Journal of The Korean Dental Society of Anesthesiology (대한치과마취과학회지)

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Dental Treatment of a Patient with Alzheimer Disease under Ambulatory General Anesthesia

알츠하이머병 환자의 외래전신마취 하 치과치료

  • Kim, Mi-Seon (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Seo, Kwang-Suk (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Kim, Hyun-Jeong (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Han, Hyo-Jo (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Shin, Teo-Jeon (Department of Pediatric Dentistry, Seoul National University Dental Hospital) ;
  • Chang, Ju-Hea (Clinic for Persons with Disabilities, Seoul National University Dental Hospital)
  • 김미선 (서울대학교 치과병원 치과마취과) ;
  • 서광석 (서울대학교 치과병원 치과마취과) ;
  • 김현정 (서울대학교 치과병원 치과마취과) ;
  • 한효조 (서울대학교 치과병원 치과마취과) ;
  • 신터전 (서울대학교 치과병원 소아치과) ;
  • 장주혜 (서울대학교 치과병원 장애인구강진료실)
  • Received : 2011.12.23
  • Accepted : 2011.12.26
  • Published : 2011.12.31
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Abstract

Background: Elderly patients with progressive dementia including Alzheimer's disease (AD) are more and more often scheduled to undergo general anesthesia for various pathologies including dental problem. But, there is high risk of deterioration of underlying mental diseases and other co-morbidities. So it is important to implement preventive strategies and take adequate measures to minimize negative perioperative events in these patients. Methods: We reviewed the 17 cases of 11 patients with AD who underwent ambulatory general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 68 (57-81) years. All of them were diagnosed with AD and some had hypertsnsion, bronchiectasis, urinary incontinence. For anesthesia induction, 3 cases (1 patient) was needed physical restraint, but others showed good or moderate cooperation. Drugs used for anesthesia induction was thiopental (11 cases), propofol (3 cases) and sevoflurane (3 cases). All patients received nasotracheal intubation without difficulties. Mean total anesthetic time was 3 hour 44 min ${\pm}$ 60 min and staying time at PACU was 83 ${\pm}$ 34 min. All the patients except one who showed hypertension discharged without any complication. There was no death or long term hospitalization because of severe complications. Conclusions: If general anesthesia is needed, pertinent diagnostic tests and workup about other medical problems, and appropriate anesthetic planning are essential for safety.

Keywords

References

  1. 서광석: 장애인의 치과치료 시 외래전신마취와 진정법. 대한장애인치과학회지 2010; 6: 77-83.
  2. 서광석, 신터전, 김현정, 한희정, 한진희, 김혜정 등: 장애인 환자의 치과치료를 위한 전신마취 시 협조도와 마취 유도 방법에 대한 통계적 고찰. 대한치과마취과학회지 2009; 9: 9-16.
  3. 한설희: Mild Cognitive Impairment. Journal of the Korean Dementia Association 2003; 2: 91-5.
  4. Caputo AC: Providing deep sedation and general anesthesia for patients with special needs in the dental office-based setting. Spec Care Dentist 2009; 29: 26- 30. https://doi.org/10.1111/j.1754-4505.2008.00059.x
  5. Cunings JL, Benson FD: Dementia: A clinical approach. Newton, MA. Butterworth-Heinemann. 1992.
  6. Di Nino G, Adversi M, Dekel BG, Fodale V, Rosa G, Melotti RM: Peri-operative risk management in patients with Alzheimer's disease. J Alzheimers Dis 2010; 22 Suppl 3: 121-7. https://doi.org/10.3233/JAD-2010-101299
  7. DJ S: Alzheimer's disease: genes, proteins, and therapy. Physiol Rev 2001; 81: 741-66. https://doi.org/10.1152/physrev.2001.81.2.741
  8. Ellefsen B, Holm-Pedersen P, Morse DE, Schroll M, Andersen BB, Waldemar G: Assessing caries increments in elderly patients with and without dementia: a one-year follow-up study. J Am Dent Assoc 2009; 140: 1392-400. https://doi.org/10.14219/jada.archive.2009.0076
  9. Fernandez CR, Fields A, Richards T, Kaye AD: Anesthetic considerations in patients with Alzheimer's disease. J Clin Anesth 2003; 15: 52-8. https://doi.org/10.1016/S0952-8180(02)00483-X
  10. Fiske J, Frenkel H, Griffiths J, Jones V: Guidelines for the development of local standards of oral health care for people with dementia. Gerodontology 2006; 23 Suppl 1: 5-32.
  11. Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA: Alzheimer disease in the US population: prevalence estimates using the 2000 census. Archives of Neurology 2003; 60: 1119-22. https://doi.org/10.1001/archneur.60.8.1119
  12. Mancini M, Grappasonni I, Scuri S, Amenta F: Oral health in Alzheimer's disease: a review. Curr Alzheimer Res 2010; 7: 368-73. https://doi.org/10.2174/156720510791162359
  13. Matear DW, Clarke D: Considerations for the use of oral sedation in the institutionalized geriatric patient during dental interventions: a review of the literature. Spec Care Dentist 1999; 19: 56-63. https://doi.org/10.1111/j.1754-4505.1999.tb01369.x
  14. Meitzner MC, Skurnowicz JA: Anesthetic considerations for patients with Down syndrome. AANA J 2005; 73: 103-7.
  15. Messieha Z: Risks of general anesthesia for the special needs dental patient. Spec Care Dentist 2009; 29: 21-5; quiz 67-8. https://doi.org/10.1111/j.1754-4505.2008.00058.x
  16. Paxton JW, Briant RH: Alpha 1-acid glycoprotein concentrations and propranolol binding in elderly patients with acute Illness. British Journal Of clinical pharmacology 1984; 18: 806-10. https://doi.org/10.1111/j.1365-2125.1984.tb02548.x
  17. Pirwitz B, Schlender M, Enders A, Knauer O: [Risks and complications anesthesia with intubation during dental treatment]. Rev Stomatol Chir Maxillofac 1998; 98: 387-9.
  18. Rocchi A, Pellegrini S, Siciliano G, Murri L: Causative and susceptibility genes for Alzheimer's disease: a review. Brain research bulletin 2003; 61: 1-24. https://doi.org/10.1016/S0361-9230(03)00067-4
  19. Ship JA, DeCarli C, Friedland RP, Baum BJ: Diminished submandibular salivary flow in dementia of the Alzheimer type. Journal of Gerontology 1990; 45: M61-6. https://doi.org/10.1093/geronj/45.2.M61
  20. Smith FK, Deputy BS, Berry FA: Outpatient anesthesia for children undergoing extensive dental treatment J Dent Chil 1978; 45: 38-41.
  21. Solca M, Salvo I, Russo R, Fiori R, Veschi G: Anaesthesia with desflurane-nitrous oxide in elderly patients. Comparison with isoflurane-nitrous oxide. Minerva anestesiologica 2000; 66: 621-6.
  22. Terry RD, Katzman R, Ed: Altzheimer disease and Congnitive loss. In R. Katzman & J. W. Rowe(Eds), Principles of Geriatric Neurology. Philadelphia. F. A. Davis Co,. 1992, pp 207-265.
  23. Turner LN, Balasubramaniam R, Hersh EV, Stoopler ET: Drug therapy in Alzheimer disease: an update for the oral health care provider. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 2008; 106: 467-76. https://doi.org/10.1016/j.tripleo.2008.06.009
  24. Vanderweyde T, Bednar MM, Forman SA, Wolozin B: Iatrogenic risk factors for Alzheimer's disease: surgery and anesthesia. J Alzheimers Dis 2010; 22 Suppl 3:91-104. https://doi.org/10.3233/JAD-2010-100843
  25. Warren JJ, Chalmers JM, Levy SM, Blanco VL, Ettinger RL: Oral health of persons with and without dementia attending a geriatric clinic. Spec Care Dentist 1997; 17: 47-53. https://doi.org/10.1111/j.1754-4505.1997.tb00866.x
  26. Zec RF, Landreth ES, Vicari SK, Feldman E, Belman J, Andrise A, et al: Alzheimer disease assessment scale: useful for both early detection and staging of dementia of the Alzheimer type. Alzheimer Dis Assoc Disord 1992; 6: 89-102. https://doi.org/10.1097/00002093-199206020-00004
  27. Zuo C, Zuo Z: Spine Surgery under general anesthesia may not increase the risk of Alzheimer's disease. Dement Geriatr Cogn Disord 2010; 29: 233-9. https://doi.org/10.1159/000295114