PSA vs. General Anaesthesia

At our clinic, we perform the treatments of uncooperative children with nitrous oxide, medazolam, in general anaesthesia or simply with a “kind word”. We do not perform treatments under procedural sedation and analgesia (abbreviated PSA).

Why?

Often, your dentists will refer you or your children to treatments under conscious sedation and analgesia or sometimes you specifically request conscious sedation—anything but general anaesthesia, right?

So, what's the difference?

In PSA, also known as deep sedation in a conscious state, a child's basic awareness is maintained, but only to the extent of maintaining slight motor function and essential life functions. The child needs to be sedated enough not to resist the dental treatment. In other words, the child is deeply asleep, not communicating, not speaking, but still breathing on their own.

The same medications are used as in general anaesthesia, just in lower concentrations. The anaesthesiologist must carefully balance the medication so that the child doesn't wake up or resist the treatment, while still breathing spontaneously. A child's body operates at a different metabolic level than an adult's, making this delicate balancing act incredibly challenging.

On top of that, the anaesthesiologist administers the sedatives intravenously, which means the child needs to have a cannula inserted.

The main difference from general anaesthesia is that intubation is avoided, where the anaesthesiologist would insert a breathing tube into the child’s throat to breathe for them. While spontaneous breathing may seem like a bonus, controlled breathing is much more predictable than the balancing act required in conscious sedation and analgesia. It gives us certainty that the child is breathing properly throughout the procedure.

With conscious sedation, where the child’s breathing is maintained, the airways must remain unobstructed at all times. This poses a significant risk during dental procedures. The child could accidentally inhale something—from our dental tools to the water used to cool the teeth during treatment. Additionally, basic reflexes like coughing are suppressed during conscious sedation, which is a hazardous factor when performing procedures in the mouth.

Our anaesthesiologists use the most advanced equipment, the same as in operating rooms, to ensure precise and controlled general anaesthesia with continuous monitoring of the child. The cost of this equipment is equivalent to several personal vehicles, therefore many anaesthesiologists providing services in dental offices don't have it. Instead, they rely on smaller portable equipment with basic monitoring, moving from office to office.

We aim to provide the most predictable, well-controlled, and well-monitored treatment possible. That's why we don't offer PSA at our clinic.