Chino Kristin, Ganzberg Steven, Mendoza Kristopher
Private Practice, Anesthesia for Dentistry, Las Vegas, Nevada.
Clinical Professor of Anesthesiology, UCLA School of Dentistry, Los Angeles, California.
Anesth Prog. 2019 Spring;66(1):44-51. doi: 10.2344/anpr-66-02-05.
The safe treatment of patients with chronic obstructive pulmonary disease (COPD) in dental office office-based settings can be quite complex without a current understanding of the etiology, course, severity, and current treatment modalities of the disease. The additional concerns of providing sedation and/or general anesthesia to patients with COPD in settings outside of a hospital demand thorough investigation of individual patient presentation and realistic development of planned treatment that patients suffering from this respiratory condition can tolerate. Along with other co-morbidities, such as advanced age and potential significant cardiovascular compromise, the dental practitioner providing sedation or general anesthesia must tailor any treatment plan to address multiple organ systems and mitigate risks of precipitating acute respiratory failure from inadequate pain and/or anxiety control. Part I of this article covered the epidemiology, etiology, and pathophysiology of COPD. Patient considerations in the preoperative period were also reviewed. Part II will cover which patients are acceptable for sedation/general anesthesia in the dental office-based setting as well as sedation/general anesthesia techniques that may be considered. Postoperative care will also be reviewed.
在牙科诊所环境中，若不了解慢性阻塞性肺疾病（COPD）的病因、病程、严重程度及当前治疗方式，安全治疗COPD患者可能会相当复杂。在医院以外的环境中为COPD患者提供镇静和/或全身麻醉，需要对个体患者情况进行全面调查，并根据患有这种呼吸系统疾病的患者能够耐受的情况，切实制定计划中的治疗方案。除了其他合并症，如高龄和潜在的严重心血管功能损害外，提供镇静或全身麻醉的牙科医生必须调整任何治疗方案，以兼顾多个器官系统，并降低因疼痛和/或焦虑控制不足而引发急性呼吸衰竭的风险。本文第一部分涵盖了COPD的流行病学、病因和病理生理学。还回顾了术前患者的注意事项。第二部分将涵盖哪些患者适合在牙科诊所环境中接受镇静/全身麻醉，以及可能考虑的镇静/全身麻醉技术。术后护理也将进行回顾。
