Ananthanarayan C, Sigal M, Godlewski W
Department of Anaesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada.
Anesth Prog. 1998 Winter;45(1):12-7.
The management of the behavior of mentally challenged adults when providing required dental care is often a problem, whether in the dental office or in a hospital setting. Our institution has a designated program to provide required dental care to this group of patients. Because of the high incidence of poor cooperation, which may include aggressive antagonistic behavior, many of these patients are scheduled for dental care under general anesthesia with an incomplete preoperative medical assessment. The purpose of this study was to determine the impact and limitations that an incomplete medical assessment may present in the delivery of dental care under general anesthesia to these adults with developmental disability. After approval from the institutional review board, the medical records of 139 patients treated in this program between 1992 and 1994 were reviewed to determine the patient profiles, anesthesia management, and complications. The charts of these patients, who underwent dental and radiographic examination, scaling and prophylaxis, and restoration and extraction of teeth under general anesthesia, were reviewed. There were 149 procedures performed on these patients, some more than once. The mean age was 29.5 yr. Males predominated females by a ratio of 2:1. All had multiple diagnoses, medical problems, and medications. Twenty-three patients had Down's Syndrome, four had schizophrenia disorders, 42 had seizure disorders, 11 had hypothyroidism, seven had heart disease, and 14 had central nervous system and neuromuscular disorders. The remainder had a variety of diagnoses, including rare syndromes. One hundred had intravenous (i.v.), 25 had mask inhalation, and 24 had intramuscular ketamine (Ketalar) induction. Nasotracheal intubation was uneventful in 139 patients, five had difficult visualization of the larynx and intubation. Ten patients experienced intraoperative complications, including nonfatal ventricular arrhythmia, slight fall in blood pressure and hypertension (greater than 20% of preoperative value), and four individuals developed laryngospasm. In the Post Anesthetic Care Unit, five patients experienced minor airway problems resulting in a desaturation of oxygen to a level below 85%. Adults with developmental disabilities can be safely managed under general anesthesia for dental treatment in a hospital setting with minimal morbidity and without extensive preoperative investigations.
无论是在牙科诊所还是医院环境中，为有智力障碍的成年人提供所需牙科护理时，对其行为的管理常常是个问题。我们机构有一个指定项目，为这类患者提供所需的牙科护理。由于合作不佳的发生率很高，这可能包括攻击性的对抗行为，许多这类患者在术前医学评估不完整的情况下，被安排在全身麻醉下接受牙科护理。本研究的目的是确定不完整的医学评估在为这些发育障碍的成年人提供全身麻醉下的牙科护理时可能带来的影响和局限性。经机构审查委员会批准后，回顾了1992年至1994年期间在该项目中接受治疗的139例患者的病历，以确定患者概况、麻醉管理和并发症情况。查阅了这些患者的病历图表，他们在全身麻醉下接受了牙科和影像学检查、洗牙和预防治疗以及牙齿修复和拔除。对这些患者共进行了149项操作，有些患者接受了不止一次操作。平均年龄为29.5岁。男性与女性的比例为2:1。所有患者都有多种诊断、医疗问题和用药情况。23例患者患有唐氏综合征，4例患有精神分裂症，42例患有癫痫症，11例患有甲状腺功能减退症，7例患有心脏病，14例患有中枢神经系统和神经肌肉疾病。其余患者有各种诊断，包括罕见综合征。100例患者采用静脉诱导，25例采用面罩吸入诱导，24例采用肌肉注射氯胺酮（凯他敏）诱导。139例患者经鼻气管插管顺利，5例患者喉镜视野和插管困难。10例患者出现术中并发症，包括非致命性室性心律失常、血压轻度下降和高血压（高于术前值的20%），4例患者发生喉痉挛。在麻醉后护理单元，5例患者出现轻微气道问题，导致氧饱和度降至85%以下。发育障碍的成年人在医院环境中接受全身麻醉下的牙科治疗时，可以安全管理，发病率最低，且无需进行广泛的术前检查。
