Complications related to the administration of general anesthesia in 600 developmentally disabled dental patients

Dental treatment of patients with systemic diseases compared to patients with developmental disabilities under general anesthesia

The medical and dental records were examined for 46 patients with systemic diseases (SD) and 75 patients with developmental disabilities (DD) aged 2-20 years, who had received dental treatment under general anesthesia (GA). Age, gender, decayed missing and filled teeth (dmft/DMFT), dental procedures, duration of GA, and posttreatment hospitalization were recorded. Before treatment, dental disease in the primary teeth was significantly higher among the group with SD (p= 0.04). In the permanent teeth, dental disease was higher among the group with DD, though not significantly. More teeth were restored, (p= 0.015) and total dmft (p= 0.043) was significantly higher among subjects with SD. In the permanent teeth, more extracted and more restored teeth and higher DMFT were noted among subjects with DD, though not significantly. Only pulpectomies were significantly more prevalent among those with DD (p= 0.038). Six subjects needed hospitalization due to their diseases after GA.

Successful and safe delivery of anesthesia and perioperative care for children with complex special health care needs

STUDY OBJECTIVE

To determine the utilization of anesthesia resources by children with complex special health care needs.

DESIGN

Observational, inception cohort study of medical records.

SETTING

Urban, pediatric, tertiary-care hospital.

MEASUREMENTS

All general anesthetic cases were screened for preexisting complex special health care needs. Medical records were reviewed for demographic, clinical, and outcome data.

MAIN RESULTS

435 children with complex special health care needs accounted for 479 delivered general anesthetic cases. This figure represented 14% of the total 3,437 cases presenting during the study period. It also represented 22% (49 of 224) of all cancellations. Down syndrome was the most identifiable developmental disorder (n = 43, 9%). Another 143 (30%) cases showed preexisting technology dependence. Scheduled surgical procedures (n = 425, 89%) comprised the majority of cases. Intraoperative and recovery room complications occurred in 6 (1%) and 133 (28%) cases, respectively. Eleven (2.3%) cases required unplanned post-anesthetic hospital ward or pediatric intensive care unit admission. Documentation of health care proxy or resuscitation status was not identified in any child under 18 years, and in only 4 of 33 children older than 18 years.

CONCLUSIONS

Children with complex special health care needs represented one out of 7 of all pediatric general anesthetic cases at a tertiary-care, academic center.

General anesthesia for developmentally disabled dental care patients: a comparison of reinforced laryngeal mask airway and endotracheal intubation anesthesia

Providing dental care for developmentally disabled patients who require general anesthesia is challenging for both and dentists and anesthesiologists. This study aimed to compare the efficacy of two anesthetic methods for dental care. The researchers retrospectively analyzed morbidity data following anesthesia using either a reinforced laryngeal mask airway (LMA) or endotracheal intubation anesthesia for a two-year time period. The subjects were developmentally disabled patients receiving dental care. Statistical analyses were by unpaired student t-tests and chi-square tests. Patients were who anesthetized with a reinforced laryngeal mask airway had a significantly shorter recovery period and lower postanesthetic complication rates when compared to patients undergoing endotracheal intubation anesthesia. Although hypoxemia (SPO2 < 90%) during dental care occurred more frequently when using the reinforced laryngeal mask airway, the difference was not significant. Nausea and vomiting were the major complications in the postanesthetic care unit and after discharge. When complication rates were compared in the two patient groups, nausea and vomiting were significantly higher during postanesthetic care and after discharge in the intubated group. In conclusion, reinforced laryngeal mask airway provides general anesthesia with less risk of side effects for developmentally disabled patients undergoing dental care.

Early childhood caries-related visits to hospitals for ambulatory surgery in New York State

OBJECTIVES

The objective of this study was to assess the utilization of ambulatory surgery at hospitals for the treatment of early childhood caries in New York State.

METHODS

Data for this study came from the Statewide Planning and Research Cooperative System in New York State. We analyzed 16,149 oral health-related ambulatory surgeries performed between 1996 and 1999 in children younger than 6 years of age.

RESULTS

Between 1996 and 1999, the rate of hospitalization for dental caries in children younger than 6 years of age ranged from 180 to 193 cases per 100,000. Approximately two-thirds of the visits by children younger than 6 years old were due to dental caries. The highest rate was observed in 3-year-old children (346.5). The most frequent type of procedure performed was placement of stainless steel crowns. Medicaid was the primary source of reimbursement.

CONCLUSIONS

These data illustrate that, although dental caries is preventable, it continues to be a significant problem in young children and results in a large number of ambulatory surgery visits.

Daily general anaesthesia for radiotherapy in unco-operative patients: ingredients for successful management

An unco-operative patient requiring daily radiation therapy presents a difficult clinical problem. After reviewing the paediatric oncology literature addressing the use of general anaesthesia for short medical procedures, we have developed checklists of procedural guidelines and monitoring equipment for the safe use of daily anaesthesia in adult patients who require a fractionated course of radiation therapy. We illustrate this by describing the successful treatment of a woman with autism and Hodgkin's disease who required daily general anaesthesia for immobilization during a 4-week course of radiation therapy. Propofol was used as the primary drug and was not associated with any adverse side-effects. There was no development of tolerance.