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麻醉医生围手术期的牙科考量

Perioperative dental considerations for the anesthesiologist.

作者信息

Yasny Jeffrey S

机构信息

Department of Anesthesiology, One Gustave L Levy Place, New York, NY 10029-6574, USA.

出版信息

Anesth Analg. 2009 May;108(5):1564-73. doi: 10.1213/ane.0b013e31819d1db5.

Abstract

Although anesthesiologists consistently work in the mouth of patients, they may not have been exposed to a comprehensive education of teeth, surrounding tissues, and intraoral prostheses. Since perioperative dental damage is one of the most common anesthesia-related adverse events and is responsible for the greatest number of malpractice claims against anesthesiologists, several dental considerations are warranted. The likelihood of perioperative dental trauma increases with the vulnerability of a patient's dentition and the presence of associated anesthesia risk factors. Minimizing dental injuries begins with the anesthesiologist's preoperative assessment of the patient's dentition and intraoral tissues. Clear documentation of the patient's preoperative dental condition and notifying the patient of the potential dental damage will diminish costs for any related postoperative dental treatment. Upon discovery of a potentially hazardous dental condition, a consultation with a dentist should be considered before proceeding with the surgical procedure. Exercising cautionary measures during provocative events, such as laryngoscopy and tracheal extubation, can aid in the prevention of dental trauma. In the event of such an injury, several management tactics can promote a swift and reasonable resolution. Establishing an increased awareness of intraoral conditions and the related perioperative risk factors may diminish the incidence of dental damage and financial costs.

摘要

尽管麻醉医生一直在患者口腔内工作,但他们可能并未接受过关于牙齿、周围组织和口腔内修复体的全面教育。由于围手术期牙齿损伤是最常见的与麻醉相关的不良事件之一,也是针对麻醉医生的医疗事故索赔最多的原因,因此有必要考虑几个牙科方面的因素。围手术期牙齿创伤的可能性会随着患者牙列的脆弱性以及相关麻醉风险因素的存在而增加。将牙齿损伤降至最低始于麻醉医生对患者牙列和口腔组织的术前评估。清晰记录患者术前的牙齿状况并告知患者潜在的牙齿损伤,将降低任何相关术后牙科治疗的成本。一旦发现潜在的危险牙齿状况,在进行外科手术之前应考虑咨询牙医。在喉镜检查和气管拔管等刺激性操作过程中采取谨慎措施,有助于预防牙齿创伤。如果发生此类损伤,几种处理策略可以促进迅速且合理的解决。提高对口腔状况和相关围手术期风险因素的认识,可能会降低牙齿损伤的发生率和经济成本。

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