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Fritz CG, Monos SD, Romeo D, Lowery A, Xu K, Atkins J, Rajasekaran K. Medico-legal liability of injuries arising from laryngoscopy. J Laryngol Otol 2024; 138:554-558. [PMID: 37982243 PMCID: PMC11063656 DOI: 10.1017/s0022215123001986] [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] [Received: 05/11/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Dental and mucosal injuries from laryngoscopy in the peri-operative period are common medico-legal complaints. This study investigated lawsuits arising from laryngoscopy. METHODS Westlaw, a legal database containing trial records from across the USA, was retrospectively reviewed. Plaintiff and/or defendant characteristics, claimed injuries, legal outcomes and awards were extracted. RESULTS Of all laryngoscopy-related dental or mucosal injuries brought before a state or federal court, none (0 per cent) resulted in a defence verdict against the provider or monetary gain for the patient. Rulings in the patient's favour were observed only when laryngoscopy was found to be the proximate cause of multiple compounding complications that culminated in severe medical outcomes such as exsanguination, septic shock or cardiopulmonary arrest. CONCLUSION Proper laryngoscopy technique and a robust informed-consent process that accurately sets patients' expectations reduces litigation risk. Future litigation pursuits should consider the low likelihood of malpractice allegation success at trial.
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Affiliation(s)
- Christian G Fritz
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
| | - Stylianos D Monos
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Dominic Romeo
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Anne Lowery
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
| | - Katherine Xu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Joshua Atkins
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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2
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Wu JH, Lee KT, Cheng KI, Du JK, Lee CY. Patient perception of service quality to preanesthetic oral examination: a cross-sectional study using the SERVQUAL model. BMC Oral Health 2024; 24:120. [PMID: 38254042 PMCID: PMC10801931 DOI: 10.1186/s12903-024-03853-2] [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: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND A phase-III interdisciplinary quality improvement program, the preanesthetic oral examination (PAOE), was implemented as a new program in an academic medical center to prevent perioperative dental injuries. This study was aimed at surveying the perceived service quality and satisfaction of patients who had undergone PAOE based on the SERVQUAL model. METHODS This cross-sectional survey was conducted at the Kaohsiung Medical University Hospital using convenience sampling. Patients referred for PAOE (PAOE group) and those who had voluntarily availed dental services (control group) were recruited. A modified SERVQUAL questionnaire was used to assess the perceived service quality and patient satisfaction with dental services. Cronbach's alpha for SERVQUAL was 0.861. RESULTS We enrolled 286 (68.8%) and 130 (31.2%) participants in the PAOE and control groups, respectively. The path analysis revealed that the PAOE group scored lower in dimensions of reliability (β = -0.074, P = 0.003), responsiveness (β = -0.148, P = 0.006), and empathy (β = -0.140, P = 0.011). Furthermore, reliability (β = 0.655, P < 0.001) and responsiveness (β = 0.147, P = 0.008) showed a direct effect on patient satisfaction. Overall, participants were highly satisfied with the dental services. CONCLUSIONS The PAOE group showed lower satisfaction and perceived quality of dental services compared to the control group. Although implementing an interdisciplinary program reduces the perceived service quality, its influence is limited. Employing an interdisciplinary teamwork is a win-win strategy encouraged to improve patient safety and reduce malpractice claims. Future suggestions should focus on establishing waiting times that are considered reasonable by patients. Patient-centered education related to the risk of perioperative dental injuries should be provided, and awareness of oral conditions for patient safety should be improved. Moreover, interprofessional education in continuous and undergraduate programs is necessary to improve professional quality.
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Affiliation(s)
- Ju-Hui Wu
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kun-Tsung Lee
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Je-Kang Du
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Yi Lee
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Tan CQL, Loh GYW, Benjamin TWR, Koh CJ, Mok JSR, Hartono JL, Chua KTC, Tan HH, Siah KTH. Dental trauma in endoscopy: A systematic review and experience of a tertiary endoscopy centre. World J Gastrointest Endosc 2023; 15:518-527. [PMID: 37663114 PMCID: PMC10473904 DOI: 10.4253/wjge.v15.i8.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/22/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Dental injury is the leading cause of litigation in anaesthesia but an underrecognized preventable complication of endoscopy. AIM To determine frequency and effects of dental injury in endoscopy, we present findings from an audit of outpatient endoscopy procedures conducted at a tertiary university hospital and a systematic review of literature. METHODS Retrospective review of 11265 outpatient upper endoscopy procedures over the period of 1 June 2019 to 31 May 2021 identified dental related complications in 0.284% of procedures. Review of literature identified a similar rate of 0.33%. RESULTS Pre-existing dental pathology or the presence of prostheses makes damage more likely but sound teeth may be affected. Pre-endoscopic history and tooth examination are key for risk stratification and may be conducted succinctly with limited time outlay. Tooth retrieval should be prioritized in the event of dental injury to minimize aspiration and be followed by prompt dental consultation for specific management. CONCLUSION Dental complications occur in approximately 1 in 300 of upper endoscopy cases. These are easily preventable by pre-endoscopy screening. Protocols to mitigate dental injury are also suggested.
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Affiliation(s)
- Chelsea Qiu Lin Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117594, Singapore
| | - Gabrielle Yi Wen Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117594, Singapore
| | - Tay Wei Rong Benjamin
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | - Calvin Jianyi Koh
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | - John Shao Rong Mok
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | - Juanda Leo Hartono
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | | | - Hee Hon Tan
- Division of Prosthodontics, National University Centre for Oral Health, Singapore 119074, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
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Razaeian S, Liebich HK. Anti-Toothbreaker: A Novel Low-Budget Device Enabling Contactless Dental Protection and a Forbidden Technique during Direct Laryngoscopy for Endotracheal Intubation. Diagnostics (Basel) 2023; 13:diagnostics13040594. [PMID: 36832082 PMCID: PMC9955906 DOI: 10.3390/diagnostics13040594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/29/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Iatrogenic dental injury is the most common complication of conventional laryngoscopy during orotracheal intubation. The main cause is unintended pressure and leverage forces from the hard metal blade of the laryngoscope. The aim of this pilot study was to introduce and test a novel, reusable low-budget device not only providing contactless dental protection during direct laryngoscopy for endotracheal intubation, but also enabling, in contrast to established tooth protectors, active levering with conventional laryngoscopes for easier visualization of the glottis. METHODS A constructed prototype for intrahospital usage was evaluated by seven participants on a simulation manikin for airway management. Endotracheal intubation was performed with and without the device using a conventional Macintosh laryngoscope (blade size 4) and a 7.5 mm endotracheal tube (Teleflex Medical GmbH, Fellbach, Germany). Necessary time and success of first pass were determined. Degree of visualization of the glottis with and without the device was stated by the participants according to the Cormack and Lehane (CL) classification system and the Percentage of Glottic Opening (POGO) scoring system. In addition, subjective physical effort, feeling of safety regarding successful intubation, and risk for dental injury were queried on a numeric scale between 1 and 10. RESULTS All participants except one stated that the intubation procedure was easier with usage of the device than without it. On average, this was subjectively perceived as being approximately 42% (range, 15-65%) easier. In addition, time to first pass success, as well as degree of glottis visualization, subjective physical effort, and feeling of safety regarding risk for dental injury, were clearly better with usage of the device. Concerning feeling of safety regarding successful intubation, there was only a minor advantage. No difference in first pass success rate and number of total attempts could be observed. CONCLUSION The Anti-Toothbreaker is a novel, reusable low-budget device which might not only provide contactless dental protection during direct laryngoscopy for endotracheal intubation, but also enables, in contrast to established tooth protectors, active levering with conventional laryngoscopes for easier visualization of the glottis. Future human cadaveric studies are needed to investigate whether these advantages also prove themselves there.
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Affiliation(s)
- Sam Razaeian
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Correspondence:
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Lee K, Kim SY, Park KM, Yang S, Kim KD, Park W. Evaluation of dental status using a questionnaire before administration of general anesthesia for the prevention of dental injuries. J Dent Anesth Pain Med 2023; 23:9-17. [PMID: 36819606 PMCID: PMC9911963 DOI: 10.17245/jdapm.2023.23.1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 02/05/2023] Open
Abstract
Background Dental evaluation and protection are important for preventing traumatic dental injuries when patients are under general anesthesia. The objective of the present study was to develop a questionnaire based on dentition-related risk factors that could serve as a valuable tool for dental evaluation and documentation. Methods We developed a questionnaire for dental evaluation before administration of general anesthesia, investigated the association between patient-and-dentist responses and mouthguard fabrication, and assessed response agreement between 100 patients. Results Protective mouthguards were fabricated for 27 patients who were identified as having a high risk of dental injury. There was a strong association between dentists' responses and mouthguard fabrication, depending on the general oral health status, use of ceramic prosthesis, presence of masticatory pain related to periodontal diseases, gingival edema, and implants (P < 0.05). Response agreement between patients and dentists for items related to dental pain, loss of dental pulp vitality, root canal therapy, dental trauma, aesthetic prosthesis, tooth mobility, and implant prosthesis was high (Cohen's kappa coefficient κ ≥ 0.6). Conclusions A high agreement was observed between patient-dentist responses and a strong association with mouthguard fabrication for items pertaining to ceramic prosthesis, masticatory pain, and dental implants. Patients with a "yes" response to these items are recommended to undergo a dental evaluation and use a dental protective device while under general anesthesia.
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Affiliation(s)
- Kyungjin Lee
- Department of Advanced General Dentistry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
| | - Seo-Yul Kim
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kyeong-Mee Park
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Sujin Yang
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kee-Deog Kim
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Wonse Park
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Republic of Korea
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Muacevic A, Adler JR, Gupta M, Bindu B, Arora M. Intraoperative Dental Injury in a Neurosurgical Patient: Concerns for the Anesthesiologist. Cureus 2022; 14:e31268. [PMID: 36505164 PMCID: PMC9731933 DOI: 10.7759/cureus.31268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/10/2022] Open
Abstract
Anesthesia-related oropharyngeal injuries are known to occur. Risk factors for intraoperative dental injuries include difficult intubation, use of transesophageal echocardiography (TEE) probe, motor-evoked potential (MEP) monitoring, poor dental hygiene, etc. Our patient was a case of a thalamic cavernoma who underwent craniotomy in a sitting position with the neck flexed along with MEP and TEE monitoring. At the end of the surgery, the lower three incisors were found to be subluxated. The subluxated teeth were stabilized using a 2-0 Ethilon suture in the operation room. Immediate dental consultation was sought postoperatively. Sitting position surgeries with associated neck flexion, simultaneous, advanced monitoring techniques like TEE and MEP, poor dental condition, and the use of hard bite blocks can predispose patients to dental injury. Preoperative dental evaluation and explanation of neuromonitoring-associated injuries can be beneficial.
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7
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Diakonoff H, De Rocquigny G, Tourtier JP, Guigon A. Medicolegal issues of peri-anaesthetic dental injuries: A 21-years review of liability lawsuits in France. Dent Traumatol 2022; 38:391-396. [PMID: 35639817 PMCID: PMC9539868 DOI: 10.1111/edt.12770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
Background/Aim Peri‐anaesthetic dental injuries (PDI) represent a major source of potential malpractice claims against anesthesiologists. Studies about the medico‐legal aspects of PDI have mainly focused on liability insurance cases thus not encompassing those cases brought to court. The aim of this study was to assess the medico‐legal issues of PDI‐related liability lawsuits in France. Material and Methods A review of judicial decisions pertaining to PDI was conducted on a French legal database, spanning the period between January 2000 and October 2021. Characteristics of decisions, patients and anesthesiologists, peri‐operative care, dental injuries, and convictions were collected when available for analysis. Results Twenty‐four judicial decisions fulfilled the inclusion criteria and were analyzed. All cases of dental injuries took place during elective surgery, 16 in the private sector and 8 in the public sector. Most injuries concerned two or more teeth and the most predominant dental injuries were luxation or avulsion (70.8% of cases). Eight cases resulted in a final verdict in favor of the plaintiff, four in the private sector (conviction rate: 25%), and four in the public sector (conviction rate: 50%). The causes of conviction were either a lack of information (5/8), a breach in the standard of care or technical negligence (3/8). The average amount of indemnification for the plaintiff was 3614 Euros (3753 Euros in 2022 inflation‐adjusted Euros) excluding legal fees. Conclusions The analysis of PDI‐related liability lawsuits shows that medico‐legal issues differ from those of PDI‐related insurance claims. Avulsion and luxation of multiple anterior teeth during elective surgery appear to be a risk factor for liability lawsuits. In addition, inadequacy of patient information about PDI‐risk seems to be a risk factor for conviction. Lastly, dental injuries are less at risk of civil conviction than other anesthesia‐related damages.
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Affiliation(s)
- Hadrien Diakonoff
- Université Paris Cité, Faculté de santé, UFR d'odontologie, Montrouge, France.,Service de médecine bucco-dentaire, hôpital Henri Mondor, Créteil, France.,Institut droit et santé, INSERM UMR_S 1145, Université de Paris, Paris, France
| | - Gaël De Rocquigny
- Service d'anesthésie-réanimation, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
| | - Jean-Pierre Tourtier
- Service d'anesthésie-réanimation, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
| | - Aurore Guigon
- Service d'odontologie, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
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Sapate M, Munde A, Narkhede H, Mane A. An innovative 'Prop technique' of mouth opening in post-COVID-19 mucormycosis maxillectomy: Finding a new way with minimal efforts. Indian J Anaesth 2021; 65:830-833. [PMID: 35001956 PMCID: PMC8680414 DOI: 10.4103/ija.ija_708_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022] Open
Abstract
General anaesthesia is associated with damage to teeth, particularly during laryngoscopy. Dental injury is more probable when pre-existing dental pathology or risk factors are present. Post-coronavirus disease -2019 mucormycosis is a rare, fulminant, lethal, angio-invasive, opportunistic fungal disease and is increasingly recognised in diabetic and immunocompromised patients. Since the flange of the laryngoscope blade appears to be the source of tooth injury, alternate methods of wide mouth opening during laryngoscopy should be examined, especially when mouth opening is limited. In this case series, we have studied 12 cases of maxillectomies with an aim to improve restricted mouth opening by using the 'Prop technique' resulting in a minimum hinging force of the flange of the blade on teeth. Preoperatively, patients were warned about the possibility of dental injuries during anaesthesia or surgery.
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Affiliation(s)
- Manisha Sapate
- Department of Anaesthesia, PCMC's PG institute, Yashwantrao Chavan Memorial hospital, Pimpri-Chinchwad, Pune, Maharashtra, India
| | - Ashwini Munde
- Department of Anaesthesia, PCMC's PG institute, Yashwantrao Chavan Memorial hospital, Pimpri-Chinchwad, Pune, Maharashtra, India
| | - Harsha Narkhede
- Department of Anaesthesia, PCMC's PG institute, Yashwantrao Chavan Memorial hospital, Pimpri-Chinchwad, Pune, Maharashtra, India
| | - Ajit Mane
- Department of Anaesthesia, PCMC's PG institute, Yashwantrao Chavan Memorial hospital, Pimpri-Chinchwad, Pune, Maharashtra, India
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Patel PN, Rohlfing ML, Levi JR. Delayed onset of tooth decay in a routine pediatric adenotonsillectomy. Am J Otolaryngol 2021; 42:103019. [PMID: 33836484 DOI: 10.1016/j.amjoto.2021.103019] [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] [Received: 02/19/2021] [Accepted: 03/28/2021] [Indexed: 11/15/2022]
Abstract
Adenotonsillectomy is a common pediatric surgical procedure with a well-defined safety profile. Major complications from this procedure include bleeding/hemorrhage, infection, pain leading to dehydration, and airway obstruction or edema. Though rare, oral endotracheal intubation and oral retractor placement may result in injuries to the teeth and the surrounding soft tissue. We describe a rare case of delayed tooth decay in a 3-year-old female following an otherwise routine adenotonsillectomy.
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Affiliation(s)
- Prachi N Patel
- Boston Medical Center- Department of Otolaryngology- Head and Neck Surgery, United States of America.
| | - Matthew L Rohlfing
- Boston Medical Center- Department of Otolaryngology- Head and Neck Surgery, United States of America.
| | - Jessica R Levi
- Boston Medical Center- Department of Otolaryngology- Head and Neck Surgery, United States of America.
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Sand Y, Erdman AG, Konia MR. Two-Segment Flexible Macintosh Laryngoscope to Improve Glottic Visualization During Endotracheal Intubation. J Med Device 2021. [DOI: 10.1115/1.4050672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
Endotracheal intubation is a frequently performed life-saving procedure in medicine. Obtaining view of glottic structures is essential for successful completion of endotracheal intubation. Most frequently used devices called laryngoscopes sometimes fail to obtain view, which would allow for a successful completion of endotracheal intubation. To improve visualization of glottic structures, practitioners can use high-tech video-laryngoscopes, but these are not available to everyone, especially not in the third world countries. Alternatively, practitioners can use two-segment laryngoscopes. We developed a prototype of a two-segment flexible laryngoscope and tested it in a simulated environment. The glottic visualization statistically significantly (p = 0.000038) improved with the use of flexible laryngoscope. Our study strengthens available evidence that multisegment laryngoscope blades can improve glottic visualization and decrease forces exerted on soft tissues of larynx.
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Affiliation(s)
- Yashovardhan Sand
- Mechanical Engineering School, University of Minnesota, 420 Delaware Street, SE MMC 294, Minneapolis, MN 55455
| | - Arthur G. Erdman
- Medical Device Center, University of Minnesota, 420 Delaware Street, SE MMC 294, Minneapolis, MN 55455
| | - Mojca R. Konia
- Department of Anesthesiology, University of Minnesota, 420 Delaware Street, SE MMC 294, Minneapolis, MN 55455
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Ease of intubation and incidence of dental injury during direct laryngoscopy: A randomized controlled trial comparing five different laryngoscope blades (Macintosh, Miller, Reduce flange, Blechman and Flangeless). TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Forces applied to maxillary incisors with different laryngoscopes. Eur J Emerg Med 2020; 27:384-385. [PMID: 32852414 DOI: 10.1097/mej.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lower maximum forces on oral structures when using gum-elastic bougie than when using endotracheal tube and stylet during both direct and indirect laryngoscopy by novices: a crossover study using a high-fidelity simulator. BMC Emerg Med 2020; 20:34. [PMID: 32375651 PMCID: PMC7201614 DOI: 10.1186/s12873-020-00328-9] [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: 03/28/2020] [Accepted: 04/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Applying excessive force during endotracheal intubation (ETI) is associated with several complications, including dental trauma and hemodynamic alterations. A gum-elastic bougie (GEB), a type of tracheal tube introducer, is a useful airway adjunct for patients with poor laryngoscopic views. However, how the use of a GEB affects the force applied during laryngoscopy is unclear. We compared the force applied on the oral structures during ETI performed by novices using the GEB versus an endotracheal tube + stylet. METHODS This prospective crossover study was conducted from April 2017 to March 2019 in a public medical university in Japan. In total, 209 medical students (4th and 5th grade, mean age of 23.7 ± 2.0 years) without clinical ETI experience were recruited. The participants used either a Macintosh direct laryngoscope (DL) or C-MAC video laryngoscope (VL) in combination with a GEB or stylet to perform ETI on a high-fidelity airway management simulator. The order of the first ETI method was randomized to minimize the learning curve effect. The outcomes of interest were the maximum forces applied on the maxillary incisors and tongue during laryngoscopy. The implanted sensors in the simulator quantified these forces automatically. RESULTS The maximum force applied on the maxillary incisors was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (39.0 ± 23.3 vs. 47.4 ± 32.6 N, P < 0.001) and C-MAC VL (38.9 ± 18.6 vs. 42.0 ± 22.1 N, P < 0.001). Similarly, the force applied on the tongue was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (31.9 ± 20.8 vs. 37.8 ± 22.2 N, P < 0.001) and C-MAC VL (35.2 ± 17.5 vs. 38.4 ± 17.5 N, P < 0.001). CONCLUSIONS Compared with the use of an endotracheal tube + stylet, the use of a GEB was associated with lower maximum forces on the oral structures during both direct and indirect laryngoscopy performed by novices. Our results suggest the expanded role of a GEB beyond an airway adjunct for difficult airways.
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Homsi JT, Brovman EY, Greenberg P, Urman RD. A closed claims analysis of vocal cord injuries related to endotracheal intubation between 2004 and 2015. J Clin Anesth 2019; 61:109687. [PMID: 31836265 DOI: 10.1016/j.jclinane.2019.109687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/09/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To provide a contemporary medicolegal analysis of claims brought against anesthesiologists for injuries related to endotracheal intubation. DESIGN A retrospective study of closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS) database between 2004 and 2015. SETTING Closed claims that occurred in any surgical specialty in which the patient was undergoing general anesthesia and anesthesiology was named as the primary responsible service. PATIENTS Twenty claims were identified for analysis in 7 surgical specialties. Patient ages ranged from 45 to 76. Data regarding patient comorbidities and case history were obtained when available. INTERVENTIONS None. MEASUREMENTS Data collected includes patient demographics such as age, outcome severity, alleged complication, plaintiff allegations, contributing factors to the injury, the surgical specialty in which the injury occurred, and the ultimate result of the claim (dismissed/denied/settled). MAIN RESULTS Out of 20 claims, settlement payments were made in 10% of claims with a mean payment amount of $7669. Mean patient age was 55.6 years. Within severity of injuries, 65% of claims were classified as "Permanent Minor." The most common contributing factor in claims was "Technical Knowledge/Performance" and the most common plaintiff allegation was "Trauma from endotracheal tube placement." Bilateral vocal cord paralysis, unilateral (left-sided) vocal cord paralysis, and laryngeal nerve injury were the top alleged complications. The surgical specialty in which claims most often resulted was orthopedic surgery. CONCLUSIONS Injuries related to endotracheal intubation remain an ongoing challenge to anesthesiologists. Their etiology is often multifactorial and was found in this study to stem most commonly from technical errors and patient co-morbidities. A detailed discussion of risks with patients during the consent process, careful documentation of such discussion, and prompt referral to specialists when needed are critical. Understanding the patterns related to injuries during intubation is essential in order to develop strategies for improved patient safety and outcomes.
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Affiliation(s)
- Joseph T Homsi
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Ethan Y Brovman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA, United States of America; Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, United States of America.
| | | | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA, United States of America.
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15
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Schieren M, Kleinschmidt J, Schmutz A, Loop T, Staat M, Gatzweiler KH, Wappler F, Defosse J. Comparison of forces acting on maxillary incisors during tracheal intubation with different laryngoscopy techniques: a blinded manikin study. Anaesthesia 2019; 74:1563-1571. [PMID: 31448404 DOI: 10.1111/anae.14815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 12/01/2022]
Abstract
Dental trauma is a common complication of tracheal intubation. As existing evidence is insufficient to validly assess the impact of different laryngoscopy techniques on the incidence of dental trauma, the force exerted onto dental structures during tracheal intubation was investigated. An intubation manikin was equipped with hidden force sensors in all maxillary incisors. Dental force was measured while 104 anaesthetists performed a series of tracheal intubations using direct laryngoscopy with a Macintosh blade, and videolaryngoscopy with a C-MAC® , or the hyperangulated GlideScope® or KingVision® laryngoscopes in both normal and difficult airway conditions. A total of 624 tracheal intubations were analysed. The median (IQR [range]) peak force of direct laryngoscopy in normal airways was 21.1 (14.0-32.8 [2.3-127.6]) N and 29.3 (17.7-44.8 [3.3-97.2]) N in difficult airways. In normal airways, these were lower with the GlideScope and KingVision hyperangulated laryngoscopes, with a reduction of 4.6 N (p = 0.006) and 10.9 N (p < 0.001) compared with direct laryngoscopy, respectively. In difficult airways, these were lower with the GlideScope and KingVision hyperangulated laryngoscopes, with a reduction of 9.8 N (p < 0.001) and 17.6 N (p < 0.001) compared with direct laryngoscopy, respectively. The use of the C-MAC did not have an impact on the median peak force. Although sex of anaesthetists did not affect peak force, more experienced anaesthetists generated a higher peak force than less experienced providers. We conclude that hyperangulated videolaryngoscopy was associated with a significantly decreased force exerted on maxillary incisors and might reduce the risk for dental injury in clinical settings.
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Affiliation(s)
- M Schieren
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - J Kleinschmidt
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - A Schmutz
- Department of Anaesthesiology and Intensive Care Medicine, Medical Centre, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - T Loop
- Department of Anaesthesiology and Intensive Care Medicine, Medical Centre, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - M Staat
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Biomechanics Laboratory, Julich, Germany
| | - K-H Gatzweiler
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Biomechanics Laboratory, Julich, Germany
| | - F Wappler
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - J Defosse
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
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16
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Hung KC, Sun CK, Shih YH, Chang YJ, Kuo CY, Chen JY, Chu CC. Impact of Trachway® video stylet use on perioperative dental injury: A retrospective study. J Clin Anesth 2019; 59:36-37. [PMID: 31203110 DOI: 10.1016/j.jclinane.2019.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/09/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan; College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Hsuan Shih
- Department of Anesthesiology, Boai Huey Shin Hospital, Kaohsiung, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chuan-Yi Kuo
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
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17
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Woldegerima YB, Kemal SD. Clinical Audit on the Practice of Documentation at Preanesthetic Evaluation in a Specialized University Hospital. Anesth Essays Res 2019; 12:819-824. [PMID: 30662114 PMCID: PMC6319065 DOI: 10.4103/aer.aer_131_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Performing preanesthetic evaluation, documenting, and keeping readily accessible record are responsibilities of anesthetists. Documentation can improve overall patient outcome. It also has an irreplaceable role in medico-legal aspects. Documentation is one of the challenges of providing quality care. Aim: The aim of this study was to evaluate the quality of documentation practice during preanesthetic visits. Materials and Methods: This clinical audit was conducted in the University of Gondar Hospital. Predefined 22 practice quality indicators were prepared according to modified global quality index. Statistical Analysis: Descriptive statistics was performed using SPSS version 20. Results: A total of 122 preanesthetic evaluation tools (PAETs) were reviewed. None of PAETs found fully completed according to the indicators. Trends differ between elective and emergency conditions. Indicators with high completion rate (>90%) were signed a consent, medical history, history of medication, allergy, anesthesia and surgery, cardiopulmonary examination, airway examination, preoperative diagnosis, and planned procedure. Anesthetic plan, vital signs, a name, per-oral status, premedication, and age were found with below average (<50%) completion rate. Conclusions: Documentation practice during the preanesthetic visit was below the standard. Unclear instructions should be replaced with standardized contents. Providing regular trainings on clinical documentation for students and staffs, and introducing modern electronic-based documentation system and preanesthetic clinics may improve the practice.
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Affiliation(s)
- Yophtahe B Woldegerima
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Semira D Kemal
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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18
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Woldegerima Y, Kemal S. Clinical audit on the practice of documentation at preanesthetic evaluation in a specialized university hospital. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Tan Y, Loganathan N, Thinn KK, Liu EHC, Loh NHW. Dental injury in anaesthesia: a tertiary hospital's experience. BMC Anesthesiol 2018; 18:108. [PMID: 30111288 PMCID: PMC6094905 DOI: 10.1186/s12871-018-0569-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental injury is a common perioperative complication, but there are no country specific data available, especially with the use of supraglottic airway devices (SAD). The aims of our study are to report the incidence, risk factors, and local practices in the management of perioperative dental injuries in Singapore. METHODS We analyzed data from the departmental database from 2011 to 2014, noting the anticipated difficulty of airway instrumentation, intubation grade, pre-existing dental risk factors, location of dental trauma discovery, position of teeth injured and presence of dental referral. The risk factors for dental trauma were then identified using logistic regression (between 51 dental trauma patients and 55,107 patients without dental trauma). RESULTS The rate of dental injury was 0.092% for general anaesthesia cases. The most significant patient risk factor is the presence of pre-existing dental risk factors (OR 12.55). Anaesthetic risk factors include McGrath MAC usage (OR 2.51) and a Cormack and Lehane grade of 3 or more (OR 7.25). Most of the dental injuries were discovered in the operating theatre. 7 (13.7%) patients had SAD inserted and only 23 (45.1%) cases were referred to dental services. CONCLUSION Videolaryngoscopy with the McGrath MAC is associated with an increased likelihood of dental injury. This could be either because videolarygoscopes were used when increased risk of dental trauma was anticipated, or due to incorrect technique of laryngoscopy. Future studies should be done to establish the causality. The management of dental injuries could be improved with development of departmental guidelines.
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Affiliation(s)
- Yanni Tan
- Department of Anaesthesia, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Nivan Loganathan
- Department of Anaesthesia, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Kyu Kyu Thinn
- Department of Anaesthesia, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Eugene Hern Choon Liu
- Department of Anaesthesia, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Ne-Hooi Will Loh
- Department of Anaesthesia, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
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20
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Lee S, Huh J, Lee JS, Lee J. The implication of using dominant hand to perform laryngoscopy: an analysis of the laryngoscopic view and blade-tooth distance. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.2.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Serin Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jaewon Huh
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Sang Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jaemin Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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21
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Takeuchi S, Shiga T, Koyama Y, Nakanishi T, Honma Y, Morita H, Goto T. Longitudinal acquisition of endotracheal intubation skills in novice physicians. PLoS One 2017; 12:e0188224. [PMID: 29136003 PMCID: PMC5685566 DOI: 10.1371/journal.pone.0188224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
Little is known about the acquisition of intubation skills among novice physicians during their one-year clinical training. Our primary objective was to determine the changes in the intubation skills of novice physicians between prior to the clinical training and after completion of the clinical training. We used data of a prospective longitudinal multicenter data registry developed to investigate factors associated with the improvement of intubation skills among novice physicians. The study participants included 90 postgraduate year 1 physicians in 2015–2016. We used 4 simulation scenarios based on the devices used (direct laryngoscope [DL] and Airway scope [AWS]) and difficulty of intubation (normal and difficult scenarios). As a marker of the intubation skills, we used the force applied on the maxillary incisors and the tongue with each intubation. We compared the data obtained prior to clinical training with those obtained after completion of one-year clinical training. When using DL, compared to prior, significantly less force were applied on the maxillary incisors and the tongue after clinical training in the normal scenario (28.0 N vs 19.5 N, p < 0.001, and 11.1 N vs 8.4 N, p = 0.004). Likewise, when using AWS, compared to prior, significantly less force were applied on the tongue after clinical training in the normal scenario (22.0 N vs 0 N, p < 0.001). The force on the tongue decreased after clinical training but not significant. These associations persisted in the difficult airway scenario. These findings suggest that force applied on oral structures can be quantified as a marker of intubation skills by using high-fidelity simulators, and the assessment of procedural competency is recommended for all novice physicians prior to performing intubation in the clinical setting to improve the quality of emergency care.
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Affiliation(s)
- Shinya Takeuchi
- Department of Emergency Medicine, Teikyo University, Itabashi, Japan
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
- * E-mail:
| | - Takashi Shiga
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
- Department of Emergency Medicine, International University of Health and Welfare, Minato, Japan
| | - Yasuaki Koyama
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Taizo Nakanishi
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Yosuke Honma
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Hiroshi Morita
- Department of Emergency Medicine, University of Fukui Hospital, Fukui, Japan
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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22
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Cho JH, Park W, Park KM, Kim SY, Kim KD. Creating protective appliances for preventing dental injury during endotracheal intubation using intraoral scanning and 3D printing: a technical note. J Dent Anesth Pain Med 2017; 17:55-59. [PMID: 28879329 PMCID: PMC5564137 DOI: 10.17245/jdapm.2017.17.1.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/22/2017] [Accepted: 02/26/2017] [Indexed: 12/12/2022] Open
Abstract
Digital dentistry has influenced many dental procedures, such as three-dimensional (3D) diagnosis and treatment planning, surgical splints, and prosthetic treatments. Patient-specific protective appliances (PSPAs) prevent dental injury during endotracheal intubation. However, the required laboratory work takes time, and there is the possibility of tooth extraction while obtaining the dental impression. In this technical report, we utilized new digital technology for creating PSPAs, using direct intraoral scanners and 3D printers for dental cast fabrication.
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Affiliation(s)
- Jin-Hyung Cho
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Wonse Park
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kyeong-Mee Park
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Seo-Yul Kim
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Deog Kim
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
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23
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Basavaraju A, Slade K. Dental damage in anaesthesia. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2017. [DOI: 10.1016/j.mpaic.2017.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Gawlak D, Łuniewska J, Stojak W, Hovhannisyan A, Stróżyńska A, Mańka-Malara K, Adamiec M, Rysz A. The prevalence of orodental trauma during epileptic seizures in terms of dental treatment - Survey study. Neurol Neurochir Pol 2017; 51:361-365. [PMID: 28711375 DOI: 10.1016/j.pjnns.2017.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 02/14/2017] [Accepted: 06/19/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Epilepsy is one of the most common neurological disorders. Seizures that occur during attacks may lead to head injuries. It is crucial to establish proper prophylactic management against trauma occurrence, as nowadays prevention is not sufficient. AIM Assessment of the frequency of head and intraoral trauma during epileptic seizures and to evaluate factors that may predispose to injuries. MATERIAL AND METHODS The questionnaire was carried out among 106 patients with epilepsy. Survey conducted questions regarding development of the disease and occurrence of orodental and head trauma. Results were statistically analyzed with the chi-square test (p<0.05). RESULTS 52.4% of subjects admitted the occurrence of oral trauma during epileptic seizures. The most common were lips, tongue or cheeks injuries. 18% patients suffered from tooth crack and 17% from tooth fracture. 50% of respondents suffered from head trauma during seizures: 41% patients reported bruises, 39% burns, 37% wounds, 10% nose fractures, 7% eye socket trauma and 3% skull crack. 14.1% of respondents experienced dentist refusal to undertake treatment, while 4% of patients had epileptic attack during dental procedures. CONCLUSIONS Dental trauma is common result of epileptic seizures. It is necessary to implement prophylactic management to prevent hard and soft tissues injuries, for example by using custom-made mouthguards. Moreover, specially designed dental programs for this group of patients should be provided.
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Affiliation(s)
- Dominika Gawlak
- Department of Prosthetics, Medical University of Warsaw, ul. Nowogrodzka 59, 02 - 006 Warsaw, Poland.
| | - Joanna Łuniewska
- Students' Scientific Association at the Department of Prosthetics, Medical University of Warsawul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Wiktoria Stojak
- Students' Scientific Association at the Department of Prosthetics, Medical University of Warsawul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Anahit Hovhannisyan
- Students' Scientific Association at the Department of Prosthetics, Medical University of Warsawul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Anna Stróżyńska
- Students' Scientific Association at the Department of Prosthetics, Medical University of Warsawul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Katarzyna Mańka-Malara
- Department of Prosthetics, Medical University of Warsaw, ul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Marcin Adamiec
- Department of Oral Surgery, Medical University of Warsawul. Nowogrodzka 59, 02 - 006 Warsaw, Poland
| | - Andrzej Rysz
- Department of Neurosurgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warsaw, Poland; Department of Neurology, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warsaw, Poland
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25
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Mullick P, Kumar A, Prakash S. Perianesthetic dental considerations. J Anaesthesiol Clin Pharmacol 2017; 33:397-398. [PMID: 29109643 PMCID: PMC5672521 DOI: 10.4103/joacp.joacp_202_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Parul Mullick
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ajay Kumar
- Department of Anaesthesia and Critical Care, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Smita Prakash
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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26
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Ham SY, Kim J, Oh YJ, Lee B, Shin YS, Na S. Risk factors for peri-anaesthetic dental injury. Anaesthesia 2016; 71:1070-6. [DOI: 10.1111/anae.13560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- S. Y. Ham
- Department of Anaesthesiology and Pain Medicine; Yonsei University College of Medicine; Seoul Korea
| | - J. Kim
- Department of Anaesthesiology and Pain Medicine; Anaesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - Y. J. Oh
- Department of Anaesthesiology and Pain Medicine; Anaesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - B. Lee
- Department of Anaesthesiology and Pain Medicine; Yonsei University College of Medicine; Seoul Korea
| | - Y.-S. Shin
- Department of Anaesthesiology and Pain Medicine; CHA Bundang Medical Center; CHA University; Seongnam Korea
| | - S. Na
- Department of Anaesthesiology and Pain Medicine; Anaesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
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27
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Brandão Ribeiro de Sousa JM, de Barros Mourão JI. Tooth injury in anaesthesiology. Braz J Anesthesiol 2015; 65:511-8. [DOI: 10.1016/j.bjane.2013.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/15/2013] [Indexed: 11/28/2022] Open
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Lee KH, You TM, Park W, Lee SH, Jung BY, Pang NS, Kim KD. Protective dental splint for oroendotracheal intubation: experience of 202 cases. J Dent Anesth Pain Med 2015; 15:17-23. [PMID: 28879254 PMCID: PMC5564065 DOI: 10.17245/jdapm.2015.15.1.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 11/25/2022] Open
Abstract
Background Dental injury as a result of oroendotracheal intubation during general anesthesia is very common. We report our experiences of using mouthguard to prevent dental injury during intubation based on our protocol. Methods This retrospective study enrolled patients referred for preanesthetic evaluation, those patients with a history of any of the dental treatments to their anterior teeth listed on our fabrication protocol from January 1, 2009 to June 30, 2010. Results No cases of dental trauma during oroendotracheal intubation were reported among the 202 patients who used a protective device. 66% of the patients had risk factors for hard tissue damage aged 10-40 years. At the ages of 40-70 years, the incidence of risk group for periodontal damage was higher. Conclusions Preanesthetic consultation was effective for preventing dental injury, so preanesthetic questionnaire and proper dental consultation would be helpful.
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Affiliation(s)
- Kang-Hee Lee
- Department of Advanced General Dentistry, Yonsei University, Seoul, Korea
| | - Tae-Min You
- Department of Advanced General Dentistry, Dankook University, Cheonan, Korea
| | - Wonse Park
- Department of Advanced General Dentistry, Yonsei University, Seoul, Korea
| | - Sun Hwa Lee
- Department of Advanced General Dentistry, Yonsei University, Seoul, Korea
| | - Bock-Young Jung
- Department of Advanced General Dentistry, Yonsei University, Seoul, Korea
| | - Nan-Sim Pang
- Department of Advanced General Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Deog Kim
- Department of Advanced General Dentistry, Yonsei University, Seoul, Korea
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N. A. Azeredo F, W. C. Maia D, Pomarico L, A. Antunes L, S. Antunes L. Perceptions regarding the occurrence and prevention of orofacial injuries during general anesthesia. J Oral Sci 2015; 57:263-7. [DOI: 10.2334/josnusd.57.263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
| | | | - Luciana Pomarico
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Rio de Janeiro Federal University
| | - Lívia A. Antunes
- Department of Specific Formation, School of Dentistry, Fluminense Federal University
| | - Leonardo S. Antunes
- Department of Specific Formation, School of Dentistry, Fluminense Federal University
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Abstract
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.
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31
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Affiliation(s)
- F S Xue
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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Yang M, Kim J, Ahn H, Choi J, Kim D, Cho E. Double-lumen tube tracheal intubation using a rigid video-stylet: a randomized controlled comparison with the Macintosh laryngoscope. Br J Anaesth 2013; 111:990-5. [DOI: 10.1093/bja/aet281] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Mourão J, Neto J, Luís C, Moreno C, Barbosa J, Carvalho J, Tavares J. Dental injury after conventional direct laryngoscopy: a prospective observational study. Anaesthesia 2013; 68:1059-65. [DOI: 10.1111/anae.12342] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - J. Neto
- Institute of Biomedical Sciences Abel Salazar; University of Oporto; Oporto; Portugal
| | - C. Luís
- Department of Anaesthesia; Centro Hospitalar São João; EPE; Oporto; Portugal
| | - C. Moreno
- Department of Anaesthesia; Centro Hospitalar São João; EPE; Oporto; Portugal
| | - J. Barbosa
- Center for Medical Education; University of Oporto; Oporto; Portugal
| | - J. Carvalho
- Faculty of Dental Medicine; University of Oporto; Oporto; Portugal
| | - J. Tavares
- Department of Surgery; Faculty of Medicine; University of Oporto; Oporto; Portugal
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Sowmya B, Raghavendra P. Management of dental trauma to a developing permanent tooth during endotracheal intubation. J Anaesthesiol Clin Pharmacol 2013; 27:266-8. [PMID: 21772697 PMCID: PMC3127316 DOI: 10.4103/0970-9185.81843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Anesthesiologists consistently work in the mouth of patients but are not exposed to comprehensive education of teeth, the surrounding structures, and intraoral prosthesis. One of the most common adverse events related to anesthesia is perioperative dental damage. To minimize these dental injuries, a preoperative assessment of patient's dentition and intra-oral tissues should be undertaken.
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Affiliation(s)
- B Sowmya
- Department of Pedodontics and Preventive Dentistry, AJ Institute of Dental Sciences, NH-17, Kuntikana, Mangalore 04, Karnataka, India
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Ozer AB, Erhan OL, Demirel I, Keles E. Dental avulsion due to direct laryngoscopy during the induction of general anaesthesia and avulsed teeth in nasopharynx. BMJ Case Rep 2012; 2012:bcr-2012-006898. [PMID: 23001105 DOI: 10.1136/bcr-2012-006898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Ayse B Ozer
- Department of Anesthesiology and Reanimation, Firat University, Elazig, Turkey.
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Cheng Y, Xue FS, Li RP, Liao X. Comparison of forces applied to the maxillary incisors by direct and indirect laryngoscopes. Acta Anaesthesiol Scand 2012; 56:663-4; author reply 664-5. [PMID: 22313543 DOI: 10.1111/j.1399-6576.2012.02649.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Najafi M. Prevention of damage to teeth and gums: an often neglected advantage of indirect laryngoscopy with the Airtraq. Anaesthesia 2012; 67:545. [DOI: 10.1111/j.1365-2044.2012.07124.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M. Najafi
- Tehran University of Medical Sciences, Tehran Heart Center, Tehran, Iran
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Bernasinski M, Lepousé C, Bankole E, Rouche O, Milloncourt L, Leon A. [Financial and medicolegal impact of dental trauma]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:191-5. [PMID: 22377413 DOI: 10.1016/j.annfar.2011.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 12/06/2011] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Dental injuries are among the most common complications of general anesthesia. Yet few studies have assessed the costs and factors that involve the responsibility of the anesthetist. STUDY DESIGN A retrospective study was conducted at the university hospital of Reims on 46 cases of dental injuries directly related to anaesthesia. RESULTS Ten patients made a claim for compensation. Two of them have received compensation following a medical expertise, which revealed for the first patient a possible alternative to general anaesthesia, and the second, hardware failure of intubation. The Administrative Court was entered once in 9 years. The global insurance-cost amounts to 4476 euros for all patients. The review of all cases of anaesthesia shows clearly that the dental claims are associated with a significant under clinical evaluation of dental status and criteria for difficult intubation during the anaesthesia. The information to the patient on this risk is not obvious from reading the anaesthesia records. No mouth guard was used. CONCLUSION This work proves that the statements of caution are the most common and a minority of dental trauma lead to a claim. Claims are due to the high cost of dental care repair. The proportion of patients receiving benefits is extremely low. Medical expertise is an essential part of the evaluation of medical responsibilities. No compensation was paid without expertise. The lack of physical examination and information are contrary to our professional obligations and may involve our responsibility. The lack of patient information is not generated for compensation to the extent that the consequences of failure are easily dental weighed against the benefits of the entire medical-surgical procedure that the patient has agreed.
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Affiliation(s)
- M Bernasinski
- Centre hospitalier universitaire de Reims, 45, rue Cognacq-Jay, 51092 Reims, France.
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Vallejo MC, Best MW, Phelps AL, O'Donnell JM, Sah N, Kidwell RP, Williams JP. Perioperative dental injury at a tertiary care health system: An eight-year audit of 816,690 anesthetics. J Healthc Risk Manag 2012; 31:25-32. [PMID: 22359260 DOI: 10.1002/jhrm.20093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Among all complications of airway management, dental injury is the most common cause of patient complaints with medicolegal consequences. Over an 8-year period, data on dental injury were collected within a large university hospital system that included community, tertiary, and quaternary care centers. Patient characteristics were compared among all patients receiving anesthesia care using billing data collected from the same period. Of the 816,690 patients who received anesthesia care, there were 360 dental injuries, giving an overall incidence of 1:2,269 (0.044%). Patients receiving general anesthesia were at an increased risk for dental injuries, with an incidence of 1:1,754 (0.057%) compared with patients receiving monitored anesthesia care in whom the incidence was 1:12,500 (0.008%). Patients in the age group 18 to 65 years had a higher incidence of dental injuries of 1:1,818 (0.055%) compared with pediatric patients, who had an incidence of 1:7,692 (0.013%). Emergency procedures were not associated with an increased risk of dental injury in the 816,690 cases. However, of the 360 patients who sustained a dental injury, emergency procedures were associated with a higher incidence of injuring multiple teeth.
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Regional Anesthesia Considerations for Awake Endotracheal Intubation and Prevention and Management of Dental Injuries. Int Anesthesiol Clin 2012; 50:1-12. [DOI: 10.1097/aia.0b013e318218f651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Laidoowoo E, Baert O, Besnier E, Dureuil B. [Dental trauma and anaesthesiology: epidemiology and insurance-related impact over 4 years in Rouen teaching hospital]. ACTA ACUST UNITED AC 2011; 31:23-8. [PMID: 21742462 DOI: 10.1016/j.annfar.2011.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 05/02/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Dental injuries are the first cause of sinistrality in anaesthesiology. However, few insurance-related data are available concerning the publicly-owned establishments, in particular on the cost of the complaints deposited. We studied the epidemiology of dental trauma in a teaching hospital and brought it closer to the induced insurance-related costs. PATIENTS AND METHODS We conducted a retrospective study, examining the files of declaration of dental trauma, from January 2005 to December 2008. The litigations for dental injuries treated by Quality and Services Department were also analysed. RESULTS Seventy-two cases of dental lesions were declared, i.e. 1/1528 general anaesthesias. Concerning the risk factors of lesion, 47 patients (65%) presented bad dental conditions identified during the pre-anaesthetic consultation; 27 patients (37%) had criteria for difficult intubation listed on the sheet of anaesthesia. The association of the 2 factors was found among 20 patients. The indication of information to the patient on the dental risk was registered on the sheet of anaesthesia in 17% of cases. The Quality and Services Department recorded 23 complaints for dental trauma over the period. In 4 cases the complaint was followed by a compensation for an average amount equal to 608 (256-1002) Euros, i.e., a total cost of 2434 Euros. CONCLUSIONS The two main risk factors of dental lesion are well identified with the consultation of anaesthesia and are noted on the file. However, information to the patient on this risk is seldom notified. The incidence of dental lesions is important, but few complaints open right to financial repair for a very low insurance-related total amount.
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Affiliation(s)
- E Laidoowoo
- Département d'anesthésie-réanimation chirurgicale, Samu, groupe de recherche sur le handicap ventilatoire, CHU Charles-Nicolle, université de Rouen, France
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Fukuda T, Sugimoto Y, Yamashita S, Toyooka H, Tanaka M. Forces applied to the maxillary incisors during tracheal intubation and dental injury risks of intubation by beginners: a manikin study. ACTA ACUST UNITED AC 2011; 49:12-5. [PMID: 21453897 DOI: 10.1016/j.aat.2011.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 01/25/2011] [Accepted: 02/08/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We wished to determine whether dental injuries during intubation would occur more frequently when performed by inexperienced beginners. We measured the laryngoscopic force exerted on maxillary teeth of a modified manikin by experienced anesthesiologists and unexperienced medical students and estimated the injury risk. METHODS Thirty-two anesthesiologists and 32 medical students participated in this study. Each testee performed tracheal intubation in two scenarios in a random order. In Scenario 1, the testee performed tracheal intubation for a manikin as a patient with normal dentition, in an emergency type situation. In Scenario 2, the testee performed tracheal intubation for a manikin as a patient with unstable dentition, in a routine anesthetic situation. RESULTS The mean peak forces in Scenarios 1 and 2 were 6.1 and 1.1 N in the experienced testee group and 7.7 and 3.8 N in the unexperienced testee group, respectively (Scenario 2, p < 0.05). The unexperienced group applied higher forces than the experienced group in the nonemergency situation. However, the maximum force applied by the inexperienced group was 40.2 N, which is substantially lower than the maximum bite force of normal incisors (150-200 N). CONCLUSION Our results suggest that the experience levels of the laryngoscopists are not a major determinant of dental injuries in patients with healthy dentition.
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Affiliation(s)
- Taeko Fukuda
- Department of Anesthesiology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, Tsukuba University, Tsukuba, Ibaraki, Japan.
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Mourão J, Neto J, Viana JS, Carvalho J, Azevedo L, Tavares J. A prospective non-randomised study to compare oral trauma from laryngoscope versus laryngeal mask insertion. Dent Traumatol 2011; 27:127-30. [DOI: 10.1111/j.1600-9657.2010.00947.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Adolphs N, Kessler B, von Heymann C, Achterberg E, Spies C, Menneking H, Hoffmeister B. Dentoalveolar injury related to general anaesthesia: a 14 years review and a statement from the surgical point of view based on a retrospective analysis of the documentation of a university hospital. Dent Traumatol 2011; 27:10-4. [DOI: 10.1111/j.1600-9657.2010.00955.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Huang YF, Ting CK, Chang WK, Chan KH, Chen PT. Prevention of dental damage and improvement of difficult intubation using a paraglossal technique with a straight Miller blade. J Chin Med Assoc 2010; 73:553-6. [PMID: 21051035 DOI: 10.1016/s1726-4901(10)70120-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 05/24/2010] [Indexed: 12/01/2022] Open
Abstract
Patients with diseased teeth, or those who are difficult to intubate, have a higher risk of dental injury during laryngoscopy. We report 3 cases of smooth endotracheal intubation using a paraglossal technique with a straight Miller blade in patients with poor dentition. Three patients with poor dentition were scheduled to undergo surgery under general anesthesia. All patients presented with extremely loose upper central incisors and had lost the other right upper teeth, while micrognathia and prominent, loose upper incisors were noted in 1 case. We elected to use a straight Miller blade using a paraglossal approach. A nasopharyngeal airway was inserted after induction of general anesthesia to facilitate mask ventilation and prevent air leakage from the mask. The Miller blade was then inserted from the right corner of the mouth, avoiding contact with the vulnerable incisors, and advanced along the groove between the tongue and tonsil. The endotracheal tube was subsequently smoothly inserted after obtaining a grade 1 Cormack and Lehane view without dental trauma in all 3 cases. Direct laryngoscopy using the paraglossal straight blade technique avoids dental damage in patients with mobile upper incisors and no right maxillary molars. It is a practical alternative method that differs from the traditional Macintosh laryngoscope in patients with a high risk of dental injury during the procedure. This technique, which provides an improved view of the larynx, might also be helpful with patients in whom intubation is difficult.
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Affiliation(s)
- Yu-Feng Huang
- Department of Anesthesiology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C
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Almazrooa SA, Chen K, Nascimben L, Woo SB, Treister N. Osteonecrosis of the Mandible After Laryngoscopy and Endotracheal Tube Placement. Anesth Analg 2010; 111:437-41. [DOI: 10.1213/ane.0b013e3181e0cdcd] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Hume-Smith H, Fowler A, Vaz F, Suaris P. Dental implant removal to facilitate suspension laryngoscopy and laser treatment of an obstructed airway. Anaesthesia 2009; 65:78-81. [PMID: 19849679 DOI: 10.1111/j.1365-2044.2009.06080.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 29-year-old patient presented with dysphonia, dysphagia and a progressive history of stridor over 6 weeks. His past medical history included childhood nasolabial rhabdomyosarcoma treated by surgery, chemotherapy and radiotherapy. This had resulted in marked abnormalities of the facial skeleton, limited neck extension and restricted mouth opening of 1 cm, in part due to dental implants. After careful discussion and planning within a multidisciplinary team, the airway was optimised by temporary removal of the dental implants. This enabled a suspension laryngoscope to be passed, permitting carbon dioxide laser treatment to an obstruction at the laryngeal inlet and eliminating the need for a tracheostomy.
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Affiliation(s)
- H Hume-Smith
- Department of Anaesthesia, The Royal National Throat, Nose and Ear Hospital, London, UK
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Vogel J, Stübinger S, Kaufmann M, Krastl G, Filippi A. Dental injuries resulting from tracheal intubation - a retrospective study. Dent Traumatol 2009; 25:73-7. [DOI: 10.1111/j.1600-9657.2008.00670.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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