scholarly journals Anesthetic Management of a Patient With Hereditary Angioedema for Oral Surgery

2019 ◽  
Vol 66 (1) ◽  
pp. 30-32
Author(s):  
Rumiko Hosokawa ◽  
Masanori Tsukamoto ◽  
Saki Nagano ◽  
Takeshi Yokoyama
Keyword(s):  
Hereditary Angioedema ◽  
Tooth Extraction ◽  
Dental Treatment ◽  
Oral Surgery ◽  
Anesthetic Management ◽  
Treatment Options ◽  
Third Molar ◽  
Intravenous Sedation ◽  
C1 Inhibitor ◽  
Impacted Third Molar

Hereditary angioedema (HAE) is a rare genetic disease that results from deficiency or dysfunction of C1 inhibitor (C1-INH). This disease is characterized by sudden attacks of angioedema. When edema occurs in the pharynx or larynx, it can lead to serious airway compromise, including death. Physical and/or psychological stress can trigger an attack. Dental treatment, including tooth extraction, is also a recognized trigger. We report a case of a 20-year-old male with HAE who required impacted third molar extractions. C1-INH concentrate was administered 1 hour before surgery, which was completed under deep intravenous sedation. This report describes the anesthetic management of a patient with HAE and reviews treatment options and concerns.

scholarly journals Anesthetic Management of a Patient With Citrullinemia Type I During Dental Treatment

2021 ◽  
Vol 68 (3) ◽  
pp. 158-162
Author(s):  
Makiko Shibuya ◽  
Rie Iwamoto ◽  
Yukifumi Kimura ◽  
Nobuhito Kamekura DDS ◽  
Toshiaki Fujisawa
Keyword(s):  
Dental Treatment ◽  
Genetic Disorder ◽  
Anesthetic Management ◽  
Third Molar ◽  
Intravenous Sedation ◽  
Type I ◽  
Oral Medications ◽  
Gag Reflex ◽  
Serum Ammonia ◽  
Citrullinemia Type I

We report a case involving intravenous sedation for third molar extractions in a 32-year-old man with citrullinemia type I (CTLN1), a genetic disorder that affects the urea cycle. The patient was diagnosed with CTLN1 after he exhibited seizures soon after birth and was intellectually disabled because of persistent hyperammonemia, although his recent serum ammonia levels were fairly well controlled. We planned to minimize his preoperative fasting, continue his routine oral medications, and monitor his serum ammonia levels at least twice. Sedation with midazolam and a propofol infusion was planned to suppress his gag reflex and reduce protein hypercatabolism due to stress. Epinephrine-containing local anesthetics, which enhance protein catabolism, were avoided, replaced by plain lidocaine for blocks and prilocaine with felypressin for infiltration anesthesia. No significant elevation in ammonia levels was observed. In patients with CTLN1, sedation can be useful for preventing hyperammonemia. Patients who develop symptomatic hyperammonemia may require urgent/emergent treatment involving other medical specialists. Therefore, preoperative endocrinology consultation, perioperative monitoring of serum ammonia levels, and preemptively coordinating for appropriate care in the event hyperammonemia occurs should all be considered.

scholarly journals Grados de ansiedad en la extracción de un tercer molar impactado. Diferencias de género / Anxiety Levels during Impacted Third Molar Extraction. Gender Differences

2017 ◽  
Vol 35 (75) ◽  
Author(s):  
Francisco Cázares de León ◽  
Alberto José Lozano Laín ◽  
Pedro Gutiérrez Lizardi ◽  
Alfredo Salinas Noyola
Keyword(s):  
Dental Treatment ◽  
Oral Surgery ◽  
Dental Anxiety ◽  
Third Molar ◽  
Sociocultural Factors ◽  
Dental Surgery ◽  
Dental Patients ◽  
Impacted Third Molar ◽  
Third Molar Extraction ◽  
Anxiety Levels

RESUMEN. Antecedentes: La ansiedad dental es común en los procedimientos de odontología y particularmente en los de cirugía oral Objetivo: Determinar el grado de ansiedad que se manifiesta ante la extracción quirúrgica de un tercer molar impactado y comparar los resultados de acuerdo a género. Métodos: El tipo de estudio es no experimental, con un diseño transversal, descriptivo y comparativo. La muestra estuvo conformada por 80 pacientes que acudieron a consulta odontológica de ambos géneros (28 varones y 52 mujeres) de entre 17 y 62 años de edad (media de 35.5 años). Resultados: Las mujeres tuvieron grados de ansiedad en un 56.3 %   contra un 27.5 % de los hombres, lo que indica que la proporción de ansiedad es mayor estadísticamente significativa para el género femenino. Conclusiones: la ansiedad es una emoción muy frecuente en los pacientes odontológicos particularmente en los que acuden a cirugía oral y específicamente en las extracciones de terceros molares. Existen diferencias entre géneros ya que el género femenino es el que presenta grados de ansiedad extrema, aunque hay que señalar que se deben considerar los factores socioculturales los cuales pueden determinar el comportamiento de cada individuo. Por último, es muy importante que el odontólogo haga uso de todas las técnicas y destrezas para evitar grados de ansiedad que pudieran conducir a estados críticos durante el tratamiento dental.ABSTRACT. Background: Dental anxiety is common in dental procedure and particular in dental surgery. Purpose: to determine the level of anxiety that is manifested before surgical removed of an impacted third molar and compare the results between the different gender. Methods: the type of study is not experimental design is transversal, but descriptive and comparative analysis. The sample consisted of 80 patients attending dental office of both male and female sex (28 males and 52 females) aged between 17 and 62 years old (mean 35.5 years). Results: the results showed that women anxiety levels showed at 53.4 % against 24.7 % of men, indicating that the proportion of anxiety is significantly higher for women. Conclusions: anxiety is a common emotion in dental patients particularly those who come to oral surgery and specifically in the third molar extractions. There are differences between genders and the female is the one with degrees of extreme anxiety, although it should be noted to consider the sociocultural factors which can determine the behavior of each individual. Finally, it is very important that the dentist makes use of all the techniques and skills to avoid anxiety levels that could lead to critical states during dental treatment.

scholarly journals TRISMUS

2018 ◽  
Vol 25 (02) ◽  
pp. 226-231
Author(s):  
Alvina Ali Shaikh ◽  
Salman Shafique ◽  
Hassan Shahid
Keyword(s):  
Tooth Extraction ◽  
Oral Surgery ◽  
Third Molar ◽  
Third Molar Surgery ◽  
Surgical Removal ◽  
Exclusion Criteria ◽  
Impacted Third Molar ◽  
Group A ◽  
Mandibular Teeth ◽  
Teeth Extraction

Objectives: To compare trismus in surgical removal of impacted mandibularthird molar using comma incision and standard Wards incision. Study Design: Cross sectionalstudy. Setting: Dental OPD of Isra Dental College, Isra University. Period: 1st January to 30thJune 2016. Materials and Methods: A sample of 50 patients of impacted third molar wasselected by non-probability purposive sampling for tooth extraction either by conventionaltechnique or by coma shaped incision at the Department of Oral surgery, Isra Dental CollegeHospital. Patients were selected according to inclusion and exclusion criteria. Post-operativemeasurement of trismus was measured on 1st, 3rd and 7th day respectively. Results: Mean ±SD age in group A and B was noted as 28.5 ± 4.32 and 27.2 ± 4.39 years respectively. Maleand female in groups A and B were noted as 16 (64%) and 9 (36%), & 14 (56%) and 11 (44%)respectively. Right and left lower mandibular teeth extraction in groups A and B were noted 11and 14, & 10 and 15 respectively. Trismus was measured preoperatively and subsequently atday 1, day 3 and day 7. Conclusion: In conclusion, the Coma incision was preferable over theconventional method- the standard Ward`s incision because of lesser degree of trismus seen.Further research with newer flap designs and the comma design should be preferred by theclinicians for the extraction of impacted third molar surgery.

scholarly journals Intravenous Sedation in Arnold-Chiari Malformation With Respiratory Failure

2019 ◽  
Vol 66 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Yoshiki Shionoya ◽  
Eishi Nakamura ◽  
Takahiro Goi ◽  
Kiminari Nakamura ◽  
Katsuhisa Sunada
Keyword(s):  
Respiratory Failure ◽  
Respiratory Depression ◽  
Chiari Malformation ◽  
Dental Treatment ◽  
Anesthetic Management ◽  
Cranial Nerves ◽  
Intravenous Sedation ◽  
Type Ii ◽  
Neck Extension ◽  
Arnold Chiari Malformation

Type II Arnold-Chiari malformation (ACM) is an abnormality in which the cerebellum, pons, and medulla oblongata are displaced downward into the spinal cord. Type II ACM is often complicated by respiratory depression, sleep-disordered breathing, and deglutition disorder as a result of medullary dysfunction and impairment of the lower cranial nerves. Bending and stretching of the neck is restricted, and anesthetic management is problematic in patients with the disorder. We performed dental treatment twice under intravenous sedation in a patient with intellectual disability with type II ACM complicated by hypercapnic respiratory failure. Propofol was used for the first sedation procedure. Repeated bouts of respiratory depression occurred on that occasion, so the airway was managed manually by lifting the jaw. However, aspiration pneumonitis occurred postoperatively. A combination of dexmedetomidine and midazolam was used for sedation on the second occasion, and the intervention was completed uneventfully without any respiratory depression. Our experience with this patient highlights the need for selection of an agent for intravenous sedation that does not require neck extension and has minimal effect on respiration in patients with type II ACM, who are at high risk of respiratory depression and pulmonary aspiration.

Treatment Strategy for Odontogenic Sinusitis

2020 ◽  
pp. 194589242094696 ◽  
Author(s):  
Byung Joon Yoo ◽  
Seon Min Jung ◽  
Ha Na Lee ◽  
Hyung Gu Kim ◽  
Jae Ho Chung ◽  
...  
Keyword(s):  
Dental Caries ◽  
Medical Management ◽  
Tooth Extraction ◽  
Dental Treatment ◽  
Treatment Options ◽  
Trauma Surgery ◽  
Sinus Surgery ◽  
Clinical Parameters ◽  
Periapical Abscess ◽  
Odontogenic Sinusitis

Background The treatment options for odontogenic sinusitis (OS) include medical management including antibiotics and saline nasal irrigation, endoscopic sinus surgery (ESS), and dental treatment. Objective The purpose of this study was to evaluate whether OS caused by dental caries and periapical abscess can be cured by dental treatment alone and which patients should consider surgery early. Methods A total of 33 patients with OS caused by dental caries and periapical abscess were enrolled. Patients with OS caused by dental implants, trauma, surgery, or tooth extraction were excluded. All patients were initially treated with dental treatment and medical management without ESS. The patients were divided into two groups according to the results of dental treatment and multiple clinical parameters were compared between the two groups. Results Among the 33 enrolled patients, 22 patients (67%) were cured with dental and medical management, and 11 patients (33%) required ESS after the failure of dental and medical management. Based on the multivariate analysis results, patients who were smokers (OR 33.4) and had a higher Lund-Mackay score on CT (OR 2.0) required ESS after the failure of dental and medical treatment. Conclusions Two-thirds of the patients with OS caused by dental caries and periapical abscess were cured with dental treatment and medical management without ESS. We recommend dental treatment and medical management first in OS caused by dental caries and periapical abscess. However, we recommend early ESS in patients with smoking habits and severe CT findings of the sinus.

Hereditary Angioedema: Management of Laryngeal Attacks

2011 ◽  
Vol 25 (6) ◽  
pp. 379-382 ◽  
Author(s):  
Sandra C. Christiansen ◽  
Bruce L. Zuraw
Keyword(s):  
Hereditary Angioedema ◽  
Treatment Options ◽  
The United States ◽  
Fresh Frozen Plasma ◽  
C1 Inhibitor ◽  
Acute Therapy ◽  
Fresh Frozen ◽  
Life Threatening ◽  
Frozen Plasma ◽  
Future Management

Background Hereditary angioedema (HAE) patients suffering from laryngeal attacks in the United States faced severely limited treatment options until 2008. These potentially life-threatening episodes occur in over one-half of the patients affected by HAE during their lifetimes. Acute therapy had been relegated to supportive care, intubation, and consideration of fresh frozen plasma (FFP)–-the latter with the potential for actually accelerating the speed and severity of the swelling. Methods In this article we will review the recently approved and emerging HAE treatments that have evolved from the recognition that bradykinin generation is the fundamental abnormality leading to attacks of angioedema. Results Acute therapy for laryngeal attacks will be discussed including purified plasma–derived C1 inhibitor (C1INH), recombinant C1INH, an inhibitor of plasma kallikrein (ecallantide), and a B2 receptor antagonist (icatibant). Prophylactic care has also been transformed from a reliance on attenuated androgens with their attendant side effects to C1INH replacement. Conclusion The arrival of these novel therapies promises to transform the future management of HAE.

Current treatment options for hereditary angioedema due to C1 inhibitor deficiency

2015 ◽  
Vol 17 (1) ◽  
pp. 27-40 ◽  
Author(s):  
Maddalena Alessandra Wu ◽  
Andrea Zanichelli ◽  
Marta Mansi ◽  
Marco Cicardi
Keyword(s):  
Hereditary Angioedema ◽  
Treatment Options ◽  
Current Treatment ◽  
C1 Inhibitor ◽  
C1 Inhibitor Deficiency

Changing Pattern of Intra-Alveolar Extraction in the Southwest Nigeria

2019 ◽  
Author(s):  
Emmanuel A. Adelusi
Keyword(s):  
Tooth Extraction ◽  
Oral Surgery ◽  
Third Molar ◽  
Female Gender ◽  
P Value ◽  
Chi Square ◽  
Second Molar ◽  
Southwest Nigeria ◽  
Chi Square Test ◽  
The Difference

Introduction: Though changing patterns of tooth extraction have been reported in the literature which included the age, gender, tooth type and indications for extraction, there is still paucity of studies that have examined the variation and changes in the pattern of tooth extraction over a period of time in a given nation. We therefore accessed the pattern and indications of tooth loss in the patients who presented at oral surgery clinic for intra-alveolar tooth extraction over a twelve month period. Methods: This is a prospective cohort study of adult patients tooth extraction between September 2015 and August 2016. Patients’ demographic and clinical data were collected with a structured questionnaire. Data were analyzed using statistical package for social sciences (SPSS) version 23.0. Variables were subjected to Pearson’s chi-square test and P <0.05 was considered statistically significant. Results: A total of 240 adults age range between 18 to 75 years of age with mean age of 36.64 years were included in the analysis. Maxillary teeth (231) and mandibular teeth (326) were extracted in 203 and 263 patients respectively. Caries and its sequelae, 223(93%) were the predominant indication for tooth extractions. Lower second molar (25%), and upper third molar (20%) had the highest frequencies. More female (126, 52.5%) than male (114, 47.5%) had extraction done, the difference is however not statistically significant (X2 =1.67, P Value = 0.195) Conclusions: Dental caries and its sequelae are the most frequent cause of tooth extraction. Tooth extraction was more in Patients in the fourth decade as well as in the Female gender, even though the difference between male and female is not statistically significant. And there is increased in number of male who had extraction done compared to what obtained in the past decades. Left side of the mouth appeared to be more affected.

scholarly journals Dexmedetomidine Infusion for Routine Dental Management of an ASA IV Patient: A Case Report

2017 ◽  
Vol 64 (2) ◽  
pp. 88-96 ◽  
Author(s):  
Andrew S. Young ◽  
Nicholas A. Russell ◽  
Joseph A. Giovannitti
Keyword(s):  
Case Report ◽  
Dental Treatment ◽  
Anesthetic Management ◽  
Functional Decline ◽  
Intravenous Sedation ◽  
Clinical Effects ◽  
Dental Management ◽  
Patients Experience ◽  
Dexmedetomidine Infusion ◽  
Caucasian Female

Anesthetic management of elderly patients requires numerous physiological considerations. With aging, degenerative changes occur in the structure and functional capacity of tissues and organs. Typically, these patients experience clinical effects with lower doses of medication. Important considerations for the geriatric populations following anesthesia include increased time to recovery and avoidance of functional decline. A case is reported in which an 83-year-old Caucasian female with a complex medical history presented for routine dental treatment under intravenous sedation via dexmedetomidine infusion.

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