Journal of The Korean Dental Society of Anesthesiology (대한치과마취과학회지)

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지

Dental Treatment of Pediatric Patients with Mouth Opening Limitation under General Anesthesia

개구 장애가 심한 소아환자에서 전신마취 하 치과치료를 위한 기도관리

  • Han, Hyo-Jo (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) ;
  • Shin, Teo-Jeon (Department of Pediatric Dentistry, Seoul National University Dental Hospital) ;
  • Kwoen, Young-Sun (Department of Pediatric Dentistry, Seoul National University Dental Hospital)
  • 한효조 (서울대학교 치과대학 치과마취과) ;
  • 서광석 (서울대학교 치과대학 치과마취과) ;
  • 김현정 (서울대학교 치과대학 치과마취과) ;
  • 신터전 (서울대학교 치과대학 소아치과) ;
  • 권영선 (서울대학교 치과대학 소아치과)
  • Received : 2011.12.20
  • Accepted : 2011.12.23
  • Published : 2011.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

For dental treatment of children with severe dental phobia, sedation or general anesthesia is usually selected for enhancement of cooperation. But in the case of mouth opening limitation due to temporomandibular disorders, general anesthesia administration is a challenge for anesthesiologist. Because airway management failure was concerned, awake fibroscopic intubation is selected first. But, skillful fibroscopic intubation is not easy in case of uncooprative children patients. In this report, we present two cases of pediatric patients with mouth opening limitation. In the first case, the patient was 52 months old and the maximum opening distance was 1.2 cm, and in the second case the patient was 38 months old and the maximum opening distance was 1.5 cm. Both patients showed severe dental phobia. After sevoflurane inhalation without any intravenous drug, we successfully performed intubation using a fibroscope.

Keywords

References

  1. 김현정, 이가영, 염광원: 소아에서 하악골절 전신마취시 굴곡성 내시경과 유도선을 이용한 경비 기관내삽관 -증례 보고-. Korean Journal of Anesthesiology 1999; 36: 162-4. https://doi.org/10.4097/kjae.1999.36.1.162
  2. Al-Samri M, Mitchell I, Drummond DS, Bjornson C: Tracheostomy in children: a population-based experience over 17 years. Pediatr Pulmonol 2010; 45: 487-93.
  3. American Society of Anesthesiologists Task Force on Management of the difficult airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98: 1269-77. https://doi.org/10.1097/00000542-200305000-00032
  4. Doi M, Ikeda K: Airway irritation produced by volatile anaesthetics during brief inhalation: comparison of halothane, enflurane, isoflurane and sevoflurane. Can J Anaesth 1993; 40: 122-6. https://doi.org/10.1007/BF03011308
  5. Epstein RH, Mendel HG, Guarnieri KM, Staudt SR, Lessin JB, Marr AT: Sevoflurane versus halothane for general anesthesia in pediatric patients: a comparative study of vital signs, induction, and emergence. J Clin Anesth 1995; 7: 237-44. https://doi.org/10.1016/0952-8180(95)00007-5
  6. Fenlon S, Pearce A: Sevoflurane induction and difficult airway management. Anaesthesia 1997; 52: 285-6.
  7. Kandasamy R, Sivalingam P: Use of sevoflurane in difficult airways. Acta Anaesthesiol Scand 2000; 44: 627-9. https://doi.org/10.1034/j.1399-6576.2000.00523.x
  8. Kim JS, Park SY, Min SK, Kim JH, Lee SY, Moon BK: Awake nasotracheal intubation using fiberoptic bronchoscope in a pediatric patient with Freeman- Sheldon syndrome. Paediatr Anaesth 2005; 15: 790-2.
  9. Mishra P, Chengode S, Narayanan A, Kausalya R, Kumar S: Utility of LMA for emergency tracheostomy in an infant with pierre Robin syndrome. Paediatr Anaesth 2009; 19: 409-10. https://doi.org/10.1111/j.1460-9592.2009.02952.x
  10. Mostafa SM, Atherton AM: Sevoflurane for difficult tracheal intubation. Br J Anaesth 1997; 79: 392-3. https://doi.org/10.1093/bja/79.3.392
  11. Oberer C, von Ungern-Sternberg BS, Frei FJ, Erb TO: Respiratory reflex responses of the larynx differ between sevoflurane and propofol in pediatric patients. Anesthesiology 2005; 103: 1142-8. https://doi.org/10.1097/00000542-200512000-00007
  12. Ovassapian A, Dykes MH, Yelich SJ: Difficult pediatric intubation--an indication for the fiberoptic bronchoscope. Anesthesiology 1982; 56: 412-3. https://doi.org/10.1097/00000542-198205000-00027
  13. Sarner JB, Levine M, Davis PJ, Lerman J, Cook DR, Motoyama EK: Clinical characteristics of sevoflurane in children. A comparison with halothane. Anesthesiology 1995; 82: 38-46. https://doi.org/10.1097/00000542-199501000-00006
  14. Seavello J, Hammer GB: Tracheal intubation in a child with trismus pseudocamptodactyly (Hecht) syndrome. J Clin Anesth 1999; 11: 254-6. https://doi.org/10.1016/S0952-8180(99)00032-X
  15. Van der Werf TS, Ligtenberg JJ, Van de Loosdrecht AA, Tulleken JE, Eindhoven GB, Zijlstra JG: Stridor and trismus: safe airway by oral awake emergency intubation. Intensive care medicine 2001; 27: 450-1. https://doi.org/10.1007/s001340000833
  16. Walker RW: Management of the difficult airway in children. Journal of the Royal Society of Medicine 2001; 94: 341-4. https://doi.org/10.1177/014107680109400706
  17. Yurino M, Kimura H: A comparison of vital capacity breath and tidal breathing techniques for induction of anaesthesia with high sevoflurane concentrations in nitrous oxide and oxygen. Anaesthesia 1995; 50: 308- 11. https://doi.org/10.1111/j.1365-2044.1995.tb04605.x