Pediatric Oral Surgery and Anesthesia
What the exam tests
Surgical questions test indications, anaesthetic dose calculations and recognition of complications.
Core rules
- Extraction indications: non-restorable caries, advanced pulpal pathology, supernumerary teeth, orthodontic needs, trauma.
- Local anaesthetic maximum doses: lidocaine 2% 4.4 mg/kg (max 300 mg); articaine 4% 7 mg/kg; mepivacaine 3% 6.6 mg/kg; bupivacaine 0.5% 2 mg/kg. One 1.8 mL cartridge of 2% lidocaine contains 36 mg.
- Epinephrine limit about 0.04 mg/kg (0.2 mg in a healthy adult); one 1:100,000 cartridge contains 0.018 mg.
- Sedation fasting: clear fluids 2 hours, breast milk 4 hours, light meal 6 hours; monitor with pulse oximetry and capnography.
- Space infection: incision and drainage, antibiotics, airway assessment; Ludwig angina is an emergency.
- Consent and behaviour management are part of every surgical plan.
Worked example
A 20 kg child needs two extractions. Lidocaine 2% maximum is 4.4 x 20 = 88 mg, or 2.4 cartridges at 36 mg each. Two cartridges deliver 72 mg, which is safe; epinephrine is 2 x 0.018 = 0.036 mg, well below the 0.8 mg limit (0.04 mg/kg).
Traps
Using adult cartridge counts; ignoring methemoglobinemia risk with prilocaine; giving aspirin to a bleeding child; forgetting tetanus status.