ABSTRACT
The dental care of people with severe learning disability and challenging behaviour presents many problems. The maintenance of oral health by regular examination, prevention and treatment may be difficult because of the limitations in patient cooperation. In many cases the diagnosis of orofacial pain may need to be discounted as a cause of uncharacteristic and sometimes aggressive behaviour. In such cases the use of general anaesthesia for examination and treatment would seem to be the obvious option but this strategy has limitations. This paper undertakes a focused review of sedation techniques as an alternative to general anaesthesia in the treatment of people with challenging behaviour. The use of novel techniques of sedation combining intravenous with oral or intranasal routes is described with patients treated in a community dental health centre. All patients had previously received treatment using general anaesthesia. The techniques described proved effective and safe for use in the primary care setting.
Subject(s)
Anesthesia, Dental , Anesthesia, General , Conscious Sedation , Dental Care for Disabled , Learning Disabilities , Mental Disorders , Administration, Intranasal , Administration, Oral , Cooperative Behavior , Dentist-Patient Relations , Humans , Hypnotics and Sedatives/administration & dosage , Hypnotics and Sedatives/therapeutic use , Injections, IntravenousABSTRACT
Intraocular pressures were recorded in two series of fifteen patients after the administration of suxamethonium and endotracheal intubation. One series received tubocurarine 0.05 mg/kg and the other gallamine 0.3 mg/kg 4 min before the suxamethonium. The pressures were compared with those in a control group of fifteen patients who received normal saline before the suxamethonium. An increase in intraocular pressure occurred in 80% of patients and was similar in all three groups.
Subject(s)
Gallamine Triethiodide/pharmacology , Intraocular Pressure/drug effects , Succinylcholine/pharmacology , Tubocurarine/pharmacology , Adult , Aged , Female , Humans , Intubation, Intratracheal , Male , Middle Aged , Neuromuscular Junction/drug effectsABSTRACT
A case is reported in which a young man suffering from hereditary angioedema was admitted with severe airway obstruction due to groww pharyngeal and laryngeal oedema. Tracheostomy was necessary. The rationale of treatment with epsilon aminocaproic acid, tranexamic acid and fresh frozen plasma is discussed. The patient subsequently underwent dental extractions under general anaesthesia with tracheal intubation without complications.
