Sugimura Mitsutaka, Kudo Chiho, Hanamoto Hiroshi, Oyamaguchi Aiko, Morimoto Yoshinari, Boku Aiji, Niwa Hitoshi
Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan,
Clin Oral Investig. 2015 Jun;19(5):1107-14. doi: 10.1007/s00784-014-1334-y. Epub 2014 Oct 28.
We retrospectively assessed the usability and precautions required during intravenous sedation (IVS) for dental treatment in geriatric outpatients with dementia.
We investigated the intraoperative complications in 65 cases (25 geriatric dental patients with dementia) under IVS, from the standpoint of local anesthesia usage, water usage during treatment, and content of treatment.
Circulatory complications occurred in 46.2 % and respiratory complications in 52.3 % of all cases (n = 65). Bradycardia occurred in 13.8 % and hypotension in 12.3 % of cases in the former, while coughing spells occurred in 41.5 % and snoring in 16.9 % of cases in the latter. Many of the local anesthesia usage cases did not require water usage, such as during tooth extraction (p < 0.0001). Water usage cases, such as for caries treatment, needed longer sedation and treatment times, resulting in more propofol usage (p < 0.001, p < 0.0001, and p < 0.01, respectively). Many coughing spells developed in the water usage cases (p < 0.05). 81.8 % of snoring and 63.3 % of circulatory complications, such as hypotension and bradycardia, developed in the tooth extraction cases (p < 0.05).
All the scheduled dental treatments in dementia patients were smoothly performed under IVS. However, stringent attention should be paid to the prevention of aspiration of fluids retained in the pharynx, airway obstruction due to therapeutic maneuvers, respiratory inhibition by sedatives, and hemodynamic fluctuations caused by invasive procedures under local anesthesia.
In the future, with the growing need for dental procedures in dementia patients, dentists will require training in the general management of such patients.
我们回顾性评估了老年痴呆门诊患者牙科治疗中静脉镇静（IVS）期间所需的可用性和注意事项。
我们从局部麻醉使用情况、治疗期间的用水情况以及治疗内容的角度，调查了65例接受IVS治疗的患者（25例老年痴呆牙科患者）的术中并发症。
所有病例（n = 65）中，循环系统并发症发生率为46.2%，呼吸系统并发症发生率为52.3%。前者中，心动过缓发生率为13.8%，低血压发生率为12.3%；后者中，咳嗽发作发生率为41.5%，打鼾发生率为16.9%。许多局部麻醉使用病例不需要用水，如拔牙时（p < 0.0001）。用水的病例，如龋齿治疗，需要更长的镇静和治疗时间，导致丙泊酚使用量增加（分别为p < 0.001、p < 0.0001和p < 0.01）。用水病例中出现许多咳嗽发作（p < 0.05）。拔牙病例中，81.8%的打鼾以及63.3%的循环系统并发症，如低血压和心动过缓发生（p < 0.05）。
痴呆患者所有预定的牙科治疗在IVS下均顺利进行。然而，应严格注意预防咽部潴留液体的误吸、治疗操作引起的气道阻塞、镇静剂导致的呼吸抑制以及局部麻醉下侵入性操作引起的血流动力学波动。
未来，随着痴呆患者对牙科治疗需求的增加，牙医将需要接受此类患者综合管理的培训。
