Airway Obstruction in the Mentally Handicapped

Kt, Kavanagh; Ns, Beckford

doi:10.1097/00007611-199207000-00029

Cited by 6 publications

(3 citation statements)

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“…In the case of cerebral palsy and mental retardation, the patients can suffer from upper-airway stenosis. 21,22 Accordingly, the perioperative management of breathing functions is vital during dental treatment under sedation.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors With Intravenous Sedation for Patients With Disabilities

Yoshikawa

Tamaki

Okumura³

et al. 2013

Anesthesia Progress

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The purpose of this study was to identify the risk factors associated with low peripheral oxygen saturation (SpO 2 ) and delayed recovery of dental patients with disabilities after intravenous sedation. A total of 1213 patients with disabilities were retrospectively investigated with respect to demographic parameters and sedation conditions. Multivariate logistic analyses were conducted for patients with an SpO 2 ,90% and a recovery period of .60 minutes to identify the risk factors for poor sedation conditions. A significant odds ratio related to decreased SpO 2 was observed for age, sex, midazolam and propofol levels, concurrent use of nitrous oxide, cerebral palsy, Down syndrome, and mental retardation. The most problematic patients were those diagnosed with Down syndrome (odds ratio, 3.003-7.978; 95% confidence interval; P , .001). Decision tree analysis showed an increased risk of decreased SpO 2 in males with Down syndrome or after administration of .0.493 mg/kg propofol in combination with midazolam. An increased risk of delayed awakening was seen in patients aged less than 21 years and in males administered .0.032 mg/kg of midazolam. Intravenous sedation for dental patients with disabilities, particularly those with cerebral palsy, Down syndrome, or mental retardation, increases the risk of decreased SpO 2 . In addition, delayed recovery is expected after midazolam administration.

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Section: Discussionmentioning

confidence: 99%

Risk Factors With Intravenous Sedation for Patients With Disabilities

Yoshikawa

Tamaki

Okumura³

et al. 2013

Anesthesia Progress

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“…Sensorimotor integration of peripheral sensory afferent reflexes, brainstem function, and the motor efferent response are responsible for laryngeal function and tone. There is an association of LM with mental retardation and congenital anomalies 9–11. Central nervous system insults from drugs or alcohol, seizures, strokes, or hypoxic brain injury can also result in acquired LM 12.…”

Section: Discussionmentioning

confidence: 99%

Submucosal nerve hypertrophy in congenital laryngomalacia

et al. 2011

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“…Any adult with suspected thermal or caustic injury to the supraglottic structures should be approached in the same manner as those with acute infectious epiglottitis. The diagnosis of airway obstruction in mentally handicapped patients is aided with flexible nasopharyngoscopy 15 . Evidence of caustic or thermal ingestion in the mentally impaired patient should also alert the physician to investigate other sites of possible damage to the upper aerodigestive tract and may necessitate esophagogastroduodenoscopy.…”

Section: Discussionmentioning

confidence: 99%

Caustic and Thermal Epiglottitis in the Adult

Kornak

Freije

Campbell

1996

Otolaryngol.--head neck surg.

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Acute supraglottic injury can be mistaken for acute epiglottitis, particularly in the patient unable or unwilling to provide a history. This dilemma is heightened by recent reports that acute epiglottitis may be more common in adults than previously believed. 1,2 In addition, acute epiglottitis in the adult has a relatively unpredictable presentation. 3 We present injuries mimicking acute epiglottitis in two mentally impaired adult patients. CASE REPORTSCase t. A 51-year-old male institutionalized schizophrenic came to the emergency department approximately 6 hours after swallowing a hot tomato. He reported pain in his throat, dysphagia, and drooling during the previous several hours. On examination, the patient was drooling but had no stridor or apparent airway distress. His temperature was 100.2 ° F orally. Examination showed no obvious burns or lesions of the oropharynx. Indirect laryngoscopy revealed a swollen epiglottis covered with yellow exudate. The true vocal cords were normal in mobility. A swollen epiglottis was seen on lateral neck radiograph.The patient was admitted and placed on airway precautions. He began receiving intravenous ampicillin/sulbactam. Throughout 5 days of hospitalization his temperature defervesced, and his tolerance of oral intake gradually improved. Repeat indirect laryngoscopy was performed each day and revealed progressively less erythema and exudate of the epiglottis. On the day before discharge, the patient still exhibited a moderate amount of epiglottic edema; however, this had been remarkably reduced since admission. The patient remained afebrile with adequate oral intake and a stable airway. He was subsequently discharged from the hospital and continued receiving Augmentin 500 mg orally four times daily for 14 days. Examination at 3.5 weeks showed no residual injury.

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Airway Obstruction in the Mentally Handicapped

Cited by 6 publications

References 0 publications

Risk Factors With Intravenous Sedation for Patients With Disabilities

Risk Factors With Intravenous Sedation for Patients With Disabilities

Submucosal nerve hypertrophy in congenital laryngomalacia

Caustic and Thermal Epiglottitis in the Adult

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