Analysis of different sedation approaches for epileptic patients in dentistry: A retrospective study

Yıl 2022, Cilt: 4 Sayı: 1, 45 - 54, 30.04.2022

Zeynep Fatma Zor Şaziye Şahin Özgün Yıldırım Bekem Saatcı Yeliz Kılınç

Öz

Few clinical studies have been reported on the use of sedation in epileptic patients receiving dental treatments. The aim of this study was to perform a retrospective analysis of epileptic patients who underwent dental treatments under sedation. The medical records of 212 epileptic patients treated under sedation were reviewed retrospectively. Demographic data, ASA classification, comorbid diseases, medications, sedation duration, sedation agents, oral disorders, dental treatments, and complications were recorded. The mean age of the patients was 24.2±9.1 years. One hundred ninety-four patients were classified as ASA II (91.5%) and 18 (8.5%) as ASA III. Mental retardation was identified in 117 (55.2%) patients. Midazolam (n=204 patients, 96.2%) and ketamine (n=168,79.2%) were the most frequently used sedation agents. Dental caries (n=192, 79.2%) and periodontal diseases (n=31, 14.6%) were the most common oral disorders. The surgical, periodontal, restorative and prosthodontic treatments were performed. Epileptic seizures (n=2), vomiting and desaturation (n=2) and hemorrhage (n=1) were observed. It was concluded that sedation can be effectively and safely used for providing dental care in epileptic patients. Cooperative work of experienced anesthesia and dental team is of great importance to provide a safe and comfortable treatment for epileptic patients requiring a specific treatment approach.

Anahtar Kelimeler

Dentistry, Epilepsy, Ketamine, Midazolam, Sedation

Kaynakça

• Akpinar H. (2019). Evaluation of general anesthesia and sedation during dental treatment in patients with special needs: A retrospective study. Journal of Dental Anesthesia and Pain Medicine, 19(4), 191–199. doi:10.17245/jdapm.2019.19.4.191.
• American Society of Anesthesiologists (ASA): Standards for Basic Anesthetic Monitoring. Available at: http://asahq.org?For-Healthcare-Professionals/Standards-Guidelines-and-Statements.aspx Accessed on June 22, 2021.
• Chellathurai, B. N., Thiagarajan, R., Jayakumaran, S., Devadoss, P., & Elavazhagan (2016). Management of a high risk epileptic patient under conscious sedation: A multidisciplinary approach. Journal of Indian Society of Periodontology, 20(1), 91–94. doi:10.4103/0972-124X.170817.
• Devinsky, O., Boyce, D., Robbins, M., & Pressler, M. (2020). Dental health in persons with disability. Epilepsy & Behavior 110, 107174. doi:10.1016/j.yebeh.2020.107174.
• Jolly, T., & McLean, H. S. (2012). Use of ketamine during procedural sedation: indications, controversies, and side effects. Journal of infusion nursing : the official publication of the Infusion Nurses Society, 35(6), 377–382. doi:10.1097/NAN.0b013e31827068c1.
• Lu, L., Xiong, W., Zhang, Y., Xiao, Y., & Zhou, D. (2019). Propofol-induced refractory status epilepticus at remission age in benign epilepsy with centrotemporal spikes: A case report and literature review. Medicine, 98(27), e16257. doi:10.1097/MD.0000000000016257.
• Melini, M., Forni, A., Cavallin, F., Parotto, M., & Zanette, G. (2020). Conscious sedation for the management of dental anxiety in third molar extraction surgery: a systematic review. BMC Oral Health, 20(1), 155. doi:10.1186/s12903-020-01136-0
• Mielnik-Błaszczak, M., Skawińska-Bednarczyk, A., Michałowski, A., & Błaszczak, J. (2018). Problems with access to dental treatment for children with epilepsy. Epilepsy & Behavior, 81, 107–110. doi:10.1016/j.yebeh.2017.12.014.
• Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. (2017). Anesthesiology, 126(3), 376–393. doi:10.1097/ALN.0000000000001452
• Ransford, N., Soryal, I., McCorry, D., Sander, J. W., Duncan, F., & Huggins, N. (2014). Specialist management of routine dental procedures in adults with refractory epilepsy. British Dental Journal, 216(7), 403–407. doi:10.1038/sj.bdj.2014.247.
• Salinas Salmeron, K. S., Kim, H. J., & Seo, K. S. (2019). Effects site concentrations of propofol using target-controlled infusion in dental treatment under deep sedation among different intellectual disability types. Journal of Dental Anesthesia and Pain Medicine, 19(4), 217–226. doi:10.17245/jdapm.2019.19.4.217.
• Schnabl, D., Guarda, A., Guarda, M., von Spreckelsen, L., Riedmann, M., Steiner, R., & Dumfahrt, H. (2019). Dental treatment under general anesthesia in adults with special needs at the University Hospital of Dental Prosthetics and Restorative Dentistry of Innsbruck, Austria: a retrospective study of 12 years. Clinical Oral Investigations, 23(11), 4157–4162. doi:10.1007/s00784-019-02854-8.
• Schöpper, M., Ludolph, A. C., & Fauser, S. (2016). Dental care in patients with epilepsy: a survey of 82 patients and their attending dentists and neurologists in southern Germany. International Dental Journal, 66(6), 366–374. doi:10.1111/idj.12251.
• Seok, U., Ji, S., Yoo, S., Kim, J., Kim, S., & Kim, J. (2016). A survey of the intravenous sedation status in one provincial dental clinic center for the disabled in Korea. Journal of Dental Anesthesia and Pain Medicine, 16(2), 123–129. doi:10.17245/jdapm.2016.16.2.123.
• Subki, A. H., Mukhtar, A. M., Saggaf, O. M., Ali, R. A., Khalifa, K. A., Al-Lulu, D. M., Alsallum, M. S., Bokhary, D. H., Baabdullah, A. M., Kassar, S. M., Jan, B. M., Hindi, M. M., & Jan, M. M. (2018). Parental perceptions of dental health and need for treatment in children with epilepsy: a multicenter cross-sectional study. Pediatric Health, Medicine and Therapeutics, 9, 165–172. doi:10.2147/PHMT.S174964.
• Walia, I.S., Bhatia, L., Singh, A., Kaur, K., Duggal A, Ajaypal.(2017). Prevalence of Medical Comorbidities in Dental Patients. Annals Internal Medical and Dental Research 3(1):DE21-DE25. doi: 10.21276/aimdr.2017.3.1.DE7.
• Wood, M. N., Manley, M. C., Bezzina, N., & Hassan, R. (2015). An audit of the use of intravenous ketamine for paediatric dental conscious sedation. British Dental Journal, 218(10), 573–577. doi:10.1038/sj.bdj.2015.39.
• Yaltırık, M., Özer, S., Tonguç, S., Kocaelli, H.(2012). Management of epileptic patients in dentistry. Surgical Science, 3(1):47-52.doi:10.4236/ss.2012.31008.
• Yeung, P. M., Wong, V., McGrath, C. P., Yiu, C., & Lee, G. (2019). Oral health status of children with epilepsy in Hong Kong. Journal of Investigative and Clinical Dentistry, 10(4), e12479. doi: 10.1111/jicd.12479.