your child goes under general anesthesia making it far more advantageous to complete all necessary dental work under 1 anesthesia appointment versus several.

Although it’s unlikely your child will receive nitrous oxide, it may be used as part of their anesthesia. However, in that event, the dentist anesthesiologist will discuss this with you.

The anesthesia provider used by our office routinely provides sedation and general anesthesia to children and adults and has done so for 10+ years. Additionally, Dr. Kramer is full-time faculty at Indiana University School of Dentistry where he teaches and directly supervises oral and maxillofacial surgery residents in the safe use of sedation and general anesthesia

Our doctors recommend specific treatment methods for your child based solely on their specific individual needs. We are happy to discuss your child’s treatment recommendations and options with you in detail. In-office general anesthesia may not be for every patient, some may need treatment completed in a hospital setting due to various factors.