Providing deep sedation and general anesthesia for patients with special needs in the dental office‐based setting

Abstract

This article discusses the issues of morbidity and mortality associated with deep sedation and general anesthesia specifically in the dental office-based setting for patients with special needs (PSN). A focused review of a particular environment and patient population was challenging as it was difficult to identify articles that discuss the unique scope of this subject. During the review of the literature, no article was identified that discussed this exact topic. There were articles that discussed the delivery of general anesthesia for PSN in an outpatient setting and associated issues of morbidity and mortality. There were also articles and sources of information that discussed the delivery of general anesthesia for other patient populations in the office-based setting. In an effort to support the scope of this article, some of these articles are discussed as they pertain to the subject of this article. In addition, an analysis of the author's practice over a 4-year period is discussed in an effort to present relevant data per the scope of this article. After reviewing the literature and the author's clinical practice, it appears that the incidence of mortality for PSN in the dental office-based setting is minimal and the incidence of morbidity for this same population is limited to relatively minor events. Ultimately, it was concluded that the delivery of general anesthesia for PSN in the dental office-based setting can be considered a very safe and successful procedure.

Our Sedation Experience on Mentally Retarded Patients

“…Oniki hasta da (%5.6) cerrahi çekim işlemi ile birlikte periodontal tedavi görmüşlerdir. Bu hasta grubunda hem genel anestezi hemde sedasyon uygulamaları sıklıkla uygulanabilmektedir [5,[10][11][12]. Genel anestezi ağırlıklı olarak uygulanmasına rağmen diş tedavisi için %50 N2O/O2 sedasyonun bile %91.4 oranında başarılı olduğu da belirtilmiştir [13].…”

“…Çoğu zamanda midazolamın antikonvülzan özelliğinden faydalanmak için kombine şekilde kullanıyoruz. Literatürde de diş hekimliğinde bu hasta grubunda farklı anestezik ajanlar kullanılmıştır [4,5,10,12,13,17]. Benzodiazepinler, narkotik ajanlar ve propofol intravenöz sedasyon için sıklıkla kullanılmaktadır.…”

The use of general anesthesia to facilitate dental treatment in adult patients with special needs

“…In any case, it is clear that there are limited treatment options for patients that exhibit a certain level of resistance or lack of cooperation in the dental chair, and that general anesthesia is likely to be an appropriate method of treatment in such patients. However, the patients' lack of cooperation means that oral health professionals need to make decisions about whether a general anesthetic procedure is required without the relevant clinical data—such as descriptions and localization of pain, clinical examination, or radiographs—that would otherwise be used to develop diagnoses and appropriate treatment plans [ 14 15 ].…”

Effect Site Concentrations of Propofol for Dental Treatment under Deep Sedation in Intellectually Disabled Patients

“…Deep sedation or general anesthesia can offer certain degree of quality dental care without patient cooperation in the status of reduced or subdued body movement [3]. Moreover, It is helpful to induce a positive attitude toward future routine dental care [4].…”