Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of general anesthesia and sedation during dental treatment in patients with special needs: A retrospective study

  • Akpinar, Hatice (Unit of Anesthesiology and Reanimation, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Suleyman Demirel)
  • Received : 2019.04.18
  • Accepted : 2019.08.03
  • Published : 2019.08.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Patients with special health care needs are more likely to develop health problems, including dental problems. Dental treatments require a good level of communication with the patient. Therefore, in these patients, sedation and general anesthesia are an extremely humanistic approach for comfortable and successful treatment. In patients with special needs, there is no standard anesthetic approach due to varying clinical conditions. The aim of this study was to provide literature content about the anesthetic approaches used by us in patients with special needs. Methods: The medical records of 710 patients with special health care needs treated under general anesthesia or sedation were reviewed retrospectively. Demographic data, the American Society of Anesthesiologists classification, Mallampati score, anesthesia duration, anesthesia type, anesthetic and analgesic agents used, dental treatment performed, secondary diseases, and complications in the perioperative period were recorded. Patients were evaluated under five groups: Down syndrome, other syndromes, psychiatric disorders, physical disabilities, and complicated medical story. Results: Among the patients evaluated, 47.5% were females and 52.5% were males (mean age $15.76{\pm}11.17$ years), and general anesthesia and sedation were administered in 72.9% and 22.1% patients, respectively. The mean duration of anesthesia was $43.20{\pm}35.85$ min. Simple dental treatments were performed in all groups, and the most common complications were observed in the other syndromes group. Conclusion: Complications can be reduced by utilizing the appropriate anesthetic approach and taking serious precautions in patients with special needs.

Keywords

References

  1. Wang YC, Lin IH, Huang CH, Fan SZ. Dental anesthesia for patients with special needs. Acta Anaesthesiol Taiwan 2012; 50: 122-5. https://doi.org/10.1016/j.aat.2012.08.009
  2. Lim MAWT, Borromeo GL. The use of general anesthesia to facilitate dental treatment in adult patients with special needs. J Dent Anesth Pain Med 2017; 17: 91-103. https://doi.org/10.17245/jdapm.2017.17.2.91
  3. American Academy of Pediatric Dentistry. Council on Clinical Affairs. Guideline on management of dental patients with special health care needs. Pediatric Dent 2012; 34: 160-5.
  4. Erdem AP, Yaman E, Sepet E, Aytepe Z. Behavior Management and Treatment Considerations For Children With Intellectual Disability. Istanbul Universitesi Dis Hekimligi Fakultesi Dergisi 2012; 46: 66-73.
  5. Pini DM, Frohlich PC, Rigo L. Oral health evaluation in special needs individuals. Einstein (Sao Paulo) 2016; 14: 501-7. https://doi.org/10.1590/s1679-45082016ao3712
  6. Cagiran EY, Efeoglu C, Balcioglu T, Koca H. Mental Retarde Hastalarda Dental Tedavi: Retrospektif Inceleme [Dental Treatment in Patients with Mental Retardation: Retrospective Study]. Turkiye Klinikleri J Med Sci 2011; 31: 830-6. https://doi.org/10.5336/medsci.2010-16906
  7. Ahuja R, Jyoti B, Shewale V, Shetty S, Subudhi SK, Kaur M. Comparative Evaluation of Pediatric Patients with Mental Retardation undergoing Dental Treatment under General Anesthesia: A Retrospective Analysis. J Contemp Dent Pract 2016; 17: 675-8. https://doi.org/10.5005/jp-journals-10024-1911
  8. Alkan M. Our Sedation Experience on Mentally Retarded Patients. J Clin Anal Med 2015; 6: 423-7. https://doi.org/10.4328/JCAM.2111
  9. Tulgar S, Boga I, Can T, Bombaci E, Gezgel I. Mental retarde ve bakim hastalarinda genel anestezi altinda dis cekimi: Tooth extraction under general anesthesia in mentally retarded and homecare patients: A retrospective study included different anethesia tecniques. Maltepe Med J 2015; 7: 1-5.
  10. Machuca MC, Velez A, Machuca G, Tormos HL, Nieves E, Bullon Fernandez P. Dental treatment under general anesthesia offered at the Hospital Pediatrico Universitario de Puerto Rico during the years 1989-1994. P R Health Sci J 1996; 15: 289-95.
  11. Neckel W, Jacobs FE, Tolksdorf W. Oral ketamine as preferred preanesthetic medication of uncooperative patients. Anasthesiol Intensivmed Notfallmed Schmerzther 1992; 27: 381-4 https://doi.org/10.1055/s-2007-1000318
  12. Rothmaier K, Bucher K, Metz I, Pitchika V, Hickel R, Heinrich-Weltzien R, et al. Preventive and invasive treatment in special needs patients: a German retrospective study. Clin Oral Investig 2017; 21: 1343-50. https://doi.org/10.1007/s00784-016-1900-6
  13. Storhaug K. The mentally retarded and the dental health services. Treatment needs and preventive strategies. Nor Tannlaegeforen Tid 1991; 101: 262-5.
  14. Sari ME, Ozmen B, Koyuturk AE, Tokay U. A retrospective comparison of dental treatment under general anesthesia on children with and without mental disabilities. Niger Clin Pract 2014; 17: 361-5. https://doi.org/10.4103/1119-3077.130243
  15. Mallineni SK, Yiu CK. Dental treatment under general anesthesia for special-needs patients: analysis of the literature. J Investig Clin Dent 2016; 7: 325-31. https://doi.org/10.1111/jicd.12174
  16. Schnabl D, Guarda A, Guarda M, von Spreckelsen LMI, Riedmann M, Steiner R, at al. Dental treatment under general anesthesia in adults with special needs at the University Hospital of Dental Prosthetics and Restorative Dentistry of Innsbruck, Austria: a retrospective study of 12 years. Clin Oral Investig 2019; 1-6.
  17. Meitzner MC, Skurnowicz JA. Anesthetic considerations for patients with Down syndrome. AANA J 2005; 73: 103-7.
  18. Melarkode K. Anaesthesia for children with down's syndrome. Anaesthesia tutorial of the week 139 22nd June 2009. ATOTW 139. P1-7 Available from: http://www. frca.co.uk/Documents/138%20Anaesthesia%20for%20ch ildren%20with%20down's%20syndrome.pdf.
  19. Fujii-Abe K, Sasao M, Fukayama H. General anesthesia for a patient with deletion 6q syndrome in addition to laryngomalacia undergoing dental treatment. J Oral Sci 2008; 50: 493-5. https://doi.org/10.2334/josnusd.50.493
  20. Akcil EF, Dilmen OK, Tunali Y. Anaesthetic Management in Costello Syndrome. Turk J Anaesthesiol Reanim 2015; 43: 427-30 https://doi.org/10.5152/tjar.2015.93546
  21. Yeoh TY, Scavonetto F, Hamlin RJ, Burkhart HM, Sprung J, Weingarten TN. Perioperative management of patients with DiGeorge syndrome undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2014; 28: 983-89. https://doi.org/10.1053/j.jvca.2013.10.025
  22. Dinner M, Goldin EZ, Ward R, Levy J. Russell-Silver syndrome: anesthetic implications. Anesth Analg 1994; 78: 1197-9.
  23. Dror Y, Freedman MH. Shwachman-diamond syndrome. Br J Haematol. 2002; 118: 701-13 https://doi.org/10.1046/j.1365-2141.2002.03585.x
  24. Kozanhan B, Saltali AO. Major Ozelligi Yuz - Ekstremite Defektleri Olan Sendromlar ve Anestezi Yontem. [Syndromes with facial-extremity defects as major feature and anesthesia management.] Genel Tip Derg 2016; 26: 28-33.
  25. Kaviani N, Ashrafi S, Jabbarifar SE, Ghaffari E. The Efficacy of Two Intravenous Sedative Drugs in Management of Uncooperative Children for Dental Treatments. J Dent 2015; 16: 29-34.
  26. Ihara Y, Fukuda KI, Saita N, Ichinohe T. Male Gender and High Trait Anxiety Are 2 Major Factors Associated With Severe Dental Fear and Avoidance. Anesth Prog 2018; 65: 177-80 https://doi.org/10.2344/anpr-65-03-08
  27. Craig DC, Boyle CA, Fleming GJ, Palmer P. A sedation technique for implant and periodontal surgery. J Clin Periodontol 2000; 27: 955-9. https://doi.org/10.1034/j.1600-051x.2000.027012955.x
  28. Bowman JP, Nedley MP, Jenkins KA, Fahncke CR. Pilot Study Comparing Nasal vs Oral Intubation for Dental Surgery by Physicians, Nurse Anesthetists, and Trainees. Anesth Prog 2018; 65: 89-93. https://doi.org/10.2344/anpr-65-02-07
  29. Galeotti A, Garret Bernardin A, D'Anto V, Ferrazzano GF, Gentile T, Viarani V, et al. Inhalation conscious sedation with nitrous oxide and oxygen as alternative to general anesthesia in precooperative, fearful, and disabled pediatric dental patients: a large survey on 688 working sessions. Biomed Res Int 2016; 2016: 7289310.
  30. Ozkan AS, Erdogan MA, Sanli M, Kacmaz O, Durmus, M, Colak C. Retrospective evaluation of dental treatment under general anaesthesia. Turk Anaesthesiol Reanim 2015; 43: 332-6. https://doi.org/10.5152/TJAR.2015.82542
  31. Chang J, Kim HY. Prognostic factors of single-visit endodontic and restorative treatment under general anaesthesia for special needs patients J Oral Rehabil 2017; 44: 96-104. https://doi.org/10.1111/joor.12458
  32. Dziedzic A. The role of general anaesthesia in special care & paediatric dentistry; inclusion criteria and clinical indications. SAAD Dig 2017; 33: 48-54.
  33. Norderyd J, Klingberg G, Faulks D, Granlund M. Specialised dental care for children with complex disabilities focusing on child's functioning and need for general anaesthesia. Disabil Rehabil 2017; 39: 2484-91. https://doi.org/10.1080/09638288.2016.1236406
  34. Polli VA, Sordi MB, Lisboa ML, de Andrade Munhoz E, de Camargo AR. Dental Management of Special Needs Patient: A Literature Review. Glob J Oral Sci 2016; 2: 33-45.

Cited by

  1. Dental Treatments under General Anesthesia on Children with Special Health Care Needs Enrolled in the Spanish Dental Care Program vol.10, pp.2, 2021, https://doi.org/10.3390/jcm10020182
  2. Dental treatment under general anesthesia for patients with severe disabilities vol.21, pp.2, 2021, https://doi.org/10.17245/jdapm.2021.21.2.87