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Pediatric Patient Selection in Office-Based Anesthesia Practice




Our practice is committed to providing both safe and outstanding anesthesia services to our patients.  One of the earliest and most important steps in the process of scheduling for office-based anesthesia care is a review of an individual patient’s health history to establish eligibility for these services.  With a parent’s permission, we will review the health summary from the referring dentist’s or surgeon’s office and, when appropriate, speak to the treating doctor and the patient’s physician. We routinely contact pediatric specialists of our patients, when indicated, to obtain specific information to establish suitability for anesthesia care in the office setting.

 

In view of the out-patient nature of our services we have defined limitations on the severity of health conditions we can safely accommodate.  We regularly care for children and adults with and without medical conditions, developmental disabilities, or other special needs.  However, some children and adults with specific or advanced medical conditions are best scheduled for treatment in an acute care environment. On an individual patient basis, we are happy to advise our dentist and surgeon colleagues where questions addressing suitability for office procedures arise.

 

Medical conditions which may affect children and limit care in the office environment include obesity, congenital heart conditions, seizures, asthma, and craniofacial abnormalities. Obesity is a major concern for anesthesiologists. Children presenting well beyond the 99% percentile based on height, age and weight are often best treated in the acute care setting.  Children with heart abnormalities who have undergone or require cardiac surgery must be individually evaluated to establish the suitability for an office procedure. Seizure disorders which are well controlled are not a contradiction to office procedures. However, children with poorly controlled seizure histories or who are currently undergoing seizure medication changes are best postponed until better control and a stable medication protocol is in place.

 

Asthma is also a major concern for anesthesia providers.  Well in advance of the scheduled procedure we will complete a detailed patient health review with a parent to better understand the overall level of disease control. Mild or moderate controlled asthma can often be managed with coordination among parents, pediatrician, and us.  However, patients with frequent flair-ups, persistent symptoms, or a recently resolved illness may require their planned procedure postponed or deferral of treatment to an acute care setting.  Finally, craniofacial conditions which involve jaw or facial deformities increase the challenges anesthesiologists experience to ensure satisfactory airways and respiration under anesthesia.  In these circumstances we would request an opportunity to meet with a parent and their child to complete a thorough physical exam, as well as to review photographs from the front and the side, as well as any prior anesthesia records.

 

We welcome the opportunity to discuss our ability to provide office-based anesthesia services for children with both parents and dentists or surgeons. Patient safely is our paramount concern. Using the completed health history, physical exam and other information supplied by other medical providers, Drs. Boorin and Gluckman will be able to confirm suitability for an anesthetic in the dental or surgical office.

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