Datta Rashmi, Sahoo N K, Malhotra Naveen, Godavarthy Purushotham, Saxena Vivek, Garg Anurag
Professor & Head (Emergency Medicine), Hamdard Institute of Medical Sciences & Research, New Delhi, India.
Former Professor (Oral & Maxillofacial Surgery) & Director General Dental Services, New Delhi, India.
Med J Armed Forces India. 2024 Jan-Feb;80(1):29-40. doi: 10.1016/j.mjafi.2022.07.002. Epub 2022 Aug 5.
Oral diseases are a burden for developing countries such as India where owing to socioeconomic conditions cost is a factor in selecting the type of treatment. Dental care in India is provided at various levels of care including standalone clinics run by individual dental surgeons, multi-speciality dental centres providing specialist care under one roof including paediatric, prosthodontics, and so on and dental centres affiliated with hospitals having facilities for provision of operation theatre and anaesthesia services. Most dental procedures are performed as day-care procedures requiring local anaesthetics, oral, or moderate intravenous sedation and anxiolytics while maxillofacial procedures are carried out in a controlled operation theatre setting. Dental procedures are fraught with risks due to shared oral surgical space and airway leading to reduced field of visibility to dentists especially with the usage of supplementary oxygenation devices, mouth props, and so on. Various dental societies have proposed minimum standards of care for provision of anaesthesia to various dental procedures; however, there are no extant guidelines in our country. The authors propose these guidelines for provision of minimal sedation (anxiolysis) and moderate sedation/analgesia for various day care dental procedures at various levels of care, keeping the aim that no patient’s life is endangered during provision of anaesthesia services at all dental locations.
口腔疾病对印度等发展中国家来说是一项负担,在这些国家,由于社会经济状况,费用是选择治疗类型时的一个考量因素。印度的牙科护理在不同层面提供,包括由个体牙科医生经营的独立诊所、在同一屋檐下提供专科护理(包括儿科、口腔修复学等)的多专科牙科中心,以及附属于拥有手术室和麻醉服务设施的医院的牙科中心。大多数牙科手术作为日间护理手术进行,需要局部麻醉、口服或中度静脉镇静及抗焦虑药,而颌面手术则在可控的手术室环境中进行。由于口腔手术空间和气道共用,牙科手术充满风险,这导致牙医的视野受限,尤其是在使用辅助给氧设备、口腔撑开器等的时候。各种牙科协会已经针对各种牙科手术的麻醉提供提出了最低护理标准;然而,我国目前尚无相关指南。作者针对各级护理机构的各种日间护理牙科手术,提出了关于提供最小镇静(抗焦虑)和中度镇静/镇痛的这些指南,目标是在所有牙科场所提供麻醉服务期间,不危及任何患者的生命。