Pasienter med tannbehandlingsvegring : en analyse av dagens tilbud i Aust-Agder med forslag til forbedringer, spesielt med tanke på innføring av dyp sedasjon som behandlingsmetode

Det finnes et ikke ubetydelig antall pasienter med tannbehandlingsvegring i Norge. Disse pasientene har ikke noe reelt behandlingstilbud innenfor det offentlige helsevesenet i dag. Vi har kartlagt omfanget av tannbehandlingsvegring og behov for et styrket tilbud til disse pasientene ved hjelp av et spørreskjema sendt ut til samtlige tannleger i Aust-Agder. Omfanget av behandlingsvegring tilsvarer i vår studie omtrent omfanget av dette i andre studier fra inn-og utland. Tannlegenes behandlingsstrategier i møte med disse pasientene består i hovedsak enten av oral premedikasjon med benzodiazepiner eller henvisning til behandling i narkose. Narkosekapasiteten er svært begrenset slik at dette i realiteten kun er et tilbud til pasienter som kommer inn under en offentlig prioritert gruppe. Dyp sedasjon er en metode for å muliggjøre tannbehandling av pasienter med behandlingsvegring. Denne metoden brukes ikke innenfor den offentlige tannhelsetjenesten og omtales heller ikke i offentlige dokumenter som omhandler tannhelsetjenesten. Med vår undersøkelse mener vi å påvise at det er et stort, udekket behov for behandling for gruppen av pasienter med behandlingsvegring. Vi mener at innføring av dyp sedasjon ved tannbehandling kan være en mulighet til å øke behandlingskapasiteten for en stor gruppe pasienter. I tillegg har vi erfaring med at behandlingen virker angstreduserende i seg selv og øker mestringsfølelsen, noe som ikke er vist for behandling i narkose. Dette planlegger vi å belyse nærmere i senere studier

Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study

© 2020 British Journal of AnaesthesiaBackground: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP

Management practices for postdural puncture headache in obstetrics : a prospective, international, cohort study

Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19-1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score <= 3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP