Anestesia Odontoiatrica ed Emergenze

Testo che contiene le fondamenta della disciplina "Anestesia Odontoiatrica", materia sconosciuta in Italia fino al 1990. Tale disciplina deve essere considerata "orfana" in quanto non considerata adeguatamente n\ue8 dall'Anestesiologia medico-chirurgica n\ue8 dall'Odontoiatria

Medical litigation as a result of awareness during general anaesthesia: a case report

In the literature, little attention has been paid to the medico-legal implications of awareness during general anaesthesia, a complication which has been reported with an incidence of 0.5-2%. We present the case of a 39-year-old nurse who experienced awareness during salpingo-adnexectomy for tubo-ovarian pregnancy. The operation was performed as an emergency, due to severe haemorrhage. Anaesthesia was induced with 125 mg of thiopental sodium and 60 mg of succinylcholine, and then maintained with repeated doses of fentanyl and 7 mg of vecuronium. In the court settlement, medical liability was rejected, because her awareness during anaesthesia was ascribed to the need to use small quantities of anaesthetics, due to severe hypotension, and not to medical error. The case presented here and a brief review of the literature indicate that awareness during anaesthesia is not always a consequence of medical negligence

Anaesthesia techniques for dental patients with uncommon diseases. A series of case report

Anaesthesia techniques for dental procedures are rarely debated among dentists and anaesthesiologists. Recommendations, indications and contraindications for sedation and/or general anaesthesia in dentistry are not so clearly established. Published scientific evidence are lacking and all the recommendations are therefore based on strong agreement among professionals. Indications for dental treatment under general anaesthesia may be related to patient’s condition, to intervention or to local anaesthesia problems. Known contraindications to this treatment are the refusal by patient and/or patient’s relatives or legal representative and conditions of major risks (ASA III-IV patients). It is wide accepted, among dentists, that LA, along with iatrosedation should be routinely employed as the first treatment step. The next step should be the addition of conscious sedation, if needed, while GA should be considered as the last resort. First and second steps should be performed by the dentist also defined “sedationist”, in this setting. Benefits and risks of general anaesthesia should be considered before taking a decision, and minimal requirements are a pre-anaesthesia consultation providing information to patients and obtaining informed consent. In this paper we report our experience regarding the management of dental patients affected by uncommon systemic diseases and our opinion regarding this issue

The Relevance of Hypnosis and Behavioural Techniques in Dentistry

Dental fear is an universal phenomenon justifying the increasing relevance of psychology and the behavioral sciences to dental training and clinical practice. It has a wide-ranging and dynamic impact in patients\u2019 lives and shows some links with other anxiety disorders, as described in psychiatry, such as post-traumatic stress disorder (PTSD) and phobia. Pharmacological sedation has been introduced and used more and more over the past two decades, in order to relieve dental anxiety and phobia and let the patient face oral surgery safely. However, its use is only a step in a much more complex approach, the aim of which is helping the patient to overcome their anxiety and get rid of it. The appropriate approach includes several steps: (1) assessing dental anxiety; (2) proper communication and ensuring patients are thoroughly informed; (3) iatrosedation to make patients comfortable and earn their trust; (4) a properly performed local anaesthesia, able to ensure a full analgesia; and (5) hypnosis and/or a wise use of drugs to ensure full anxiety control as needed. Iatrosedation combines the principles of verbal and non-verbal communication and the emphatic approach pertaining to neurolinguistic programming. Given its effectiveness in relieving dental anxiety, it should be regarded as the essential strategy of communication with the patient. Hypnosis is a powerful tool in dentistry. A relevant advantage, unique to hypnosis, is its twofold role: (1) achieving an effective and even deep sedation and amnesia while maintaining the patient\u2019s collaboration; and (2) treating dental anxiety and phobia, helping the patient to overcome it, as well as other associated anxiety disorders (e.g., claustrophobia).As far as eye movement desensitizaion and reprocessing (EMDR) is concerned, there is still a shortage of information on EMDR in dentistry, but it might be potentially useful when dental phobia is related to previous bad experiences involving PTSD components. The superiority of hypnosis and other behavioural techniques in comparison with pharmacological sedation lies in their ability to help patients rid themselves of their dental anxiety. While pharmacological sedation only affords a temporary respite and helps the patient to cope with a single procedure, hypnosis and iatrosedation can effectively allow for both an excellent sedation in a physiological way and the treatment of patient\u2019s anxiety, helping them to get rid of their fear and other anxiety components