Problems in managing a co-morbid patient with no previous medical records undergoing alternative therapy

2021 ◽  
pp. 002581722110380
Author(s):  
Joanna Baptist ◽  
Premalatha Shetty ◽  
Rica Singh ◽  
Basavaprabhu Achappa
Keyword(s):  
Intellectual Disability ◽  
General Anaesthesia ◽  
Antiepileptic Drugs ◽  
Medical Records ◽  
Alternative Therapy ◽  
Autistic Spectrum ◽  
Anaesthetic Agents ◽  
Medical Evaluation ◽  
Hormonal Dysfunction ◽  
Legal Consequences

Individuals with intellectual disability are often uncooperative for complete dental evaluation and treatment. Many of these patients fall within autistic spectrum disease. These patients are also said to be associated with other medically relevant disorders such as seizures, and metabolic and hormonal dysfunction. Undertaking treatment of such patients under general anaesthesia will require complete medical evaluation. As many of the antiepileptic drugs interact with anaesthetic agents, a sound knowledge of drugs taken by the patient is necessary. However, when the patient is under alternative therapy, this problem becomes multi-fold. This paper will discuss the basic, but real problems with the gap of understanding between allopathic and alternative therapy, the importance of reviewing the patients’, previous medical records, and its medico-legal consequences. It will also raise the issue of delays in management with increased cost and time of hospitalisation in such patients.

Impairment Tutorial: Spinal Cord Stimulation and Intraspinal Opioids:Impairment Rating Issues

2000 ◽  
Vol 5 (5) ◽  
pp. 4-5
Author(s):  
James B. Talmage ◽  
Leon H. Ensalada
Keyword(s):  
Medical Records ◽  
Evaluation Process ◽  
Current Approach ◽  
Satisfaction Survey ◽  
Start Time ◽  
Medical Evaluation ◽  
Independent Medical Evaluation ◽  
Other Information ◽  
Physician Reviews ◽  
Written Informed Consent

Abstract Evaluators must understand the complex overall process that makes up an independent medical evaluation (IME), whether the purpose of the evaluation is to assess impairment or other care issues. Part 1 of this article provides an overview of the process, and Part 2 [in this issue] reviews the pre-evaluation process in detail. The IME process comprises three phases: pre-evaluation, evaluation, and postevaluation. Pre-evaluation begins when a client requests an IME and provides the physician with medical records and other information. The following steps occur at the time of an evaluation: 1) patient is greeted; arrival time is noted; 2) identity of the examinee is verified; 3) the evaluation process is explained and written informed consent is obtained; 4) questions or inventories are completed; 5) physician reviews radiographs or diagnostic studies; 6) physician records start time and interviews examinee; 7) physician may dictate the history in the presence of the examinee; 8) physician examines examinee with staff member in attendance, documenting negative, physical, and nonphysiologic findings; 9) physician concludes evaluation, records end time, and provides a satisfaction survey to examinee; 10) examinee returns satisfaction survey before departure. Postevaluation work includes preparing the IME report, which is best done immediately after the evaluation. To perfect the IME process, examiners can assess their current approach to IMEs, identify strengths and weaknesses, and consider what can be done to improve efficiency and quality.

scholarly journals Intravenous anaesthesia in goats: A review

2013 ◽  
Vol 84 (1) ◽  
Author(s):  
T. Brighton Dzikiti
Keyword(s):  
General Anaesthesia ◽  
Muscle Relaxation ◽  
Scientific Information ◽  
Working Environment ◽  
Total Intravenous Anaesthesia ◽  
Intravenous Anaesthesia ◽  
Anaesthetic Agents ◽  
Inhalation Anaesthetic ◽  
Intravenous Anaesthetic ◽  
Balanced Anaesthesia

Intravenous anaesthesia is gradually becoming popular in veterinary practice. Traditionally, general anaesthesia is induced with intravenous drugs and then maintained with inhalation agents. Inhalation anaesthetic agents cause more significant dose-dependent cardiorespiratory depression than intravenous anaesthetic drugs, creating a need to use less of the inhalation anaesthetic agents for maintenance of general anaesthesia by supplementing with intravenous anaesthesia drugs. Better still, if anaesthesia is maintained completely with intravenous anaesthetic drugs, autonomic functions remain more stable intra-operatively. Patient recovery from anaesthesia is smoother and there is less pollution of the working environment than happens with inhalation anaesthetic agents. Recently, a number of drugs with profiles (pharmacokinetic and pharmacodynamic) suitable for prolonged intravenous anaesthesia have been studied, mostly in humans and, to a certain extent, in dogs and horses. There is currently very little scientific information on total intravenous anaesthesia in goats, although, in the past few years, some scholarly scientific articles on drugs suitable for partial intravenous anaesthesia in goats have been published. This review article explored the information available on drugs that have been assessed for partial intravenous anaesthesia in goats, with the aim of promoting incorporation of these drugs into total intravenous anaesthesia protocols in clinical practice. That way, balanced anaesthesia, a technique in which drugs are included in anaesthetic protocols for specific desired effects (hypnosis, analgesia, muscle relaxation, autonomic stabilisation) may be utilised in improving the welfare of goats undergoing general anaesthesia.

scholarly journals Association of Prenatal Exposure to Valproate and Other Antiepileptic Drugs With Intellectual Disability and Delayed Childhood Milestones

2020 ◽  
Vol 3 (11) ◽  
pp. e2025570
Author(s):  
Christine Aarenstrup Daugaard ◽  
Lars Pedersen ◽  
Yuelian Sun ◽  
Julie Werenberg Dreier ◽  
Jakob Christensen
Keyword(s):  
Intellectual Disability ◽  
Antiepileptic Drugs ◽  
Prenatal Exposure

scholarly journals Complete Dental Management of an Autism and Intellectual Disability Patient under General Anaesthesia: A Case Report

2021 ◽  
Vol 55 (8) ◽  
Author(s):  
Karin Nadia Firsty ◽  
Nailur Rahmy Wahdany ◽  
Dian Lupita Sari ◽  
Yesri Sasmita Purba ◽  
Tania Saskianti ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
General Anaesthesia ◽  
Neurodevelopmental Disorder ◽  
Autism Spectrum ◽  
Recurrent Pain ◽  
Restricted Interests ◽  
Posterior Teeth ◽  
Dental Management ◽  
Left Posterior ◽  
Patient Cooperation

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and the presence of restricted interests and repetitive behaviours. Comorbidities following ASD, such as seizure, intellectual disability, and sensory impairment worsen patients’ ability to care for themselves. We present the case of a 22-year-old man with autism, intellectual disability and visual impairment who had recurrent pain in his upper and lower left posterior teeth that had cavities. On the first visit, the patient was observed and had panoramic x-ray. Clinical examination could not be done properly due to lack of patient cooperation. Restoration, pulp capping, tooth extraction, and odontectomy were planned under general anaesthesia.

scholarly journals Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yuzo Shimazu ◽  
Rie Otsuki ◽  
Masao Murakami ◽  
Akio Konishi ◽  
Keiichi Kan ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Cancer Patients ◽  
Proton Therapy ◽  
Medical Records ◽  
Odds Ratio ◽  
Proton Beam Therapy ◽  
Background Information ◽  
Paediatric Cancer ◽  
Treatment Protocols ◽  
General Anaesthesia Group

Abstract Proton therapy for paediatric cancer patients is an effective treatment; however, young children have may have difficulties staying still during irradiation. This study investigated the indication of general anaesthesia in paediatric proton therapy. Background information and anaesthesia/treatment protocols were retrospectively extracted from the medical records of cancer patients under 15 years who underwent proton therapy at Southern TOHOKU General Hospital, Fukushima, Japan between April 2016 and December 2018. The anaesthesia and non-anaesthesia groups were compared to evaluate factors determining the need for general anaesthesia. Thirty-two patients who received 285 irradiations were analysed. The median age was 5 years old (range: 1–15), and 13 patients (40.6%) were female. Twelve (37.5%) patients received general anaesthesia. In the general anaesthesia group, airway management using a laryngeal mask was performed in 11 patients (91.6%). Patient age was significantly lower in the general anaesthesia group than in the non-anaesthetised group (p < 0.001). Considering all background factors, only age was strongly associated with anaesthesia in the univariate logistic regression model (odds ratio 0.55 [95% confidence interval 0.35–0.86]; P < 0.01). Thus, age is one of the most important factors determining the need for general anaesthesia during proton therapy in children.

scholarly journals Intellectual disability in patients with epilepsy with eyelid myoclonias

2018 ◽  
Vol 6 ◽  
pp. 2050313X1877795 ◽  
Author(s):  
Maria Arvio ◽  
Oili Sauna-aho ◽  
Timo Nyrke ◽  
Nina Bjelogrlic-Laakso
Keyword(s):  
Intellectual Disability ◽  
Antiepileptic Drugs ◽  
Magnetic Resonance Imaging Finding ◽  
Well Being ◽  
Physical Growth ◽  
Childhood And Adolescence ◽  
Normal Brain ◽  
Narrow Spectrum ◽  
Average Intelligence ◽  
Patients With Epilepsy

We describe here the clinical outcome of four women with epilepsy with eyelid myoclonia (aged 21–53 years). All patients had an uneventful early history, normal physical growth and appearance and no comorbid sensory or motor disability and normal brain magnetic resonance imaging finding. Two women were moderately and one mildly intellectually disabled and one showed a low-average intelligence. The overall well-being of the patients was hampered by psychiatric or various somatic comorbidities and related psychosocial problems. The three women with an intellectual disability had been treated with narrow-spectrum antiepileptic drugs and one also with vigabatrin during childhood and adolescence. The patient with a low-average intelligence had been on broad-spectrum antiepileptic medication (i.e. valproate and ethosuximide) since the epilepsy diagnosis but she has had compliance problems. Based on these cases, the cognitive deficits in patients with epilepsy with eyelid myoclonia may occur more commonly than what has been thought hitherto. We discuss the role of narrow-spectrum antiepileptic drugs as a contributing factor to poor seizure control and an impaired intelligence.

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