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Shimizu Y, Ohshimo S, Saeki N, Oue K, Sasaki U, Imamura S, Kamio H, Imado E, Sadamori T, Tsutsumi YM, Shime N. New acoustic monitoring system quantifying aspiration risk during monitored anaesthesia care. Sci Rep 2023; 13:20196. [PMID: 37980396 PMCID: PMC10657450 DOI: 10.1038/s41598-023-46561-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/02/2023] [Indexed: 11/20/2023] Open
Abstract
Respiratory monitoring is crucial during monitored anaesthesia care (MAC) to ensure patient safety. Patients undergoing procedures like gastrointestinal endoscopy and dental interventions under MAC have a heightened risk of aspiration. Despite the risks, no current system or device can evaluate aspiration risk. This study presents a novel acoustic monitoring system designed to detect fluid retention in the upper airway during MAC. We conducted a prospective observational study with 60 participants undergoing dental treatment under MAC. We utilized a prototype acoustic monitoring system to assess fluid retention in the upper airway by analysing inspiratory sounds. Water was introduced intraorally in participants to simulate fluid retention; artificial intelligence (AI) analysed respiratory sounds pre and post-injection. We also compared respiratory sounds pre-treatment and during coughing events. Coughing was observed in 14 patients during MAC, and 31 instances of apnoea were detected by capnography. However, 27 of these cases had breath sounds. Notably, with intraoral water injection, the Stridor Quantitative Value (STQV) significantly increased; furthermore, the STQV was substantially higher immediately post-coughing in patients who coughed during MAC. In summary, the innovative acoustic monitoring system using AI provides accurate evaluations of fluid retention in the upper airway, offering potential to mitigate aspiration risks during MAC.Clinical trial number: jRCTs 062220054.
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Affiliation(s)
- Yoshitaka Shimizu
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan.
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noboru Saeki
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kana Oue
- Department of Dental Anesthesiology, Division of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Utaka Sasaki
- Department of Dental Anesthesiology, Division of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Serika Imamura
- Department of Dental Anesthesiology, Division of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Hisanobu Kamio
- Department of Dental Anesthesiology, Division of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Eiji Imado
- Department of Dental Anesthesiology, Division of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Takuma Sadamori
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Shimizu Y, Saeki N, Ohshimo S, Doi M, Oue K, Yoshida M, Takahashi T, Oda A, Sadamori T, Tsutsumi YM, Shime N. Usefulness of new acoustic respiratory sound monitoring with artificial intelligence for upper airway assessment in obese patients during monitored anesthesia care. THE JOURNAL OF MEDICAL INVESTIGATION 2023; 70:430-435. [PMID: 37940528 DOI: 10.2152/jmi.70.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Monitored anesthesia care (MAC) often causes airway complications, particularly posing an elevated risk of aspiration and airway obstruction in obese patients. This study aimed to quantify the levels of aspiration and airway obstruction using an artificial intelligence (AI)-based acoustic analysis algorithm, assessing its utility in identifying airway complications in obese patients. To verify the correlation between the stridor quantitative value (STQV) calculated by acoustic analysis and body weight, and to further evaluate fluid retention and airway obstruction, STQV calculated exhaled breath sounds collected at the neck region, was compared before and after injection of 3 ml of water in the oral cavity and at the start and end of the MAC procedures. STQV measured immediately following the initiation of MAC exhibited a weak correlation with body mass index. Furhtermore, STQV values before and after water injection increased predominantly after injection, further increased at the end of MAC. AI-based analysis of cervical respiratory sounds can enhance the safety of airway management during MAC by quantifying airway obstruction and fluid retention in obese patients. J. Med. Invest. 70 : 430-435, August, 2023.
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Affiliation(s)
- Yoshitaka Shimizu
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noboru Saeki
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuru Doi
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kana Oue
- Department of Dental Anesthesiology, Division of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Mitsuhiro Yoshida
- Department of Dental Anesthesiology, Division of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Tamayo Takahashi
- Department of Dental Anesthesiology, Division of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Aya Oda
- Department of Dental Anesthesiology, Division of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Takuma Sadamori
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Safety of deep intravenous propofol sedation in the dental treatment of children in the outpatient department. J Dent Sci 2022. [DOI: 10.1016/j.jds.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Kim T, Chi SI, Kim H, Seo KS. Analysis of behavioral management for dental treatment in patients with dementia using the Korean National Health Insurance data. J Dent Anesth Pain Med 2021; 21:461-469. [PMID: 34703895 PMCID: PMC8520838 DOI: 10.17245/jdapm.2021.21.5.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background The global population is aging rapidly, and accordingly, the number of patients with dementia is increasing every year. Although the need for dental treatment increases for various reasons in patients with dementia, they cannot cooperate during dental treatment. Therefore, behavioral management, including sedation (SED) or general anesthesia (GA), is required for patients with dementia. Thus, this study aimed to investigate the trends and effects of SED or GA in patients with dementia undergoing dental treatment in South Korea based on the Korean National Health Insurance claims data. Methods This study utilized customized health information data provided by the Health Insurance Review and Assessment Service. Among patients with records of using sedative drugs during dental treatment from January 2007 to September 2019, patients with the International Classification of Diseases-10 code for dementia (F00, F01, F02, F03, and G30) were selected. We then analyzed the full insurance claims data for dental care. Age, sex, sedative use, and dental treatment of patients were analyzed yearly. In addition, the number of cases of GA or SED per year was analyzed, and changes in behavioral management methods with increasing age were investigated. Results Between January 2007 and September 2019, a total of 4,383 (male, 1,454; female, 2,929) patients with dementia received dental treatment under SED or GA. The total number of SED and GA cases were 1,515 (male, 528 ; female, 987) and 3,396 (male, 1,119 ; female, 2,277) cases, respectively. The total number of cases of dental treatment for 4,383 patients with dementia was 153,051 cases, of which 2.22% were under GA and 0.98% were under SED. Midazolam was the most commonly used drug for SED. Conclusion Although gingivitis and pulpitis were the most common reasons for patients with dementia to visit the dentist, GA or SED for patients with dementia was frequently used in oral and maxillofacial or periodontal surgery.
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Affiliation(s)
- Taeksu Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Seong In Chi
- Department of Pediatric Dentistry, Dankook University Sejong Dental Hospital, Sejong, Korea
| | - Hyuk Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
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The Involvement of Caregivers of Patients with Dementia during Mastoid Surgery under Local Anaesthetic. The Journal of Laryngology & Otology 2021; 136:82-86. [PMID: 34702389 DOI: 10.1017/s0022215121003194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Analysis of intravenous sedation for dental treatment in elderly patients with severe dementia-a retrospective cohort study of a Japanese population. J Dent Sci 2020; 16:101-107. [PMID: 33384785 PMCID: PMC7770320 DOI: 10.1016/j.jds.2020.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/11/2020] [Indexed: 01/20/2023] Open
Abstract
Background/purpose Patients with severe dementia require intravenous sedation during dental treatment. However, few reports have compared the outcomes of intravenous sedation management among sedatives. Intravenous sedation in the elderly with severe dementia undergoing dental treatment was evaluated retrospectively. Materials and methods Patients’ characteristics and type of dementia were obtained from medical records. Midazolam (MID), dexmedetomidine (DEX), and propofol (PRO) were administered as sedatives. The systolic blood pressure (SBP), heart rate (HR), SpO2, bispectral index (BIS) values and complications were evaluated. Results Nineteen patients with severe dementia who underwent 62 instances of sedation were included. There was no difference in patient background between sedatives. The sedation time and permission time to return home were significantly longer in DEX than in MID or PRO group. Half the usual dose in MID and lower limits of the routine dose was effective in DEX and PRO. HR was significantly lower in DEX group. There were 3 cases with airway obstruction requiring nasopharyngeal airway and 4 cases of apnea when MID was administered. Two cases of Cheyne-Stokes-like respiration when MID or DEX was administered. SpO2 <94% was found in 22 cases (35%) irrespective of the sedative. A patient with dementia with Lewy bodies had experienced hallucinations during the recovery period after sedation when MID or DEX was administered. The BIS value of ≤80 was noted during complications. Conclusion Intravenous sedation for dental treatment in the elderly with severe dementia, needs a dose titration. All sedatives had respiratory-related complications which mandate close monitoring.
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Lim GXD, Boyle CA. Conscious sedation service for geriatric and special-care dentistry: A health policy brief. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820903762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Geriatric and special care dentistry (GSD) involves oral health care for seniors and individuals with disabilities. Due to ethical issues, finances, waiting times, treatment versatility and so on, conscious sedation (CS) may have a place to optimise the delivery of care. Objectives: This article identifies considerations for implementing CS in GSD services in Singapore. Methods: Taking the form of a health policy brief, this review (a) defines the situation for patients with special-care needs and justified the need for dental CS, (b) makes reference to practices from countries with established dental CS services, (c) states and evaluates available CS techniques for the GSD centre in Singapore and (d) discusses action plans and considerations for implementation. Results: Demographic analysis revealed that 23.8% of the GSD patients could have benefitted from CS, or 44.7% of all patients who required behavioural management. The key advantages of CS included enhanced safety, more teeth saved and a reduction in general anaesthesia wait, amongst others. Conventional dental CS techniques included midazolam via various routes, nitrous oxide and ketamine. To establish a CS service, key points of consideration need to be conceptualised first, such as adequate training, perception of patients and providers, operational costs, facilities and developing guidance specific for oral health professionals. Conclusion: A local CS service will be beneficial for GSD patients in view of the challenges faced. A group of experts and stakeholders is needed to provide practical consensus.
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Affiliation(s)
- Guang Xu David Lim
- Geriatric and Special Care Dentistry Clinic, National Dental Centre, Singapore
- Tzu Chi Free Clinic (Redhill), Buddhist Compassion Relief Tzu Chi Foundation, Singapore
- Oral Health Therapy, Nanyang Polytechnic, Singapore
| | - Carole Ann Boyle
- Department of Sedation and Special Care Dentistry, Guy’s and St Thomas NHS Foundation Trust, UK
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Dexmedetomidine and Midazolam Sedation Reduces Unexpected Patient Movement During Dental Surgery Compared With Propofol and Midazolam Sedation. J Oral Maxillofac Surg 2018; 77:29-41. [PMID: 30076807 DOI: 10.1016/j.joms.2018.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/02/2018] [Accepted: 07/02/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Owing to its unpredictability, unexpected patient movement is one of the most important problems during surgery while under monitored anesthesia care with sedation. The purpose of this study was to compare unexpected patient movement during dental surgery while under dexmedetomidine and propofol sedation. MATERIALS AND METHODS The authors designed and implemented a prospective randomized controlled trial. Patients undergoing dental surgery requiring intravenous sedation were randomly assigned to dexmedetomidine and midazolam (dexmedetomidine group) or propofol and midazolam (propofol group) sedation. In each group, midazolam 0.02 mg/kg was administered in conjunction with continuous administration of dexmedetomidine or propofol to maintain a bispectral index value of 70 to 80. Unexpected patient movement interfering with the procedure was defined as acceptable, defined as no body movement or only 1 controllable movement, or unacceptable, defined as at least 2 controllable movements or any uncontrollable movement. The primary outcome was unexpected patient movement, and the secondary outcome was defined as snoring and cough reflex. Other variables included demographic and procedural characteristics. Continuous or ordinal variables were analyzed using the Student t test or Mann-Whitney test. Dichotomous or categorical variables were analyzed using the χ2 test or Fisher exact test. A P value less than.05 was considered statistically significant. RESULTS Eighty-eight patients were enrolled in the study (dexmedetomidine group, n = 44; propofol group, n = 44). There were no relevant differences between groups for demographics and baseline variables. Intraoperative unacceptable patient movement occurred more commonly in the propofol group (n = 13; 30%) than in the dexmedetomidine group (n = 4; 9%; P = .015). Intraoperative snoring occurred more commonly in the dexmedetomidine than in the propofol group (P = .045). Incidence and number of cough reflexes were comparable between groups. CONCLUSION Dexmedetomidine and midazolam sedation decreases unexpected patient movement during dental surgery compared with propofol and midazolam sedation.
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Vaessen HHB, Schouten ANJ, van der Hoeve H, Knape JTA. The feasibility of office-based propofol sedation for dental care in patients with intellectual disability by sedation practitioners. SPECIAL CARE IN DENTISTRY 2016; 37:93-98. [PMID: 27805733 DOI: 10.1111/scd.12210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The quality of oral health care for intellectually disabled patients is a significant challenge due to behavioral issues. Intravenous propofol sedation may be useful to relieve the anxiety and fear, and make dental procedures more acceptable. The aim of this study was to evaluate the safety and effectiveness of propofol sedation, by trained nonmedical sedation practitioners, during dental treatments in an office-based setting. METHODS Intellectually disabled patients (124) were subjected to restorative dental procedures and moderately sedated using intravenous propofol. Vital signs, cooperation of the patient, and sedation depth were continuously assessed. RESULTS Propofol sedation was effective for dental treatment. All procedures resulted in a sufficient level of sedation without moderate or severe complications. CONCLUSION Propofol sedation can be safely and effectively performed in an office-based setting by sedation practitioners, who have experience in propofol sedation and are trained in the care of patients with disabilities.
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Affiliation(s)
- Hermanus H B Vaessen
- Sedation Practitioner, Division of Anaesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, The Netherlands
| | - Antonius N J Schouten
- Division of Anaesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, The Netherlands
| | - Henriette van der Hoeve
- Dentist, Department of Dentistry, Abrona Intramural Care Unit, Sterrenberglaan 6, Huis ter Heide, The Netherlands
| | - Johannes T A Knape
- Clinical Professor, Department of Dentistry, Abrona Intramural Care Unit, Sterrenberglaan 6, Huis ter Heide, The Netherlands
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