Evaluation of Advanced Behavior Guidance Techniques Used in Dentistry: Sedation and General Anesthesia

Yıl 2020, Cilt: 42 Sayı: 5, 466 - 473, 15.09.2020

Hande G. Aytuluk

https://doi.org/10.20515/otd.725531

Öz

Although most of the dental procedures can be held in the office setting, sedation or general anesthesia is required in some of the patients. The aim of this study was to review patients who underwent dental procedures under anesthesia with the emphasis on patient characteristics, procedural and anesthetic properties, and to consider this issue from various aspects. Medical records of 362 patients who underwent dental procedures under sedation or general anesthesia were analyzed. Demographic data, the reasons for treatment under anesthesia, anesthetic, and procedural characteristics were recorded. Patients were evaluated under three groups according to their ages (<10years: children; n=159, 10-24 years: young people; n=113, ≥25 years; n=90: adults). Noncompliance was the main reason for dental surgery under anesthesia in children (76.1%) and young people (41.6%). Mental retardation (26.7%) and extreme dental phobia (24.4%) were found to be the most frequent reasons for dental surgery under anesthesia in adults. For the reversal of rocuronium, while neostigmine was the primary choice in pediatric patients, sugammadex was the most preferred reversal agent in adults. Patients undergoing dental procedures under anesthesia constitute a specialized patient group (e.g. pediatric patients and patients with special needs). Therefore, implementing nonsurgical interventions and postponing elective surgeries to an appropriate time must be taken into consideration. For the safety and the quality of the dental procedure, the choice of anesthesia technique must be made according to the risk and benefit analysis.

Anahtar Kelimeler

anesthetics, child, dental anesthesia, general anesthesia, outpatients

Diş Hekimliğinde Kullanılan İleri Davranış Yönlendirme Tekniklerinin Değerlendirilmesi: Sedasyon ve Genel Anestezi

Öz

Dental işlemlerin çoğu ofis ortamında yapılabilmesine rağmen, bazı hastalarda sedasyon veya genel anestezi gereklidir. Bu çalışmanın amacı, anestezi altında dental prosedür uygulanan hastaları hasta özellikleri, işlemsel ve anestezi özellikleri vurgulanarak gözden geçirmek ve bu konuyu farklı açılardan ele almaktır. Sedasyon veya genel anestezi altında dental prosedür uygulanan 362 hastanın tıbbi kayıtları incelendi. Demografik veriler, anestezi altında tedavi nedenleri, anestezi ve prosedür özellikleri kaydedildi. Hastalar yaşlarına göre üç grup altında değerlendirildi (<10 yaş: çocuklar; n = 159, 10-24 yaş: gençler; n = 113, ≥25 yaş; n = 90: yetişkinler). Çocuklarda (76.1%) ve gençlerde (41.6%) anestezi altında diş cerrahisinin temel nedeni uyumsuzluktu. Mental retardasyon (26.7%) ve aşırı diş fobisi (24.4%) yetişkinlerde anestezi altında diş cerrahisinin en sık nedenleri olarak bulundu. Roküronyumun geri çevrilmesi için çocuk hastalarda neostigmin birincil seçenek iken, sugammadeks yetişkinlerde en çok tercih edilen ilaçtı. Anestezi altında diş tedavisi gören hastalar özel bir hasta grubu oluşturmaktadır (örneğin pediyatrik hastalar ve özel ihtiyaçları olan hastalar). Bu nedenle cerrahi olmayan müdahalelerin uygulanması ve elektif ameliyatların uygun bir zamana ertelenmesi dikkate alınmalıdır. Dental prosedürün güvenliği ve kalitesi için, risk ve fayda analizine göre anestezi tekniği seçimi yapılmalıdır.

Anahtar Kelimeler

anestezikler, ayaktan hastalar, çocuk;, dental anestezi, genel anestezi

Kaynakça

• 1- American Academy of Paediatric Dentistry. Guideline on behavior guidance for the paediatric dental patient. Pediatr Dent. 2017;39(6):246-59.
• 2- World Health Organization, Commonwealth Medical Association Trust and UNICEF. Orientation Programme on Adolescent Health for Health-care Providers; 2006. Available from: https://www.who.int/maternal_child_adolescent/documents/pdfs/9241591269_op_handout.pdf
• 3- Turkish Anesthesiology and Reanimation Association Anesthesia Practice Guides. General Anesthesia and Sedation Applications in Dentistry (in Turkish), 2016. Available from: http://www.tard.org.tr/akademi/?p=kilavuz-detay&bID=13&session=12295985635616-24591971271232
• 4- Foundation NPS. Free from Harm: Accelerating Patient Safety Improvement Fifteen Years After “To Err is Human”. Boston, MA: National Patient Safety Foundation; 2015. Available from: https://www.aig.com/content/dam/aig/america-canada/us/documents/brochure/free-from-harm-final-report.pdf
• 5- American Academy of Pediatric Dentistry. Guideline on use of anesthesia personnel in the administration of office-based deep sedation/general anesthesia to the pediatric dental patient. Pediatr Dent. 2016;38(6):246-9.
• 6- Coté CJ, Wilson S; American Academy of Pediatrics; American Academy of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics. 2019;143(6). pii: e20191000. doi: 10.1542/peds.2019-1000.
• 7- Lee H, Milgrom P, Huebner CE, et al. Ethics rounds: death after pediatric dental anesthesia: an avoidable tragedy?. Pediatrics. 2017;140(6). pii: e20172370. doi: 10.1542/peds.2017-2370.
• 8- Giovannitti JA Jr. Anesthesia for off-floor dental and oral surgery. Curr Opin Anaesthesiol. 2016;29(4):519-25.
• 9- Bosnjak ZJ, Logan S, Liu Y, et al. Recent insights into molecular mechanisms of propofol-induced developmental neurotoxicity: implications for the protective strategies. Anesth Analg. 2016;123(5):1286-96.
• 10- Wu J, Bie B, Naguib M. Epigenetic manipulation of brain-derived neurotrophic factor improves memory deficiency induced by neonatal anesthesia in rats. Anesthesiology. 2016;124(3):624-40.
• 11- Sun LS. Introduction to "anesthesia and neurodevelopment in children": a supplement from the sixth pediatric anesthesia neurodevelopmental assessment (PANDA) symposium. J Neurosurg Anesthesiol. 2019;31(1):101-2.
• 12- Backeljauw B, Holland SK, Altaye M, et al. Cognition and brain structure following early childhood surgery with anesthesia. Pediatrics. 2015;136(1):e1–12. doi: 10.1542/peds.2014-3526.
• 13- Sun LS, Li G, Miller TL, et al. Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA. 2016;315(21):2312-20.
• 14- U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women; 2016. Available from: https://www.fda.gov/media/101937/download
• 15- SmartTots. Consensus Statement of the Use of Anesthetic and Sedative Drugs in Infants and Toddlers; 2015. Available from: http://www.pedsanesthesia.org/wp-content/uploads/2015/12/ConsensusStatement.pdf.
• 16- Ing C, Wall MM, DiMaggio CJ, et al. Latent class analysis of neurodevelopmental deficit after exposure to anesthesia in early childhood. J Neurosurg Anesthesiol. 2017;29(3):264-73.
• 17- Talpos JC, Chelonis JJ, Li M, et al. Early life exposure to extended general anesthesia with isoflurane and nitrous oxide reduces responsivity on a cognitive test battery in the nonhuman primate. Neurotoxicology. 2019;70:80-90.
• 18- Cabrera OH, Gulvezan T, Symmes B, et al. Sex differences in neurodevelopmental abnormalities caused by early-life anaesthesia exposure: a narrative review. Br J Anaesth. 2020;124(3):e81-e91. doi: 10.1016/j.bja.2019.12.032.
• 19- Ing C, Ma X, Sun M, et al. Exposure to surgery and anesthesia in early childhood and subsequent use of attention deficit hyperactivity disorder medications. Anesth Analg. 2020. doi: 10.1213/ANE.0000000000004619.
• 20- Lee JJ, Sun LS, Levy RJ. Report on the sixth pediatric anesthesia neurodevelopmental assessment (PANDA) symposium, "Anesthesia and Neurodevelopment in Children". J Neurosurg Anesthesiol. 2019;31(1):103-7.
• 21- Brailo V, Janković B, Lozić M, et al. Dental treatment under general anesthesia in a day care surgery setting. Acta Stomatol Croat. 2019;53(1):64-71.
• 22- American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): unique challenges and treatment options. Pediatr Dent. 2016;38(6):55–6.
• 23- Özkan AS, Erdoğan MA, Şanlı M, et al. Retrospective evaluation of dental treatment under general anaesthesia. Turk J Anaesthesiol Reanim. 2015;43(5):332-6.
• 24- Akpinar H. Evaluation of general anesthesia and sedation during dental treatment in patients with special needs: a retrospective study. J Dent Anesth Pain Med. 2019;19(4):191-9.
• 25- Şimşek T, Yılmaz M. retrospective comparison of general anesthesia and sedation unused in pediatric patients during dental procedures. Kocaeli Medical J. 2017;6(1):59-62.
• 26- Landsman IS, Hays SR, Karsanac CJ, et al. Pediatric Anesthesia. Editors: Coran AG, Adzick NS, Caldamone AA, et al. Pediatric Surgery (7th Ed). Philadelphia: Elsevier BV; 2012.p.201-26.
• 27- Wu TS, Tseng WC, Lai HC, et al. Sugammadex and laryngospasm. J Clin Anesth. 2019;56:52.