1
|
Shah D, Sen J, Bawiskar D. Non-operating Room Anesthesia (NORA): A Comprehensive Review of Monitored Anesthesia Care. Cureus 2024; 16:e68024. [PMID: 39347359 PMCID: PMC11431130 DOI: 10.7759/cureus.68024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 08/28/2024] [Indexed: 10/01/2024] Open
Abstract
Monitored anesthesia care (MAC) is being increasingly employed in non-operative environments, particularly in the realms of endoscopy and magnetic resonance imaging (MRI) procedures. This in-depth analysis delves into the essential components of MAC within these specific contexts, with a primary focus on ensuring patient safety, evaluating efficacy, and assessing procedural outcomes. It is a common practice in endoscopic procedures to necessitate sedation for the purpose of alleviating discomfort and anxiety, ultimately ensuring patient cooperation and the successful completion of the procedure. MAC, which entails the administration of sedatives and analgesics under the close supervision of an anesthesia professional, offers a personalized approach that carefully balances the depth of sedation with maintaining optimal patient safety standards. Within the domain of MRI procedures, where challenges such as claustrophobia and motion artifacts can significantly impact the process, MAC plays a crucial role in providing a controlled setting that not only enhances image quality but also improves patient compliance throughout the procedure. The review extensively investigates the various pharmacological agents commonly utilized in these scenarios, including but not limited to midazolam and fentanyl, shedding light on their pharmacokinetic and pharmacodynamic properties specific to these contexts. Furthermore, the critical role of the anesthesia provider in effectively managing potential complications, such as respiratory depression, hemodynamic instability, and allergic reactions, is thoroughly examined and discussed. The analysis extends to the implementation of MAC protocols, encompassing pre-procedural assessments, continuous intra-procedural monitoring, and comprehensive post-procedural care, all aimed at ensuring the best possible outcomes for patients. Additionally, the review delves into the economic considerations associated with MAC, taking into account its impact on procedural efficiency, healthcare costs, and patient throughput within these settings. By exploring current guidelines and recommendations established by professional societies such as the American Society of Anesthesiologists (ASA), this review aims to provide a holistic understanding of the best practices in MAC for both endoscopy and MRI procedures. Through the synthesis of available evidence, the primary objective of this review is to contribute to informing clinical practices, enhancing patient safety measures, improving procedural success rates, and ultimately advocating for the broader adoption of monitored anesthesia care in diverse non-operative medical settings.
Collapse
Affiliation(s)
- Dhruv Shah
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayshree Sen
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dushyant Bawiskar
- Sports Medicine, Abhinav Bindra Targeting Performance, Bangalore, IND
| |
Collapse
|
2
|
Yazdanbakhsh E, Bohlouli B, Patterson S, Amin M. The use of general anesthesia for dental treatment of children with special healthcare needs in Alberta, Canada. Int J Paediatr Dent 2024. [PMID: 38988130 DOI: 10.1111/ipd.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/23/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Children with special healthcare needs (SHCN) often require specialized interventions due to their disabilities. Dental general anesthesia (DGA) is a treatment modality, which improves their access to care but concerns about repeated DGAs persist. AIM This study investigated DGA utilization in children with SHCN and identified factors associated with multiple DGAs in Alberta, Canada (2010-2020). DESIGN This retrospective population-based study used administrative data encompassing all children (<18 years) undergoing DGA in publicly funded facilities. Children were identified as SHCN based on their diagnosis codes and categorized into behavioral/psychiatric disorders, mental/intellectual disabilities, physical disabilities, systemic conditions, syndromes/congenital anomalies, physical-mental disabilities, and disabilities with medical conditions. RESULTS This study analyzed 3884 DGA visits for children with SHCN, predominantly males aged 6-11 and from low-income families. Mental/intellectual disabilities were prevalent (31.8%), and autism was the leading disease. Caries was the primary dental diagnosis across all groups, whereas pulp problems were higher in psychiatric/behavioral disorders (23.6%), and periodontal problems were more common in physical-mental disabilities (13.2%). 28.7% had multiple DGAs, with younger age, disabilities with medical conditions, mental/intellectual disabilities, and initial pulp treatments, increasing the likelihood of multiple DGAs. CONCLUSION This study highlights the importance of individualized prevention and less conservative treatments for younger children to reduce oral health disparities.
Collapse
Affiliation(s)
- Elnaz Yazdanbakhsh
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Babak Bohlouli
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Steven Patterson
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Amin
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
3
|
Pérez-García S, Acosta-Ibarra J, Ruiz-Roca JA, Añez C, Gargallo-Albiol J. Comparison of hemodynamic changes with general or local anesthesia during dental treatment in pediatric patients: A prospective clinical study. SPECIAL CARE IN DENTISTRY 2024; 44:563-574. [PMID: 37327048 DOI: 10.1111/scd.12890] [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: 03/16/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIM Severe hemodynamic fluctuations during dental treatment can trigger highly undesirable physical reactions. A study was made to determine whether the administration of propofol and sevoflurane contributes to the stabilization of hemodynamic parameters during dental treatment in pediatric patients versus the use of local anesthesia alone. MATERIALS AND METHODS Forty pediatric patients needing dental treatment were assigned to either general anesthesia with local anesthesia (study group [SG]) or local anesthesia alone (control group [CG]). Two percent sevoflurane in oxygen (100% oxygen, 5 L/min) and continuous propofol infusion (target-controlled infusion [TCI], 2 μg/mL) were used as general anesthesia agents in SG; and 2% lidocaine with 1:80,000 adrenaline was used as local anesthesia in both groups. Heart rate, blood pressure and oxygen saturation were measured before starting dental treatment (baseline) and every 10 min during dental treatment. RESULTS Blood pressure (p < .001), heart rate (p = .021) and oxygen saturation (p = .007) decreased substantially after the administration of general anesthesia. The levels of these parameters subsequently remained low and then recovered at the end of the procedure. On the other hand, the oxygen saturation values remained closer to baseline in SG versus CG. In contrast, the hemodynamic parameters experienced lesser fluctuations in CG than in SG. CONCLUSIONS General anesthesia affords more favorable cardiovascular parameters during the entire dental treatment in comparison to local anesthesia alone (blood pressure and heart rate decrease significantly and oxygen saturation proves more stable and with values closer to baseline), and allows dental treatment to be performed on healthy, lacking cooperative ability children who otherwise could not be treated with local anesthesia alone. No side effects were observed in either group.
Collapse
Affiliation(s)
- Silvia Pérez-García
- Department of Oral and Maxillofacial Surgery, International University of Catalonia, Barcelona, Spain
| | | | | | - Cristóbal Añez
- Universitat Rovira i Virgili, Anesthetist, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Jordi Gargallo-Albiol
- Department of Oral and Maxillofacial Surgery, International University of Catalonia, Barcelona, Spain
- Department of Periodontics and Oral Medicine, The University of Michigan, School of Dentistry, Ann Arbor, Michigan, USA
| |
Collapse
|
4
|
Li Y, Qu Q, Yue Y, Guo Y, Yi X. Evaluation of children's oral diagnosis and treatment using imaging examination using AI based Internet of Things. Technol Health Care 2024; 32:1323-1340. [PMID: 37781823 PMCID: PMC11091629 DOI: 10.3233/thc-230099] [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: 01/30/2023] [Accepted: 05/18/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Although cone beam computed tomography (CBCT) plays an important role in the diagnosis and treatment of oral diseases, its image segmentation method needs to be further improved, and there are still objections about the clinical application effect of general anesthesia (GA) on children's dental fear (CDF). OBJECTIVE This study aimed to investigate the application value of CBCT based on intelligent computer segmentation model in oral diagnosis and treatment of children in the context of biomedical signals, and to analyze the alleviating effect of GA on CDF. METHODS Based on the regional level set (CV) algorithm, the local binary fitting (LBF) model was introduced to optimize it, and the tooth CBCT image segmentation model CV-LBF was established to compare the segmentation accuracy (SA), maximum symmetric surface distance (MSSD), average symmetric surface distance (ASSD), over segmentation rate (OR), and under segmentation rate (UR) between these model and other algorithms. 82 children with CDF were divided into general anesthesia group (GAG) (n= 38) and controls (n= 44) according to the voluntary principle of their families. Children in GAG were treated with GA and controls with protective fixed intervention. Children's fear survey schedule-dental subscale (CFSS-DS) and Venham scores were counted before intervention in the two groups. CFSS-DS scores were recorded at 2 hours after intervention and after recovery in children in GAG. CFSS-DS and Venham scores were performed in all children 1 week after surgery. RESULTS The results showed that the SA value of CV-LBF algorithm was higher than that of region growing algorithm (P< 0.05). OR, UR, MSSD, and ASSD values of CV-LBF algorithm were evidently lower than those of other algorithms (P< 0.05). CFSS-DS scores were lower in GAG than in controls 2 hours after intervention and at return visits after 1 week of intervention (P< 0.001), and Venham scores were lower in GAG than in controls after intervention (P< 0.001). After intervention, the proportion of children with Venham grade 0, 1, 2, and 3 was obviously higher in GAG than in controls (P< 0.001), while the proportion of children with Venham grade 4 and 5 was clearly higher in controls than in GAG (P< 0.001). CONCLUSION The results revealed that the computer intelligent segmentation model CV-LBF has potential application value in CBCT image segmentation of children's teeth, and GA can effectively alleviate anxiety of children with CDF and can be used as biomedical signals.
Collapse
Affiliation(s)
- Yan Li
- Department of Anesthesiology, Yantai Mountain Hospital, Yantai, Shandong, China
| | - Qizhi Qu
- CT/MR Division, Liaocheng Third People’s Hospital, Liaocheng, Shandong, China
| | - Yuxue Yue
- CT/MR Division, Liaocheng Third People’s Hospital, Liaocheng, Shandong, China
| | - Yuxuan Guo
- Department of Stomatology, Affiliated Hospital of Northwest University/Xi’an Third Hospital, Xi’an, Shaanxi, China
| | - Xiuna Yi
- Department of Anesthesiology, Yantai Mountain Hospital, Yantai, Shandong, China
| |
Collapse
|
5
|
Pastore I, Bedin E, Marzari G, Bassi F, Gallo C, Mucignat-Caretta C. Behavioral guidance for improving dental care in autistic spectrum disorders. Front Psychiatry 2023; 14:1272638. [PMID: 38034927 PMCID: PMC10682214 DOI: 10.3389/fpsyt.2023.1272638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Autism spectrum disorders (ASDs) impair many aspects of everyday life and may prevent access to dental care, often limiting it to emergencies. Impaired oral health has long-lasting negative consequences on health status and on the acquisition of oral habits (e.g., oral respiration and grinding) or competencies (e.g., proper speech production). Children with ASD may be scared in the dental setting, which is rich in sensory stimuli and requires physical contact. Due to their behavioral manifestations, they represent a challenge for dentists and hygienists. We created a dedicated pathway with behavioral support for children with ASD to allow dental care and possibly limit the use of general anesthesia. Methods We evaluated the effects of behavioral support in a quasi-experimental design by comparing two groups of children with ASD. The first group (n = 84) was visited every 2 months for 3 years and received additional support (visual aids, caregiver training, and longer visit duration). A control group, matched for age and sex, was visited at least twice a year or more, if needed, according to standard healthcare guidelines. Results Compliance with the schedule was high throughout the 3 years. The degree of collaboration significantly improved after 1 year in the supported group, while the control group did not change. At the end of the study, collaboration remained significantly higher than at the beginning in the supported group. Half of dental treatments were possible without general anesthesia in supported children. No adverse effect was apparent on collaboration due to COVID-19 restrictions. Discussion Behavioral techniques improved the compliance of ASD children to regular dentistry visits and treatment. Furthermore, oral hygiene at home was similarly improved, addressing oral health from a lifelong perspective.
Collapse
Affiliation(s)
- Irene Pastore
- Community Dentistry Department, Ospedale Immacolata Concezione, Piove di Sacco, Italy
| | - Elena Bedin
- Community Dentistry Department, Ospedale Immacolata Concezione, Piove di Sacco, Italy
| | - Giulia Marzari
- Community Dentistry Department, Ospedale Immacolata Concezione, Piove di Sacco, Italy
| | - Francesca Bassi
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Claudio Gallo
- Community Dentistry Department, Ospedale Immacolata Concezione, Piove di Sacco, Italy
| | | |
Collapse
|
6
|
Chou CH, Tsai CL, Lin KL, Wu SC, Chiang MH, Huang HW, Hung KC. A new formula to predict the size and insertion depth of cuffed nasotracheal tube in children receiving dental surgery: a retrospective study. Sci Rep 2023; 13:12585. [PMID: 37537321 PMCID: PMC10400640 DOI: 10.1038/s41598-023-39793-0] [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: 03/25/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
This retrospective study aimed to develop a new formula for selecting the appropriate size and determining the depth of the cuffed nasotracheal intubation (NTI) for a cuffed endotracheal tube (cETT) in pediatric patients undergoing dental surgery. In addition, the clinical data on cETT (i.e., the size and depth of insertion) was compared with those calculated with age-based formulas to evaluate their correlation. A total number of 684 patients who received NTI were enrolled (healthy group, n = 607; special-need group, n = 77). The ETT size used in real-world scenarios was smaller (i.e., about 0.5 and 0.94 mm) than the age-based formula, while the ETT depth was greater (i.e., about 1.5 cm) than the age-based formula in both groups. In the healthy group, age, gender, and body weight were identified as predictors of ETT size and depth through multiple linear regression analysis, while only age and body weight were predictors in the special-needs group. New formulas were developed based on these findings, with ETT size = 3.98 + 0.052 × age + 0.048 × gender (male = 1, female = 0) + 0.023 × body weight (kg) and ETT depth = 15.1 + 0.43 × age + 0.300 × gender (male = 1, female = 0) + 0.007 × body weight (kg). The new formula could be useful for both healthy and special-need pediatric populations undergoing dental procedures.
Collapse
Affiliation(s)
- Chen-Hung Chou
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Ling Tsai
- Department of Pediatric Dentistry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kai-Lieh Lin
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Min-Hsien Chiang
- Department of Anesthesiology, Shin Huey Shin Hospital, Kaohsiung, Taiwan
| | - Hui-Wen Huang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, 804, Taiwan.
- Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung District, Tainan, 71004, Taiwan.
| |
Collapse
|
7
|
Turjanski S, Musić L, Špiljak B, Bučević Sojčić P, Karlović Z, Zajc I. Analysis of Hospital-Based Dental Procedures Under General Anesthesia in Uncooperative Patients: a Retrospective Study. Acta Stomatol Croat 2023; 57:22-31. [PMID: 37288155 PMCID: PMC10243710 DOI: 10.15644/asc57/1/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND General anesthesia is a well-documented therapeutic option for the provision of dental treatment, particularly in patients with special healthcare needs and uncooperative pediatric patients. OBJECTIVES This retrospective study aimed to analyze the characteristics of dental general anesthesia (DGA) procedures for uncooperative patients of all ages in a tertiary healthcare facility, Clinical Hospital Dubrava, in Zagreb, Croatia. MATERIAL AND METHODS The hospital records for the patients treated for various dental reasons under GA were obtained at the Clinical Hospital Dubrava in Zagreb, Croatia. RESULTS Between 2014 and 2019, a total of 810 DGA procedures were performed including 607 patients. The median age was 18 years. Almost half of the patients referred to undergo DGA procedures were from the City of Zagreb and Zagreb County, 27.8% (N=225) and 21.0% (N=170), respectively. More than 90% of patients undergoing DGA procedures were referred with 1 to 3 medical conditions. 47.9% of patients had 1 to 3 dental conditions, of which caries was the most common condition (95.7%). The mean waiting time (±SD) was 113.06 (±62.62) days. 90 patients (14.8%) were referred for dental procedures under GA more than once, accounting for 203 procedures (25.1%). CONCLUSIONS DGA remains a single dental treatment option for specific individuals. There is an institutional and, also, an organizational need to address the long waiting times and high repeated DGA rates.
Collapse
Affiliation(s)
- Sarah Turjanski
- Resident of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb and University Hospital Centre Zagreb
- Postgraduate doctoral study program, School of Dental Medicine, University of Zagreb
| | - Larisa Musić
- Department of Periodontology, School of Dental Medicine, University of Zagreb
| | - Bruno Špiljak
- Postgraduate doctoral study program, School of Dental Medicine, University of Zagreb
| | - Petra Bučević Sojčić
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb
| | - Zoran Karlović
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb and University Hospital Centre Zagreb
| | - Ivan Zajc
- Department of Oral Surgery, School of Dental Medicine, University of Zagreb and Clinical Hospital Dubrava, Zagreb
| |
Collapse
|
8
|
Gómez-Ríos I, Pérez-Silva A, Serna-Muñoz C, Ibáñez-López FJ, Periago-Bayonas PM, Ortiz-Ruiz AJ. Deep Sedation for Dental Care Management in Healthy and Special Health Care Needs Children: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3435. [PMID: 36834126 PMCID: PMC9960832 DOI: 10.3390/ijerph20043435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Very young children, and those with disabilities and extensive oral pathology, who cannot be treated in the dental chair, require deep sedation or general anesthesia for dental treatment. OBJECTIVE The aim of this study is to describe and compare the oral health status in healthy and SHCN children and the treatments performed under deep sedation on an outpatient basis with a minimal intervention approach, and their impact on quality of life. METHODS A retrospective study between 2006 and 2018 was made. A total of 230 medical records of healthy and SHCN children were included. The data extracted were age, sex, systemic health status, reason for sedation, oral health status before sedation, treatments administered during sedation, and follow-up. The quality of life after deep sedation of 85 children was studied through parental questionnaires. Descriptive and inferential analyses were made. RESULTS Of the 230 children, 47.4% were healthy and 52.6% were SHCN. The median age was 7.10 ± 3.40 years (5.04 ± 2.42 in healthy children and 8.95 ± 3.09 in SHCN children). The main reason for sedation was poor handling in the dental chair (99.5%). The most frequent pathologies were caries (90.9%) and pulp pathology (67.8%). Healthy children had more teeth affected by decay and with pulp involvement. Patients aged < 6 years received more pulpectomies and pulpotomies. After treatment, parents stated that children were more rested and less irascible, ate better, increased in weight, and had improved dental aesthetics. CONCLUSIONS Differences in treatments carried out did not depend on the general health status or the failure rate but on age, with more pulp treatments in healthy children who were younger, and more extractions near to the age of physiological turnover in children with SHCN who were older. Intervention under deep sedation with a minimally invasive treatments approach met the expectations of parents and guardians, as it improved the children's quality of life.
Collapse
Affiliation(s)
- Inmaculada Gómez-Ríos
- Department of Integrated Pediatric Dentistry, Biomedical Research Institute of Murcia, School of Dentistry, University of Murcia, 30008 Murcia, Spain
| | - Amparo Pérez-Silva
- Department of Integrated Pediatric Dentistry, Biomedical Research Institute of Murcia, School of Dentistry, University of Murcia, 30008 Murcia, Spain
| | - Clara Serna-Muñoz
- Department of Integrated Pediatric Dentistry, Biomedical Research Institute of Murcia, School of Dentistry, University of Murcia, 30008 Murcia, Spain
| | | | - Paula M. Periago-Bayonas
- Agronomic Engineering Department, Universidad Politécnica de Cartagena (UPCT), Paseo Alfonso XIII, 48, 30203 Cartagena, Spain
| | - Antonio J. Ortiz-Ruiz
- Department of Integrated Pediatric Dentistry, Biomedical Research Institute of Murcia, School of Dentistry, University of Murcia, 30008 Murcia, Spain
| |
Collapse
|