ÇOCUKLARIN DİŞ TEDAVİLERİNDE YAPILAN DERİN SEDASYON İŞLEMLERİNDE NON-İNVAZİV MEKANİK VENTİLASYON VE NAZAL KANÜL KULLANIMININ KARŞILAŞTIRILMASI

Year 2021, , 282 - 288, 24.12.2021

Seher Orbay Yaşlı Dilek Günay Canpolat Ahmet Emin Demirbaş

https://doi.org/10.34108/eujhs.1040326

Abstract

Derin sedasyon prosedürlerinde, ek oksijen genellikle hastalara nazal kanül yoluyla verilir. Non-invaziv mekanik ventilasyon (NIMV), özellikle hipoksinin tedavisinde kullanılan oksijenasyon yöntemidir. Hasta güvenliği ve diş hekiminin tedaviyi uygulama kolaylığı açısından çocukların diş tedavilerinde derin sedasyon işlemlerinde oksijenasyon yöntemi olarak nazal kanül ve nazal maske ile NIMV uygulamalarının kullanımını karşılaştırmayı amaçladık.
Hastalar nazal maske grubu (M) ve nazal kanül grubu (N) olarak iki gruba ayrıldı. Oksijenasyon için N grubu hastalara nazal kanül kullanılırken, M grubu hastalara nazal maske ile NIMV uygulandı. Hastaların hemodinamik parametreleri, görülen komplikasyonlar ve diş hekiminin memnuniyet derecesi kaydedildi ve karşılaştırıldı. Anestezi indüksiyonu sonrası ve işlemin beşinci dakikasında grup M'de kan oksijen saturasyonu (SpO2) anlamlı olarak yüksekti. İşlem sırasında görülen hipoksi olayı (SpO2 ≤90) sayısı grup N'de anlamlı olarak daha yüksekti. Cerrah memnuniyeti grup M'de anlamlı olarak daha yüksekti. Çalışmamız ile; diş tedavileri için derin sedasyon uygulanan çocuklarda oksijenizasyonda burun maskesi ile uygulanan NIMV’nin hipoksi riskini azalttığı ve oksijenizasyonda nazal kanül kullanmaktan daha güvenli olduğu kanaatine varılmıştır.

Keywords

Derin sedasyon, diş tedavisi, nazal kanül, nazal maske, noninvaziv mekanik ventilasyon

COMPARISON OF NON-INVASIVE MECHANICAL VENTILATION AND NASAL CANNULA USE IN DEEP SEDATION PROCEDURES PERFORMED FOR DENTAL TREATMENTS OF CHILDREN

Abstract

For deep sedation procedures, supplemental oxygen is usually administered via a nasal cannula to the patients. Non-invasive mechanical ventilation (NIMV) is the oxygenation method, especially used in the treatment of hypoxia. We aimed to compare the use of nasal cannula and NIMV applications as oxygenation methods for deep sedation procedures in the dental treatments of children, especially in terms of patient safety and the convenience of the dentist to apply the treatment. Patients were divided into two groups as the nasal mask group (M) and the nasal cannula group (N). For oxygenation, while a nasal cannula was used for group N, NIMV with a nasal mask was applied for group M. Hemodynamic parameters of the patients, complications and dentist's satisfaction degree were recorded and compared. Saturation of blood oxygen (SpO2) was significantly higher in group M after induction of anesthesia and in the fifth minute of the procedure. Hypoxia (SpO2 ≤90) event number during the procedure was significantly higher in group N. Surgeon satisfaction was significantly higher in group M. We concluded that, in children undergoing deep sedation for dental treatments, NIMV applied with a nasal mask reduces the risk of hypoxia and is safer than using a nasal cannula.

Keywords

Deep sedation, dental treatment, nasal cannula, nasal mask, noninvasive mechanical ventilation

References

• American Academy on Pediatric Dentistry Clinical Affairs Committee-Behavior Management Subcommittee; American Academy on Pediatric Dentistry Council on Clinical Affairs. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent 2008; 30(7Suppl):125-133.
• Nelson T, Nelson G. The role of sedation in contemporary pediatric dentistry. Dent Clin North Am 2013; 57(1): 145-161.
• Yamakage M, Kamada Y, Toriyabe M, et al. Changes in respiratory pattern and arterial blood gases during sedation with propofol or midazolam in spinal anesthesia. J Clin Anesth 1999; 11(5):375-379.
• Smith I, Thwaites AJ. Target-controlled propofol vs. sevoflurane: double-blind, randomized comparison in day-case anesthesia. Anesthesia 1999; 54(8):745-752.
• Stark RD, Bınks SM, Dutka YN, et al. A review of the safety and tolerance of propofol ‘Diprivan’. Postgrad Med J 1985; 61(3):152-156.
• Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alfaxalone-alphadolone. Br Med J 1974; 22;2(5920):656-659.
• Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995; 7(1):89-91.
• Sbrana F, Ripoli A, Formichi B. Anesthetic management in atrial fibrillation ablation procedure: Adding non-invasive ventilation to deep sedation. Indian Pacing Electrophysiol J 2015; 15(2):96-102.
• Maxwell LG, Yaster M. The myth of conscious sedation. Arch Pediatr Adolesc Med 1996; 150(7):665-667.
• Coté CJ. "Conscious sedation": Time for this oxymoron to go away!. J Pediatr 2001; 139(1):15-17; discussion 18-9.
• Kannikeswaran N, Mahajan PV, Sethuraman U, et al. Sedation medication received and adverse events related to sedation for brain MRI in children with and without developmental disabilities. Paediatr Anaesth 2009; 19(3):250-256. Jain S. Sedation: A Primer for Pediatricians. Pediatr Ann 2018; 47(6):e254-e258. Tobias JD, Leder M. Procedural sedation: A review of sedative agents, monitoring, and management of complications. Saudi J Anaesth 2011; 5(4):395-410.
• Pratila MG, Fischer ME, Alagesan R, et al. Propofol versus midazolam for monitored sedation: a comparison of intraoperative and recovery parameters. J Clin Anesth 1993; 5(4):268-274. Cravero JP, Beach ML, Blike GT, et al. Pediatric Sedation Research Consortium. The incidence and nature of adverse events during pediatric sedation/ anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg 2009; 108(3):795-804.
• Coté CJ, Karl HW, Notterman DA, et al. Adverse sedation events in pediatrics: Analysis of medications used for sedation. Pediatrics 2000; 106(4):633-644.
• Coté CJ, Notterman DA, Karl HW, et al. Adverse sedation events in pediatrics: A critical incident analysis of contributing factors. Pediatrics 2000; 105(4 pt 1):805-814.
• Pratila MG, Fischer ME, Alagesan R, et al. Propofol versus midazolam for monitored sedation: a comparison of intraoperative and recovery parameters. J Clin Anesth 1993; 5(4):268-274.
• Dial S, Silver P, Bock K, Sagy M. Pediatric sedation for procedures titrated to a desired degree of immobility results in unpredictable depth of sedation. Pediatr Emerg Care 2001; 17(6):414-420.
• Motas D, McDermott NB, VanSickle T, Friesen RH. Depth of consciousness and deep sedation attained in children as administered by nonanaesthesiologists in a children’s hospital. Paediatr Anaesth 2004; 14(3):256-260.
• Malviya S, Voepel-Lewis T, Tait AR, et al. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth 2002; 88(2):241-245.
• Mathru M, Esch O, Lang J, et al. Magnetic Resonance Imaging of the Upper AirwayEffects of Propofol Anesthesia and Nasal Continuous Positive Airway Pressure in Humans. Anesthesiology 1996; 84(2):273-279.
• Iwama H, Obara S, Ozawa S, et al. A survey of combined epidural-propofol anesthesia with noninvasive positive pressure ventilation as a minimally invasive anesthetic protocol. Med Sci Monit 2003; 9(7):CR316-323.
• Suresh D, Purdy G, Wainwright AP, Flynn PJ. Use of continuous positive airway pressure in paediatric dental extraction under general anaesthesia. Br J Anaesth 1991; 66(2):200-204.
• Feldman JM. Optimal ventilation of the anesthetized pediatric patient. Anesth Analg 2015; 120(1):165-175.