Atención odontológica bajo sedación endovenosa (R2) en niños hospitalizados con enfermedades respiratorias crónicas

RESUMEN: El Hospital Josefina Martínez está especializado en atención de niños con enfermedades respiratorias crónicas. En él hemos implementado un modelo de atención odontológica, bajo sedación endovenosa, monitorización cardiorespiratoria con participación de un equipo multidisciplinario. Objetivos: Describir la atención odontológica en pacientes hospitalizados con enfermedades respiratorias crónicas. Identificar las patologías bucales más prevalentes y los tratamientos realizados. Material y Método: El estudio se realizó incluyendo las atenciones odontológicas bajo sedación endovenosa, entre los años 2014-2016, considerando a 18 pacientes hospitalizados. Todos recibieron sedación y analgesia con Midazolam-Ketamina con monitorización continua no invasiva durante el procedimiento. Resultados: Se encontró una alta prevalencia de gingivitis, anomalías dentomaxilares y patologías de erupción. La lesión de caries tuvo baja prevalencia. Los tratamientos realizados fueron: profilaxis, destartarje, aplicación de barniz de clorhexidina y/o flúor, exodoncias, exposición quirúrgica de dientes y restauraciones. Conclusiones: Es importante mostrar nuestra experiencia, ya que hemos realizado tratamientos en forma oportuna, eficiente y de bajo costo, mejorando la salud bucal de los niños. Además fueron atendidos sin necesitar traslado a otro centro de salud, permitiendo resolver las urgencias y la atención odontológica integral de los pacientes.

ABSTRACT: The Josefina Martínez Hospital specializes in the care of children with chronic respiratory diseases. There, we implemented a model of dental care under intravenous sedation and cardiorespiratory monitoring, with the participation of a multidisciplinary team. Objective: Describe dental care in hospitalized patients with chronic respiratory diseases. Identify the most prevalent oral diseases and the treatments performed. Materials and Methodology: The study was conducted including dental care under intravenous sedation, between 2014 and 2016, considering 18 hospitalized patients. All received sedation and analgesia with Midazolam-Ketamine with continuous non-invasive monitoring during the procedure. Results: A high prevalence of gingivitis, dentomaxillary abnormalities and eruption disorders was found. Caries lesion had a low prevalence. The treatments performed were: prophylaxis, scaling, application of chlorhexidine and / or fluoride varnish, extractions, surgical exposure of teeth and restorations. Conclusion: It is important to show our experience, since we have made timely, efficient and low cost treatments, improving the oral health of children. In addition, they were attended without requiring the transfer to other health centers, which allowed to meet the emergencies and the comprehensive dental care of the patients.

A survey of the intravenous sedation status in one provincial dental clinic center for the disabled in Korea

BACKGROUND: The objective of the present study was to examine the status of patients who had received dental treatment under intravenous (IV) sedation at Chungnam Dental Clinic for the Disabled in Korea from its inception to the present time, and to review the analysis results. METHODS: Retrospective analysis was performed on 305 cases of patients who had received dental treatments under IV sedation between January 2011 and May 2016. The analysis examined the patient's sex, age, primary reason for IV sedation, duration of anesthesia and dental treatment, type of dental treatment performed, number of clinical departments involved in the dental treatment and level of multidisciplinary cooperation, and annual trends. RESULTS: Most dental treatments using intravenous sedation were performed on medically disabled patients or dentally disabled patients with an extreme gag reflex or dental phobia. The mean duration of IV sedation was 72.5 min, while the mean duration of treatment was 58.0 min. The types of dental treatments included surgical treatment (n = 209), periodontal treatment (n = 28), prosthodontic treatment (n = 28), restorative treatment (n = 23), implant surgery (n = 22), endodontic treatment (n = 9), reduction of temporomandibular joint dislocation (n = 1), and treatment of traumatic injuries (n = 1), with treatments mostly performed on adult patients. CONCLUSIONS: With increasing demand for minimally painful treatment, cases using IV sedation are on an upward trend and are expected to continue to increase.

A survey of the intravenous sedation status in one provincial dental clinic center for the disabled in Korea

BACKGROUND: The objective of the present study was to examine the status of patients who had received dental treatment under intravenous (IV) sedation at Chungnam Dental Clinic for the Disabled in Korea from its inception to the present time, and to review the analysis results. METHODS: Retrospective analysis was performed on 305 cases of patients who had received dental treatments under IV sedation between January 2011 and May 2016. The analysis examined the patient's sex, age, primary reason for IV sedation, duration of anesthesia and dental treatment, type of dental treatment performed, number of clinical departments involved in the dental treatment and level of multidisciplinary cooperation, and annual trends. RESULTS: Most dental treatments using intravenous sedation were performed on medically disabled patients or dentally disabled patients with an extreme gag reflex or dental phobia. The mean duration of IV sedation was 72.5 min, while the mean duration of treatment was 58.0 min. The types of dental treatments included surgical treatment (n = 209), periodontal treatment (n = 28), prosthodontic treatment (n = 28), restorative treatment (n = 23), implant surgery (n = 22), endodontic treatment (n = 9), reduction of temporomandibular joint dislocation (n = 1), and treatment of traumatic injuries (n = 1), with treatments mostly performed on adult patients. CONCLUSIONS: With increasing demand for minimally painful treatment, cases using IV sedation are on an upward trend and are expected to continue to increase.

Anesthesia management in performing interventional procedures / 介入放射学杂志

Objective To describe the importance of anesthesia management in performing interventional procedures. Methods A total of 24 382 patients, who were admitted to authors’ hospital during the period from April 2011 to April 2015 to receive level Ⅲ or level Ⅳ interventional procedures, were enrolled in this study. According to the anesthesia method, the patients were divided into (1) mechanical ventilation group (group A), i.e. intravenous general anesthesia combined with laryngeal mask or endotracheal intubation, (2) intravenous general anesthesia and autonomous respiratory group (group B), (3) conscious sedation group (group C) and (4) local anesthesia group (group D). The heart rate (HR), mean arterial pressure (ABP), blood oxygen saturation (SpO2) and anesthesia-related complications of the patients of all four groups were kept under close observation before, during and after the interventional procedures, the results were statistically analyzed. Results The anesthesia was successfully implemented according to the operation plan in all 24 382 patients. Interventional procedure of level Ⅲ was performed in 16 702 patients(68.5%) and interventional procedure of levelⅣwas adopted in 7 680 patients (31.5%). The patients receiving interventional procedure of level Ⅲof group A, B, C and D were 6 797 (40.7%), 3 608 (21.6%), 5 095(30.5%) and 1 202(7.2%) respectively;while the patients receiving interventional procedure of level Ⅳ of group A, B, C and D were 4 193 (54.6%), 2 527 (32.9%), 699 (9.1%) and 261 (3.4%)respectively. No statistically significant differences in preoperative HR, ABP and SpO2 existed between each other among the four groups (P>0.05). In group A, B and C the HR and ABP values determined in operation were not statistically different from the preoperative ones(P>0.05), and the differences in HR and ABP values among the three groups were also not statistically different (P>0.05);SpO2 levels showed no obvious changes (P>0.05). In group D, the HR and ABP values determined in operation were significantly higher than the preoperative ones (P0.05). In 22 patients of group D the operation had to be stopped as they were unable to tolerate the procedure. Conclusion In performing different levels of interventional procedures, level Ⅲ and level Ⅳ intervention surgeries in particular, careful selection of individualized anesthesia plan on the base of patient’s condition and operation requirement is an important guarantee for ensuring a safe operation with no interference, and it is also a good way to reduce the pain severity of patient. Therefore, individualized anesthesia plan is worth to be widely used in interventional procedures.

Intravenous sedation for gastrointestinal endoscopy in very elderly patients of Thailand.

Background: The use of sedation for gastrointestinal endoscopy (GIE) procedures in elderly patients has been established as a safe and effective technique. However, it is still uncertain whether the situation is valid for Asians. Objective: Evaluate the outcome of intravenous sedation (IVS) for GIE procedures in very elderly patients (>86 years old) in Thailand and compare the clinical efficacy of IVS between very elderly and those younger (<86 years old) Methods: We undertook a retrospective review of the sedation service records of patients who underwent GIE procedures between 2007 and 2008 at Siriraj Hospital, Thailand. All sedations were administered by anesthetic personnel in the endoscopy room. The cohort was divided into three groups, <65 years old (group 1), 65-85 years old (group 2), and >86 years old (group 3). Results: Sedation was provided for 1,779 patients (965, 687, and 127 patients in group 1, 2, and 3, respectively) in 2,061 GIE procedures. Fentanyl, midazolam and propofol were the most common IVS drugs used in all three groups. Patients in group 3 required lower mean doses of these intravenous sedatives than those in group 1 or 2 (p <0.001). Mean procedure time in group 3 was longer than in group 1 or 2 (p=0.010). Adverse events in group 3 occurred more frequently when compared to group 1 or 2 (p <0.001). Transient hypotension was the main complication across all aged groups. Conclusion: IVS for GIE procedure in very elderly patients was associated with higher minor advance events but relatively safe and effective when carried out by trained anesthetic personnel with appropriate monitoring and dose adjustment.

Sedative methods used during extraction of wisdom teeth in patients with a high level of dental anxiety

INTRODUCTION: Intravenous sedation is performed to ensure smooth and safe surgery. Dental anxiety is a reaction to an unknown danger. The Spielberger's state-trait anxiety inventory (STAI) can be used to simultaneously evaluate the levels of state and trait anxiety. State anxiety is defined as subjective feelings of nervousness. This study assessed the presurgical anxiety using STAI and performed intravenous sedation for patients whose level of state anxiety was > stage IV. Based on our clinical experience, it is believed that higher doses of sedatives are needed to induce the desired levels of sedation in patients with a high level of state anxiety. OBJECTIVES: This study examined whether the sedative consumption of the patient with a high anxiety level increased. PATIENTS AND METHODS: Patients with state anxiety scores of > or =51 were included in Group V, and those with state anxiety scores ranging from 42 to 50 were placed in Group IV. To induce sedation, intravenous access was established, and a bolus dose of 3.0 mg midazolam was administered intravenously. Sedation was maintained by administering a continuous infusion of propofol, which was aimed at achieving an Observer's Assessment of Alertness/Sedation scale of 10-12/20. In this study, midazolam was initially administered when the body movements appeared to occur or the blood pressure increased. This was followed by the administration of higher doses of propofol if low sedation was observed. RESULTS: There were no significant differences in the patient demographics, duration of sedation, and doses of local anaesthetic agents between Groups IV and V. The midazolam dose and mean propofol dose needed to maintain comparable levels of sedation were significantly higher in Group V than in Group IV. CONCLUSION: In female patients, whose level of preoperative state anxiety is more than Stage V of STAI, a large quantity of sedatives is needed for intravenous sedation.

Manejo multidisciplinario de la sedacion intravenosa en Cirugía Bucal

La sedación intravenosa se ha convertido en una de las técnicas más comúnmente empleadas para evitar traumas psicológicos a los pacientes que necesiten de algún tipo de cirugía bucal. Pues como todos sabemos el término Cirugía está asociado a miedo y ansiedad, y si se agrega la palabra Bucal que implica Odontología, para muchos es sinónimo de dolor y angustia. La necesidad de manejar el paciente que se somete a una cirugía bucal sin ansiedad, tensión, miedo, ni dolor, plantea la posibilidad de usar la sedación intravenosa como método para eliminar esas situaciones ante el procedimiento quirúrgico pero es muy importante la presencia del Anestesiólogo como integrante indispensable junto con el Cirujano para poder ser utilizada, además del ayudante del cirujano y el personal auxiliar. En el presente trabajo se revisarán las funciones de cada uno de los integrantes del equipo multidisciplinario que se necesita para que éste tipo de alternativa de tratamiento quirúrgico se aplique coordinada y eficazmente, permitiendo reducir al mínimo o evitando el riesgo que pudiera alguna vez ocasionar su aplicación, brindando al paciente la vigilancia de parámetros vitales y el suficiente confort antes, durante y después de la cirugía.

Intravenous sedation has become the most common procedure to avoid psychological trauma in the oral surgery patients. As we know the word Surgery is associated with fear and anxiety and if we add the word Oral that imply Dentistry for the majority of the people is synonymous of pain and suffer. The importance of management these feelings bring the possibility of use the intravenous sedation as a technique that controls and avoid those situations but it is very important to use an anesthesiologist as a indispensably member with the surgeon besides the surgical assistant and the hygienist. We are going to expose the specific functions of each member of the multidisciplinary team that is needed to apply this kind of surgical treatment efficiently and allowing to minimize or avoid the risks that in any case it should occur, taking good care of the patient before, during and after the surgery.