79 research outputs found
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
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 patientâs
condition, to intervention or to local anaesthesia
problems. Known contraindications to this treatment
are the refusal by patient and/or patientâs 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 âsedationistâ, 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
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
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
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