scholarly journals Acceptability of intravenous propofol sedation for adolescent dental care

2019 ◽  
Vol 21 (3) ◽  
pp. 295-302
Author(s):  
C. Dixon ◽  
A. Aspinall ◽  
S. Rolfe ◽  
C. Stevens
Keyword(s):  
General Anaesthesia ◽  
Thematic Analysis ◽  
Dental Care ◽  
Patient Reported Outcomes ◽  
Dental Treatment ◽  
Anaesthetic Agent ◽  
Patient Acceptability ◽  
Propofol Sedation ◽  
Patient Reported ◽  
Adolescent Patients

Abstract Purpose Propofol is an intravenous anaesthetic agent commonly utilised in general anaesthesia, however in sub-anaesthetic concentrations can be utilised to provide sedation through automated dosing of target-controlled infusion (TCI). TCI has been shown to provide accurate and stable predicted plasma and effect-site concentrations of propofol. A four-part mixed-method prospective study was undertaken to evaluate the safety and patient acceptability of intravenous propofol sedation in adolescent patients requiring dental care. There is a paucity in the literature on patient-reported outcomes and patient safety in the management of adolescent patients for dental treatment. Methods Demographics were recorded including age, gender, ASA Classification and Children’s Fear Survey Schedule—Dental Subscale (CFSS-DS) completed pre-operatively. Behaviour ratings of the Frankl and Houpt scales were recorded followed by post-operative questionnaire and telephone consultation. Consultation was completed following the procedure to determine patient satisfaction, memory of the procedure and any reported side effects of treatment. Qualitative thematic analysis was utilised. Results 55 patients were recruited for the study, of which 49 (mean age 14.67 years) completed the sedation study and were treated safely with no post-operative complications. The mean lowest oxygen saturation was 98.12% SpO2 (SD 2.6). Thematic analysis demonstrated positive patient-reported outcomes to IV sedation. Conclusion Propofol TCI sedation is an effective treatment modality for the management of dentally anxious adolescents as a safe alternative to general anaesthesia, allowing the opportunity for increased provision of treatment per visit on those patients with a high dental need. Further randomised controlled trials comparing propofol TCI to other pharmacological managements are required.

Dental care for the bariatric patient

Dental Update ◽  
2021 ◽  
Vol 48 (4) ◽  
pp. 302-306
Author(s):  
Jessica Hamilton ◽  
Mary Gittins ◽  
Andrew Geddis-Regan ◽  
Graham Walton
Keyword(s):  
General Anaesthesia ◽  
Dental Care ◽  
Clinical Relevance ◽  
Conscious Sedation ◽  
Dental Treatment ◽  
Careful Consideration ◽  
Equitable Access ◽  
Bariatric Patient ◽  
Access To Dental Care ◽  
Obese Population

As the overweight and obese population increases, one must be mindful of the implications on the delivery of dental care to this group. Appropriate facilities must be available, which may warrant structural and equipment adaptations to clinical and non-clinical areas. The complexity of dental treatment planning and delivery may be compounded by medical comorbidities, and careful consideration must be given to the suitability and safety of conscious sedation and general anaesthesia in order to facilitate treatment. This article aims to discuss how safe provision and equitable access to dental care can be achieved for the bariatric population. CPD/Clinical Relevance: This article aims to discuss the challenges posed by the increase in the overweight and obese population and considerations to be taken for provision of safe and equitable bariatric dental care.

Involving patients to improve their care through real-time patient reported outcome (PRO)-CTCAE chemotoxicity surveys in an outpatient chemodaycare (DC) setting: Evaluating patient acceptability.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 64-64 ◽  
Author(s):  
Hannah Solomon ◽  
Catherine Brown ◽  
Ashlee Vennettilli ◽  
Aein Zarrin ◽  
Aditi Dobriyal ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Quality Care ◽  
Patient Characteristics ◽  
Patient Reported Outcome ◽  
Clinic Visit ◽  
Survey Method ◽  
Patient Acceptance ◽  
Patient Acceptability ◽  
Patient Reported ◽  
Patient’S Perception

64 Background: In a busy DC setting, the efficiency of identifying important treatment toxicities is essential to quality care. Using a systematic approach to collecting patient-reported outcomes in the waiting rooms of DC units is one possible means of improving care while involving patients. This study reports such a pilot study, and the associated assessment of patient acceptance of this approach. Methods: 156 cancer patients over the age of 18 receiving chemotherapy treatment at Princess Margaret Cancer Centre completed a patient-reported chemotoxicity assessment using PRO-CTCAE items on tablet technology. Main symptoms assessed were: fatigue, nausea and vomiting, diarrhea and constipation, pain, aching muscles and/or joints and dysgeusia. Patient’s perception on the usefulness of PROMs and their willingness to complete such a tool routinely was assessed. Results: The median age was 53.5 (range: 19-88 years), 38% were male and 66% were Caucasian. Over 80% did not find the survey overly time consuming (or made their visit more difficult). Less than 1% were distressed by the survey questions. Over 80% reported that the survey asked the appropriate questions. While 81% considered the PROMs useful in informing their physician of their symptoms, 25% reported they would not be willing to complete the survey at each clinic visit. Another 25% were unsure of their feelings toward this approach. 93% were happy to complete the survey using tablet touchscreen technology. Conclusions: Most patients found the survey method of self-reporting one’s symptoms to be acceptable, non-distressful, and an important practice. From the patient perspective, the process of reporting one’s symptoms using tablet touchscreen technology is both simple and feasible.Yet, only 50% of patients would be willing to complete this survey at every clinic visit. Additional mixed-methods analysis looking at patient characteristics associated with acceptance/non-acceptance and willingness to complete the survey on a regular basis is ongoing and will be reported at the conference.

Too old to sedate: How old is too old?

Dental Update ◽  
2021 ◽  
Vol 48 (2) ◽  
pp. 106-113
Author(s):  
Natalie Bradley
Keyword(s):  
Older People ◽  
General Anaesthesia ◽  
Old Age ◽  
Dental Care ◽  
Clinical Relevance ◽  
Older Patients ◽  
Dental Treatment ◽  
Anxiety Control ◽  
The Uk ◽  
Dental Work

The UK population is ageing with over a quarter of people predicted to be over 65 by 2040. People are retaining their teeth into old age, often having experienced complex restorative dental work over the years. The increasing complexity of dental treatment that older people require will create challenges for those who provide care for this population, including dental treatment under sedation or general anaesthesia. This article discusses the medical, dental and social considerations that need to be taken into account when planning dental care for older patients under sedation or general anaesthesia. CPD/Clinical Relevance: Dentists who provide sedation must be able to appropriately assess and manage their older patients safely if considering this method of pain and anxiety control for dental treatment.

scholarly journals Patient-Reported Outcomes, Return-to-Sport Status, and Reinjury Rates After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Minimum 2-Year Follow-up

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096447
Author(s):  
Lilah Fones ◽  
Regina O. Kostyun ◽  
Andrew D. Cohen ◽  
J. Lee Pace
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Function ◽  
Adolescent Athletes ◽  
Patient Reported ◽  
Adolescent Patients ◽  
Anterior Cruciate

Background: Significant variation exists in the published rates of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR). Functional outcomes and psychological response to injury have been implicated as factors that influence return to sport. Most studies focus on patients aged in the mid-20s, and less is known about this topic in adolescents. Purpose: To report midterm ACLR results for adolescent patients with regard to return to primary sport, patient-reported outcomes, and reinjury rate. Study Design: Case-control study; Level of evidence, 3. Methods: Adolescent athletes were contacted at a minimum of 2 years after ACLR. Patients completed 2 patient-reported outcome measures, the ACL--Return to Sport After Injury (ACL-RSI) and the International Knee Documentation Committee (IKDC) subjective form, and responded to questions regarding preinjury primary sport and level of competition, post-ACLR return to primary sport status, and reinjury. Results: A total of 74 patients (mean ± SD surgical age, 15.9 ± 1.5 years; follow-up age, 19.9 ± 2.0 years; response rate, 24.5%) completed the surveys at a mean of 4.0 ± 2.0 years after primary ACLR. Outcome scores averaged 90.3 ± 12.3 for IKDC and 81.6 ± 20.4 for ACL-RSI. Questionnaire responses indicated that 27.0% of patients did not return to or sustain primary sport participation after ACLR; the principal reasons were poor knee function, team/training change, and fear of another injury. Both IKDC and ACL-RSI scores were statistically lower in patients who did not successfully return to their primary sport in contrast to patients who successfully resumed their primary sport (IKDC, P = .026; ACL-RSI, P < .001). IKDC and ACL-RSI scores were moderately positively correlated with one another ( r Spearman = 0.60). There were 18 patients (reinjury rate, 24.3%) who suffered another ACL injury; 8 of these injuries included ipsilateral ACL graft tear (retear rate, 10.8%). Conclusion: In our cohort, 73% of adolescent patients successfully returned to their primary preinjury sport at a minimum of 2 years after ACLR. Both knee function and psychological responses to injury were important in determining an adolescent athlete’s return to sport. The findings support the use of the IKDC and ACL-RSI at midterm follow-up, with higher scores associated with a greater likelihood of adolescent patients returning to sport after ACLR.

A Care Pathway for Children Unable to Accept Dental Care within the General Dental Services Involving the Use of Inhalation Sedation and General Anaesthesia

2015 ◽  
Vol 4 (2) ◽  
pp. 29-34 ◽  
Author(s):  
Allyson R Shepherd ◽  
Halimah Ali
Keyword(s):  
General Anaesthesia ◽  
Dental Care ◽  
Dental Treatment ◽  
Care Pathway ◽  
Treatment Modalities ◽  
General Anaesthetic ◽  
Dental Services ◽  
Inhalation Sedation ◽  
Dental Practitioners ◽  
The Right

Dental treatment is the commonest reason for a child to be in hospital in the UK. This is a shocking statistic for a preventable disease. How can we reduce the high numbers of dental general anaesthetics? It is essential that dental treatment under general anaesthesia (GA) is fully justifiable, ensuring that the right patients receive the right treatment. Guidance for general dental practitioners on when to refer a child for a dental GA is discussed. Treatment planning for this dentally high-risk group of children requires a holistic approach. It is complex and requires an experienced and competent clinical team, including dental care professionals with additional postgraduate qualifications. Often, alternative treatments are successful and a GA can be avoided. An audit of 85 patients referred for GA with Oldham Community Dental Service demonstrated 35% of patients accepted treatment with local anaesthesia only, 25% required inhalation sedation and only 25% were actually referred on for GA. Treatment for this group of patients must include the availability and provision of appropriate alternative treatment modalities, with the right staff and facilities, including those for dental general anaesthetic sessions. Ongoing follow-up within the general dental services is essential for this group of patients.

scholarly journals PATIENT REPORTED OUTCOMES ARE ASSOCIATED WITH ISOMETRIC STRENGTH DEFICITS EARLY AFTER ACL RECONSTRUCTION IN ADOLESCENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0022
Author(s):  
Adam Weaver ◽  
Lauren Macmillan ◽  
Danielle Suprenant ◽  
Nicholas Giampetruzzi
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Pearson Correlation ◽  
Return To Sport ◽  
Peak Torque ◽  
Isometric Strength ◽  
Patient Reported ◽  
Adolescent Patients ◽  
The Relationship

Background: Quadriceps Femoris (QF) strength has been identified to impact patient reported function following ACL reconstruction (ACLR) at time of return to sport. Patients with higher subjective reports of knee function displayed greater QF symmetry. To our knowledge the relationship between patient reported outcomes and strength measurements have not been studied during the rehabilitation process in adolescent patients post ACLR. Hypothesis/Purpose: The purpose of this study was to examine the relationship of International Knee Documentation Committee subjective form (IKDC) and the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scores to isometric QF strength at three months status post ACLR. Methods: A retrospective chart review was conducted on patients treated with ACLR between July 2017 and April 2019 at a single institution. Patients between 12 and 20 years of age that underwent ACLR and completed a three-month functional tests assessment were included in the study. Data was collected for IKDC and ACL-RSI scores, and isometric strength testing at 60° of knee flexion on the HUMAC isokinetic dynamometer (CSMI USA, Stoughton, MA). Pearson correlation was used to determine if there is an association between IKDC and isometric strength, and Spearman Correlation to determine if there is an association between ACL-RSI and isometric strength. Results: The cohort included 138 patients (68 females; 16.16±1.88) (97.31±16.12 post-op days) status post ACLR, with an average IKDC score of 69.73±13.19 and average ACL-RSI score of 60.08±24.19. Hamstring autografts were the most common reconstruction (n=80, 58%). The average QF peak torque was 71.30±28.98 ft-lbs and average isometric QF strength deficit was 31.07±23.85 percent. IKDC scores were positively associated with QF peak torque isometric strength (r=0.437, P=<.0001). ACL-RSI scores were also positively associated with peak torque QF isometric strength (r=0.284, P=.001) and negatively associated with QF strength deficit (r= -.279, P=<.002). Conclusion: IKDC and RSI were positively associated with QF isometric strength in adolescent patients three months status post ACLR. These finding suggest that QF strength impacts patients’ reported function and psychological readiness to return to sport at this time point. Possible impact on rehabilitation includes implementing strategies to progress QF strength from three months status post to time of return to sport.

scholarly journals The structure of dental procedures under general anaesthesia in children and adolescents with epilepsy

2014 ◽  
Vol 124 (1) ◽  
pp. 29-32
Author(s):  
Małgorzata Tkaczuk-Płocica ◽  
Jolanta Szymańska ◽  
Joanna Rosiak
Keyword(s):  
Children And Adolescents ◽  
General Anaesthesia ◽  
Dental Care ◽  
Dental Treatment ◽  
Mixed Dentition ◽  
Permanent Teeth ◽  
Treatment Needs ◽  
Deciduous Dentition ◽  
Occlusal Surfaces ◽  
Patients With Epilepsy

Abstract Introduction. One of the indications for dental treatment in general anaesthesia of children and adolescents is the patients’ refusal to cooperate with the dentist; this concerns especially the so-called special care patients, and among them, those suffering from epilepsy. Aim. The aim of the study was to evaluate the structure of treatment procedures in conservative dentistry and dental surgery performed under general anaesthesia in children and adolescents with epilepsy. Material and methods. The analysis covered case histories of 109 patients with epilepsy, aged 3-18 years, who received dental treatment under general anaesthesia. The patients were divided into three age groups, according to the dentition type: patients with deciduous dentition - 3-5 years of age; with mixed dentition - 6-12 years, and with permanent dentition - 13-18 years. The analysis concerned the procedures on both deciduous and permanent teeth. Results. An average number of extractions in a child with full deciduous dentition was 3.9 teeth, while in a child with mixed dentition - 2.7 teeth. The greatest number of deciduous teeth extractions concerned first and second molars. Carious cavities in the occlusal surfaces of permanent teeth, due to deep caries, were the most frequently treated lesions. Conclusions. In patients with epilepsy treated under general anaesthesia, extensive treatment needs, resulting from prophylactic and therapeutic neglect in dental care, were found. Conservative and surgical treatment, combined with prophylactic procedures, performed under general anaesthesia seems one of the necessary elements of a complex dental care in uncooperative children and adolescents

A Comparison of Costs in Providing Dental Care for Special Needs Patients under Sedation or General Anaesthesia in the North East of England

2006 ◽  
Vol os13 (4) ◽  
pp. 125-128 ◽  
Author(s):  
Neeta T Prabhu ◽  
June H Nunn ◽  
David J Evans
Keyword(s):  
Special Needs ◽  
General Anaesthesia ◽  
Dental Care ◽  
Dental Treatment ◽  
Dental Service ◽  
North East ◽  
The North ◽  
The Cost ◽  
Mean Cost ◽  
Service Managers

Objective To compare the costs of providing dental treatment under general anaesthesia or sedation for special needs patients. Methods After a Delphi exercise, a questionnaire was designed, piloted and then sent to nine NHS Trust dental service managers, within the Salaried Dental Services in the North East of England, to obtain information on the costs incurred during the treatment of special needs patients using sedation or general anaesthesia. The questionnaire related to the average number of such patients treated per session, staff costs, depreciation cost for buildings and equipment, and overhead costs including consumables and drugs. Results All nine dental service managers returned completed questionnaires. The all-inclusive cost for treatment per patient under general anaesthesia ranged from £203.65–£479.50 (mean cost: £285.79) and for sedation from £57.60–£153.50 (mean cost: £90.81). On average three special needs patients were treated per session. The greatest variation in the costs for general anaesthesia was due to staffing costs, which ranged from £1064.10 to £350.00 per session across the Trusts. Conclusions In the small number of centres sampled, the cost of delivering dental care under sedation or general anaesthesia was shown to vary widely. Overall, the mean cost of sedation was one-third that of general anaesthesia. However, the cost of both was substantial and cognisance needs to be taken of the costs of such services.

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