scholarly journals Pilot Study Comparing Nasal vs Oral Intubation for Dental Surgery by Physicians, Nurse Anesthetists, and Trainees

2018 ◽  
Vol 65 (2) ◽  
pp. 89-93 ◽  
Author(s):  
J. Patrick Bowman ◽  
Michael P. Nedley ◽  
Kimberly A. Jenkins ◽  
Charles R. Fahncke
Keyword(s):  
General Anesthesia ◽  
Dental Treatment ◽  
Nasotracheal Intubation ◽  
Orotracheal Intubation ◽  
Nurse Anesthetists ◽  
Radiographic Imaging ◽  
Dental Surgery ◽  
Physical Status Classification ◽  
Medicine Physician ◽  
Significant Difference

The purpose of this article was to determine if pediatric dental treatment under general anesthesia utilizing orotracheal intubation takes longer than using nasotracheal intubation techniques. Twenty-six American Society of Anesthesiologists Physical Status Classification I and II pediatric dental patients, ages 2–8 years treated under general anesthesia, were assigned to 1 of 2 groups: (a) nasotracheal intubation (control, n = 13), (b) orotracheal intubation (experimental, n = 13). Times for intubation, radiographic imaging, and dental procedures, as well as total case time were quantified. Data were collected on airway difficulty, numbers of providers needed for intubation, intubation attempts, and intubation trauma. There was a significant difference in mean intubation time (oral = 2.1 minutes versus nasal = 6.3 minutes; p < .01). There was no difference in mean radiograph time (oral = 4.2 minutes versus nasal = 3.4 minutes; p = .144), and overall radiograph image quality was not affected. There was no difference in dental procedure time (p = .603) or total case time (p = .695). Additional providers were needed for intubation and more attempts were required for nasotracheal intubation versus orotracheal intubation (6 additional providers/22 attempts vs 0 additional providers/15 attempts, p < .01 and p < .05, respectively). Nine of 13 nasotracheal intubations were rated as traumatic (69%) versus 0 of 13 for orotracheal intubations (0%) (p < .01). In 7/9 orotracheal intubation cases (78%), the tube was not moved during treatment (p < .01). Orotracheal intubation does not increase case time, does not interfere with radiographic imaging, and is less traumatic for the patient when performed by physician anesthesiologists, emergency and pediatric medicine physician residents, certified registered nurse anesthetists, and student nurse anesthetists, all with variable nasotracheal intubation experience.

Comparison among the Intubation Techniques Employed in the Course of Management of Pan-Facial Trauma

2021 ◽  
Author(s):  
Aravindh RJ
Keyword(s):  
General Anesthesia ◽  
Nasotracheal Intubation ◽  
Functional Results ◽  
Orotracheal Intubation ◽  
Facial Trauma ◽  
Minimal Risk ◽  
Intermaxillary Fixation ◽  
Intubation Technique ◽  
Submental Intubation ◽  
Intraoperative Period

Objective: To find the best method of intubation in patients sustaining pan-facial trauma by comparing the pros and cons of each technique. Materials and methods: Three different types of intubation techniques (nasotracheal intubation, orotracheal intubation, and sub-mental intubation) were considered in this study. The study population involves 9 patients who have undergone treatment for pan-facial trauma under general anesthesia (3 patients per technique) and the variables of clinical outcome of each group were recorded. Results: Nasal intubation is the most common and safest method of intubation. However, it can’t be used in some types of pan-facial trauma. In cases like these, oral intubation is not preferred. As it severely compromises maxillofacial repair because of interference with the placement of intermaxillary fixation [3](IMF), which is used to establish the patient s occlusion in the intraoperative period. Submental intubation is an alternative with minimal risk to tracheostomy when orotracheal or nasotracheal intubation is not appropriate. The submental intubation technique gave an uninterrupted surgical field, unobstructed airway, ease of gaining occlusion in general anesthesia, less intraoperative and postoperative complications and it overcomes the disadvantages of both nasotracheal and orotracheal intubation. Conclusion: Preferred techniques of securing an airway are orotracheal, nasotracheal intubation. However these techniques may not always be applicable, thus a trauma surgeon-anesthetist team should always have alternative techniques in their armamentarium which secures the patient's airways without interfering with occlusion, to gain at most postoperative esthetic and functional results.

scholarly journals A Comprehensive Approach Limiting Extractions under General Anesthesia Could Improve Oral Health

2020 ◽  
Vol 17 (19) ◽  
pp. 7336
Author(s):  
Nicolas Decerle ◽  
Pierre-Yves Cousson ◽  
Emmanuel Nicolas ◽  
Martine Hennequin
Keyword(s):  
Quality Of Life ◽  
Oral Health ◽  
General Anesthesia ◽  
Dental Treatment ◽  
Preoperative Evaluation ◽  
Health Related Quality ◽  
Dental Surgery ◽  
Related Quality ◽  
Health Related

Access to dental treatment could be difficult for some patients due to dental phobia or anxiety, cognitive or sensorial disabilities, systemic disorders, or social difficulties. General anesthesia (GA) was often indicated for dental surgery, and there is almost no available data on adapted procedures and materials that can be applied during GA for maintaining functional teeth on the arches and limiting oral dysfunctions. This study evaluates changes in oral health-related quality of life and mastication in a cohort of uncooperative patients treated under GA according to a comprehensive and conservative dental treatment approach. Dental status, oral health-related quality of life, chewed bolus granulometry, kinematic parameters of mastication, and food refusals were evaluated one month preoperatively (T0), and then one month (T1) and six months post-operatively (T2). One hundred and two adult patients (mean age ± SD: 32.2 ± 9.9 years; range: 18–57.7) participated in the preoperative evaluation, 87 were treated under GA of which 36 participated in the evaluation at T1 and 15 were evaluated at T2. Preoperative and postoperative data comparisons demonstrated that oral rehabilitation under GA helped increase chewing activity and oral health-related quality of life. The conditions for providing dental treatment under GA could be arranged to limit dental extractions in uncooperative patients.

scholarly journals Repeated General Anesthesia in a Patient With Noonan Syndrome

2015 ◽  
Vol 62 (2) ◽  
pp. 71-73 ◽  
Author(s):  
Yoshinao Asahi ◽  
Ryosuke Fujii ◽  
Naoko Usui ◽  
Hajime Kagamiuchi ◽  
Shiro Omichi ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Noonan Syndrome ◽  
Congenital Heart ◽  
Dental Treatment ◽  
Heart Diseases ◽  
Anesthetic Management ◽  
Nasotracheal Intubation ◽  
Suction Catheter ◽  
Congenital Heart Diseases ◽  
Autosomal Dominant Disorder

Abstract Noonan syndrome (NS) is an autosomal dominant disorder characterized by facial anomalies, short stature, chest deformity, congenital heart diseases, and other comorbidities. The challenges faced during anesthetic management of patients with NS could be due to congenital heart diseases, hemostatic disorders, and airway anomalies. Here we describe dental treatment under general anesthesia performed for a 28-year-old man with NS. He had characteristic features of NS along with mild pulmonary valve stenosis. Dental treatment under general anesthesia was performed successfully on 13 occasions with nasotracheal intubation under curve-tipped suction catheter guidance or insertion of a reinforced laryngeal mask airway. This case suggests that for patients with NS, who might present several challenges, dental anesthesiologists should consider the extent of the patient's disorders to enable them to perform dental treatment safely under general anesthesia.

A Retrospective Audit of Dental Treatment Provided to Special Needs Patients under General Anesthesia During a Ten-Year Period

2018 ◽  
Vol 42 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Sreekanth Kumar Mallineni ◽  
Cynthia Kar Y Yiu
Keyword(s):  
Stainless Steel ◽  
General Anesthesia ◽  
Special Needs ◽  
Recovery Time ◽  
Dental Treatment ◽  
Composite Restorations ◽  
Dental Procedures ◽  
Significant Difference ◽  
Operative Recovery ◽  
Amalgam Restorations

Objective: The purpose of this study was to perform a comprehensive audit of dental treatment provided to special needs patients (SNP) under general anesthesia (GA) over a ten-year period. Study design: Special needs patients who received dental treatment under GA as an in-patient at Queen Mary Hospital, Hong Kong SAR during the time period January 2002 and December 2011 were included in the study. The study population was divided into three groups, based on age (<6years, 6–12 years, >12 years). One-way ANOVA was used to evaluate the effect of “age group” on duration of treatment, post-recovery time, treatment procedures and utilization of different restorative materials. Kappa statistics were used for intra-examiner reliability. Results: A total of 275 patients (174 males and 101 females) were included in the study. The mean age of the patients at the time they received GA was 12.37±10.18 years. Dental procedures performed were mostly restorative in nature (47%). The >12 years group had significantly shorter treatment duration (p<0.05). No significant difference in post-operative recovery time was observed among the three age groups (p>0.05). The <6 years group received significantly less preventive, but more restorative procedures (p<0.05). Significantly fewer extractions were performed in the 6–12 years group (p<0.05). The use of composite restorations was significantly higher in the <6 years group; while amalgam restorations were more frequently used in the >12 years group (P<0.05). Stainless steel crowns were more frequently employed in SNP under 12 years of age (p<0.05). Intra-examiner reliability was good (k=0.94). Conclusions: Most of the dental procedures performed under GA on SNP were restorative procedures. For children less than 6 years of age, had longer treatment time under GA. Composite restorations and stainless steel crowns were more frequently used in the primary dentition and amalgam restorations were more frequently employed in the permanent dentition.

scholarly journals Pediatric Dental Surgery Under General Anesthesia: Uncooperative Children

2018 ◽  
Vol 65 (4) ◽  
pp. 225-230 ◽  
Author(s):  
Robert L. Campbell ◽  
Navin S. Shetty ◽  
Kaavya S. Shetty ◽  
Herbert L. Pope ◽  
Jeffrey R. Campbell
Keyword(s):  
General Anesthesia ◽  
Recovery Time ◽  
Pediatric Patients ◽  
Dental Treatment ◽  
Age Groups ◽  
Pulmonary Complications ◽  
Dental Practice ◽  
Dental Surgery ◽  
Dental Rehabilitation ◽  
Sedative Agents

Dental treatment of young pediatric patients can be confounded by lack of cooperation for dental rehabilitation procedures and even examination and/or radiographs. With the recent US Food and Drug Administration warning applied to many anesthetic/sedative agents for children less than 3 years old, a retrospective review of general anesthesia (GA) cases from 1 private pediatric dental practice was studied for age, gender, body mass index, anesthetic duration, airway management used, extent of dental surgical treatment, recovery time, and cardiac/pulmonary complications. For the 2016 calendar year, 351 consecutive GA cases were identified with patients aged 2–13 years. Of these, 336 underwent nasal endotracheal intubation. Forty-six of 351 patients (13%) were younger than 3 years. Median anesthesia duration was approximately 1.7 hours for all age groups. Dental treatment consisting of 8–9 teeth including crowns, fillings, and extractions was most frequently encountered. One hundred sixty-eight patients (48%), however, required care for 10–18 teeth. There were no episodes of significant oxygen desaturation. The overall complication rate was 1.1%, with 2 cases of postextubation croup, 1 case of mild intraoperative bronchospasm, and 1 case of intraoperative bradycardia. Complications did not correlate with children being overweight or obese.

Intra Operative Use of Anti Emetic Drugs for Children Undergoing Full Dental Rehabilitation under General Anesthesia. A Double Blind Randomized Clinical Trial

2016 ◽  
Vol 40 (3) ◽  
pp. 235-240 ◽  
Author(s):  
Hisham Y El Batawi ◽  
Ahmed A Shorrab
Keyword(s):  
Clinical Trial ◽  
General Anesthesia ◽  
Dental Treatment ◽  
Postoperative Nausea And Vomiting ◽  
Control Group ◽  
Double Blind ◽  
Dental Procedures ◽  
Dental Staff ◽  
Significant Difference ◽  
Dental Rehabilitation

Background: Postoperative Nausea and Vomiting (PONV) is a common complication following dental treatment under general anesthesia (DGA) that may lead to unplanned hospitalization, increased costs and dissatisfaction of parents. Aim: To investigate the incidence of Postoperative Vomiting (POV) on children who underwent dental rehabilitation under general anesthesia and to compare possible preventive effect of Dexamethasone and Ondansetron on occurrences of POV. Study design: A double blind randomized parallel clinical trial was carried out on 352 ASA I children who underwent DGA in a private Saudi hospital in Jeddah. Children were allocated randomly to four groups. Group D of 91 children, received Dexamethasone PONV prophylaxis, group O of 87 children received Ondansetron, group DO of 93 children received combination of the two drugs and group C the control group of 81 children. The three groups were investigated by blinded dental staff for POV episodes, number of times analgesia was needed and post anesthesia care unit time (PACUT). Results: There was a no significant difference between the two drugs on POV. There was a significant difference in POV between control group and groups D, O, and DO. There was significant reduction in need for analgesia in the Dexamethasone groups. The three groups, which had PONV prophylaxis, showed significant reduction in PACUT compared to control group. Conclusions: Antiemetic drugs are useful adjuncts in DGA. Some dental procedures may have higher emetic potential than others. The type of dental procedures done is to be considered when deciding the drug profile in children undergoing DGA.

Children Oral Health Following Treatment under General Anesthesia: A Retrospective Study

2021 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Oral Health ◽  
General Anesthesia ◽  
Behavior Management ◽  
Dental Treatment ◽  
Caries Experience ◽  
P Value ◽  
Behavior Changes ◽  
Carious Lesions ◽  
Number Of Patients ◽  
Significant Difference

Introduction: Dental treatment for children can be provided and completed in dental chair using one or more behavior management methods applied in dentistry. When these methods did not work, special behavior management technique such as treatment under general anesthesia (GA) may be provided for optimal dental treatment. The purpose of this study was to evaluate long term oral health status such as oral hygiene (OH), recall rate, behavior changes and development of new or recurrent carious lesions in children who received dental treatment under GA. Methods: Data were collected retrospectively from dental records of 433 children who received dental treatment under GA between 2006 and 2010. Collected data looked at 1) Age, 2) Gender, 3) OH before treatment and at the recall visits, 4) Behavior changes, 5) New or recurrent caries experience, and 6) Treatment of these lesions. Results: Age of patients ranged between 2 and 13 yrs. Boys to girls were 223 (51%) to 210 (48%) respectively. OH post operatively was significantly improved in comparison to that before treatment (p-Value < 0.0001). However, OH was almost the same among patients who attended recall visits (p-Value = 0.79). Number of patients who attended recall visits reduced significantly by time (p-Value < 0.0001). There was significant improvement in patient cooperation post operatively in comparison to that pre-operatively (p-Value < 0.0001). There was no significant difference in the incidence of new or recurrent carious lesions through recall visits (p-Value = 0.73). Conclusion: Dental treatment under GA did not seem to be effective in the improvement of OH or in reducing caries experience. However, children behavior showed some improvement in the follow up visits due to no active treatment required or simple dental procedures may be implemented.

Effects of Video Information on Parental Preoperative Anxiety Level and Their Perception of Conscious Sedation vs. General Anesthesia for the Dental Treatment of Their Young Child

2007 ◽  
Vol 31 (2) ◽  
pp. 90-92 ◽  
Author(s):  
Ari Kupietzky
Keyword(s):  
General Anesthesia ◽  
Conscious Sedation ◽  
Dental Treatment ◽  
Treatment Options ◽  
Young Patients ◽  
Anxiety Level ◽  
Preoperative Anxiety ◽  
Video Information ◽  
Significant Difference ◽  
The Impact

Aim. To investigate the impact of video information on parental preoperative anxiety and perception and their preference of conscious sedation versus general anesthesia for the dental treatment of young patients. Method/materials. Parents were given a verbal explanation regarding the two treatment options and were then asked to fill out a prescreening questionnaire. Their preference for mode of treatment was obtained and their preoperative anxiety level was measured on a visual analog scale (VAS). A video film depicting two children under going dental treatment with conscious sedation (CS) and a third child undergoing general anesthesia (GA) for dental treatment was shown to the parent. Following the viewing of the video film a post-screening questionnaire was given. Parents' post screening anxiety was measured and they were asked if their perception and preference of the two modes of treatment remained the same or changed. Results. 40 parents were included and completed the trial. The prescreening anxiety level of parents was 2.79 (± 1.05, SD) and was not significantly different than the post screening anxiety level of 2.91 (± .99 SD, paired t- test p=0.432). The majority of parents preferred CS to GA for the treatment of their child prior to screening of the video. Among the few who chose GA (n=5) all but one changed their choice after viewing the video to CS. However, this difference was not found to be statistically significant due to the small number of subjects in this group (McNemar test, p = 0.125). Most parents voiced the opinion that the video film contributed to their knowledge and also considered GA as having more risks than CS. An interesting finding was that a statistically significant difference was found regarding parent's perception of the two procedures and what they actually saw in the video. The majority of parents stated that their initial perception of GA was not similar to their viewing experience, conversely, CS matched their expectations. Conclusion. Parents' anxiety regarding their child's dental treatment under GA or CS is not affected by the viewing of a video film depicting either method. Parent's perception of GA is different than the actual procedure and may affect their choice of treatment.

scholarly journals Inhalation Conscious Sedation with Nitrous Oxide and Oxygen as Alternative to General Anesthesia in Precooperative, Fearful, and Disabled Pediatric Dental Patients: A Large Survey on 688 Working Sessions

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Angela Galeotti ◽  
Annelyse Garret Bernardin ◽  
Vincenzo D’Antò ◽  
Gianmaria Fabrizio Ferrazzano ◽  
Tina Gentile ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Adverse Effects ◽  
General Anesthesia ◽  
Conscious Sedation ◽  
Dental Treatment ◽  
Young Patients ◽  
Dental Patients ◽  
Dental Procedures ◽  
Significant Difference ◽  
Disabled Patients

Aim. To evaluate the effectiveness and the tolerability of the nitrous oxide sedation for dental treatment on a large pediatric sample constituting precooperative, fearful, and disabled patients.Methods. 472 noncooperating patients (aged 4 to 17) were treated under conscious sedation. The following data were calculated: average age; gender distribution; success/failure; adverse effects; number of treatments; kind of dental procedure undertaken; number of dental procedures for each working session; number of working sessions for each patient; differences between males and females and between healthy and disabled patients in relation to success; success in relation to age; and level of cooperation using Venham score.Results. 688 conscious sedations were carried out. The success was 86.3%. Adverse effects occurred in 2.5%. 1317 dental procedures were performed. In relation to the success, there was a statistically significant difference between healthy and disabled patients. Sex and age were not significant factors for the success. Venham score was higher at the first contact with the dentist than during the treatment.Conclusions. Inhalation conscious sedation represented an effective and safe method to obtain cooperation, even in very young patients, and it could reduce the number of pediatric patients referred to hospitals for general anesthesia.

scholarly journals Maxillary sinusitis developed as sequelae of accidental middle turbinectomy that occurred during nasotracheal intubation: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joungmin Kim ◽  
Taehee Pyeon ◽  
Hyun Jung Lee ◽  
Hyung Chae Yang
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinusitis ◽  
Nasotracheal Intubation ◽  
Middle Turbinate ◽  
Orotracheal Intubation ◽  
Late Complications ◽  
Lateral Nasal Wall ◽  
Dental Surgery ◽  
Tube Obstruction

Abstract Background Nasotracheal intubation is a very useful technique for orofacial or dental surgery. However, the technique itself can be more traumatic than that of orotracheal intubation. Complications such as turbinectomy or bleeding are often reported. However, little is known about the follow-up of patients after these complications. Case presentation The present case describes an accidental middle turbinectomy that led to endotracheal tube obstruction during nasotracheal intubation, and discusses its long-term follow-up. A 19-year-old man underwent mandibular surgery under general anesthesia and nasotracheal intubation. His right middle turbinate was completely avulsed and became firmly occluded within the tube during nasotracheal intubation. The nasotracheal intubation was performed again and the operation was completed safely. The patient was discharged without sequelae after postoperative care. However, he had symptoms of nasal obstruction and sleep disturbance for 3 months postoperatively. Synechiae were detected between the nasal septum and lateral nasal wall on a right rhinoscopic examination and facial computed tomography at 3 months postoperatively. Additionally, he showed ipsilateral maxillary sinusitis on facial computed tomography at the 2-year follow-up examination. Conclusions Nasotracheal intubation can cause late complications as well as early complications. Therefore, if nasotracheal intubation is to be performed, the anesthesiologist should identify the nasal anatomy of the patient accurately and prepare appropriately. In addition, if complications occur, follow-up observation should be performed.

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