Swallowing Dysfunction in the Brain-Damaged with Drooling

Ekedahl, C; Månsson, Ingemar; Sandberg, N

doi:10.3109/00016487409126339

Cited by 59 publications

(25 citation statements)

References 4 publications

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“…Earlier reports showed ID is a risk factor of postoperative pulmonary complications [12], [13], which is compatible with our data that surgical patients with ID were at higher risk of developing pneumonia than patients without ID. Risk of aspiration pneumonia in patients with ID is substantially high due to multiple factors, including ID-associated gastroesophageal reflux [14], dysfunctional pharyngoesophageal sphincter [15], and anticonvulsants and/or tranquilizers that may cause hypersalivation when prescribed for ID-accompanying seizures [16]. Drugs for postoperative pain or agitation may also depress pharyngeal reflexes.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Adverse Outcomes in Intellectually Disabled Surgical Patients: A Nationwide Population-Based Study

et al. 2011

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BackgroundIntellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients.MethodsA nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact.ResultsControls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37), pneumonia (odds ratio 2.01, 1.61 to 2.49), postoperative bleeding (odds ratio 1.35, 1.09 to 1.68) and septicemia (odds ratio 2.43, 1.85 to 3.21) without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability.ConclusionIntellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients.

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Section: Discussionmentioning

confidence: 99%

Postoperative Adverse Outcomes in Intellectually Disabled Surgical Patients: A Nationwide Population-Based Study

et al. 2011

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“…Drooling is caused by the swallowing disorder and occurs in 10–58% of children with CP [11, 44, 46]. From a clinical point of view, it makes sense to distinguish between “anterior” and “posterior” drooling.…”

Section: Swallowing Problems In Cerebral Palsymentioning

confidence: 99%

Clinical practice

et al. 2011

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Cerebral palsy (CP) is the most common physical disability in early childhood. The worldwide prevalence of CP is approximately 2–2.5 per 1,000 live births. It has been clinically defined as a group of motor, cognitive, and perceptive impairments secondary to a non-progressive defect or lesion of the developing brain. Children with CP can have swallowing problems with severe drooling as one of the consequences. Malnutrition and recurrent aspiration pneumonia can increase the risk of morbidity and mortality. Early attention should be given to dysphagia and excessive drooling and their substantial contribution to the burden of a child with CP and his/her family. This review displays the important functional and anatomical issues related to swallowing problems in children with CP based on relevant literature and expert opinion. Furthermore, based on our experience, we describe a plan for approach of investigation and treatment of swallowing problems in cerebral palsy.

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“…All four published studies allude to or discuss potential problems with blinding and known issues with lack of uniform assessment tools and subjectivity of assessment tools. However, such quantitative measures of sialorrhea as measuring weight of saliva absorbed into cotton dental pads are not easily accomplished and do not measure patients’ physical discomfort or social embarrassment 1. Blasco and Stansbury suggest that subjectivity may have clinical validity, and reviews of glycopyrrolate and drooling11–14 also discuss issues related to appropriate outcome measure for drooling intervention studies.…”

Section: Resultsmentioning

confidence: 99%

“…Persistent and severe drooling is socially disabling for patients and families, complicates hygiene care, and causes secondary dermatologic and infectious problems. Chronic drooling is a common management issue, with reported prevalence rates varying from 10%1 to almost 40% 2. Most reports focus on children with cerebral palsy but may include patients with other neurological disorders.…”

Section: Introductionmentioning

confidence: 99%

Oral glycopyrrolate for the treatment of chronic severe drooling caused by neurological disorders in children

Evatt¹

2011

NDT

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Excessive drooling may complicate the care of children with chronic neurological conditions by socially isolating both patients and families and by causing secondary dermatitis and infection. Normal control of saliva requires normal integrity of oral structures, normal oropharyngeal sensation, and motor functioning, as well as normal cognitive awareness and rate of salivary production. Glycopyrrolate is an anticholinergic medication with a quaternary structure that recently received Food and Drug Administration approval to treat sialorrhea due to neurological problems in children ages 3–16 years. This review summarizes the few published studies of safety and efficacy of glycopyrrolate for drooling in children with chronic neurological conditions.

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Swallowing Dysfunction in the Brain-Damaged with Drooling

Cited by 59 publications

References 4 publications

Postoperative Adverse Outcomes in Intellectually Disabled Surgical Patients: A Nationwide Population-Based Study

Postoperative Adverse Outcomes in Intellectually Disabled Surgical Patients: A Nationwide Population-Based Study

Clinical practice

Oral glycopyrrolate for the treatment of chronic severe drooling caused by neurological disorders in children

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