Pre-emptive Local Anesthesia and Sevoflurane Consumption in Pediatric Dental Anesthesia

Inclusion Criteria: * Children aged 4 to 12 years * Scheduled for elective day-case dental treatment under general anesthesia * ASA physical status I or II * Planned sevoflurane-based general anesthesia * Planned oral endotracheal intubation * Eligibility for standardized low-flow anesthesia with fresh gas flow of 1 L/min * Eligibility for BIS-guided sevoflurane titration * Written informed consent obtained from a parent or legal guardian Exclusion Criteria: * Age younger than 4 years or older than 12 years * ASA physical status III or higher * Emergency dental procedures * Known allergy or contraindication to sevoflurane * Known allergy or contraindication to amide local anesthetics, articaine, or epinephrine * Known or suspected malignant hyperthermia susceptibility * Significant cardiovascular, respiratory, hepatic, renal, or neurological disease requiring non-standard anesthetic management * Chronic opioid or sedative use * Planned airway management other than oral endotracheal intubation * Dental procedures in which withholding pre-emptive local anesthesia is considered clinically inappropriate for safety or hemostasis * Refusal of participation by parent or legal guardian