Anaesthesia in Dental Medicine

Abstract

Uvod. Većina stomatoloških zahvata radi se u lokalnoj anesteziji (90%). Razlozi za to su jednostavna priprema bolesnika, ambulantno liječenje i rijetke komplikacije. No postoje bolesnici i stanja kod kojih zahvat nije moguće učiniti u lokalnoj anesteziji. Svrha je ovoga rada utvrditi indikacije i komplikacije opće anestezije u stomatoloških bolesnika. Materijali i metode. Analizirano je 864 bolesnika u razdoblju od godine 2001. - 2004. u KB “Dubrava” u kojih je učinjen stomatološki zahvat. U preoperativnoj pripremi bolesnicima su potrebni laboratorijski nalazi, EKG, anamneza te pedijatrijski ili internistički pregled. Premedicirani su atropinom i midazolamom intramuskularno, a vrsta anestezije je određena prema vrsti zahvata, dobi i općem bolesnikovu stanju. Rezultati. Analizirano je 864 bolesnika u razdoblju od godine 2001. 2004. u KB “Dubrava” u kojih je učinjen operativni zahvat. Indikacije za opću anesteziju bila su djeca, duševno zaostale osobe i osobe s upalom mekih tkiva usne šupljine. Ekstrakcije zuba rađene su u inhalacijskoj anesteziji na masku (692), a bolesnici s višestrukim popravcima zuba bili su intubirani (172).Tijekom anestezije mjeren je krvni tlak, EKG, periferna saturacija kisikom i koncentracija CO2. Bolesnici su postoperativno praćeni 6 sati i nakon toga otpušteni kući ako nisu imali komplikacija. Komplikacije su bile rijetke: laringo i bronhospazam u 3 bolesnika, aritmije u 5, mučnina i povraćanje u 6, a postoperacijske ekscitacije pojavile su se u 3 bolesnika. Zaključak. Djeca i duševno zaostale osobe bile su najčešće indikacije za opću anesteziju u stomatologiji. Komplikacije su se pojavile u 17 bolesnika (1,8 %), što je prihvatljiv rizik za tu vrstu zahvata.Introduction. The majority of dental procedures are carried out under local anaesthesia (90%). Reasons for this are the simple preparation of the patient, out-patient treatment and rare complications. However, there are patients and conditions for which such procedures are impossible to perform under local anaesthesia. Aim. The aim of this study was to determine the indications and complications of general anaesthesia in dental patients. Materials and methods. We analysed 864 patients during a period from 2001 to 2004 in the University Hospital Dubrava, in whom dental operations were performed. In preoperative preparation patients require laboratory findings, ECG, case history and paediatric or internist examination. They are premedicated with atropine and midazola intramuscularly, and the type of anaesthesia determined according to the type of operation, age and general condition of the patient. Results. During the period from 2001 to 2004 864 patients were analysed in the University Hospital Dubrava, in whom an operation was performed. Indications for general anaesthesia were children, mentally retarded persons and those with inflamed soft tissues of the oral cavity. Teeth extractions were performed under inhalation anaesthesia on a mask (692), and patients with multiple dental repairs were intubated (172). During anaesthesia blood pressure, ECG, peripheral saturation with oxygen and CO2 concentration was measured. The patients were monitored for 6 hours after the operation, after which they were released from hospital if there were no complications. Complications were rare: laryngo and bronchospasm in 3 patients, arrhythmia in 5, nausea and vomiting in 6, and postoperational excitation occurred in 3 patients. Conclusion. Children and mentally retarded persons were the most frequent indications for general anaesthesia in dental medicine. Complications occurred in 17 patients (1.8%) which is an acceptable risk for this type of operation