Prevention of dental damage and improvement of difficult intubation using a paraglossal technique with a straight Miller blade

[Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation]

BACKGROUND AND OBJECTIVES

Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health.

METHODS

Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale.

RESULTS

The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points.

CONCLUSIONS

The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.

Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation

BACKGROUND AND OBJECTIVES

Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health.

METHODS

Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale.

RESULTS

The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points.

CONCLUSIONS

The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.

[Tooth injury in anaesthesiology]

BACKGROUND AND OBJECTIVES

Dental injury is the most common complication of general anaesthesia and has significant physical, economic and forensic consequences. The aim of this study is to review on the characteristics of dental injury associated with anaesthesiology and existing methods of prevention.

CONTENTS

In this review, the time of anaesthesia in which the dental injury occurs, the affected teeth, the most frequent type of injury, established risk factors, prevention strategies, protection devices and medico-legal implications inherent to its occurrence are approached.

CONCLUSIONS

Before initiating any medical procedure that requires the use of classic laryngoscopy, a thorough and detailed pre-aesthetic evaluation of the dental status of the patient is imperative, in order to identify teeth at risk, analyze the presence of factors associated with difficult intubation and outline a prevention strategy that is tailored to the risk of dental injury of each patient.

Dental avulsion due to direct laryngoscopy during the induction of general anaesthesia and avulsed teeth in nasopharynx

General anaesthesia was induced to a 32-year-old female patient. During direct laryngoscopy, the four upper front incisors were avulsed and fell into the patient's oral cavity without fracture. After endotracheal intubation, her oral cavity was searched laryngoscopically but the teeth were not found. Radiological findings of her chest and abdomen obtained by the C-armed x-ray device and endoscopic findings of the oesophagus were normal. Her head and neck imaging revealed a radiopaque lesion in the nasopharyngeal area. Later, the nasopharyngeal area was examined endoscopically and the teeth were removed following adenoidectomy. We emphasise that preoperative evaluation is essential for dental injuries, and patients with a risk of dental injury must be detected before surgery. The localisation of the broken teeth must be identified and removed, and one must keep in mind that the dental fragments can travel to the nasopharynx.