Anesthesia progress最新文献

Myhre syndrome (MS) is a rare genetic connective tissue disorder characterized by intellectual disability, growth deficiency, muscular pseudohypertrophy, hearing loss, restricted joint mobility, laryngotracheal stenosis, choanal stenosis, and facial deformities. We encountered a case of difficult endotracheal intubation in a patient with MS. A 17-year-old girl with trismus, macroglossia, and difficulty with neck flexion was scheduled to undergo general anesthesia for dental treatment. Because of these characteristic clinical manifestations, endotracheal intubation was performed with a flexible fiber-optic bronchoscope. When providing general anesthesia for patients with MS, preoperative evaluation of the airway and preparation for potentially difficult tracheal intubation are required.

Objective: Previous studies in Canada suggest that mortality and serious morbidity during deep sedation and/or general anesthesia (DS/GA) for dentistry in out-of-hospital facilities are low. The purpose of this study was to estimate the period prevalence of mortality and serious morbidity associated with outpatient DS/GA for dentistry in British Columbia, Canada.

Methods: Events were identified by retrospectively searching the Chief Coroner of British Columbia database from 1987 to 2019, the College of Dental Surgeons of British Columbia database from 1984 to 2019, and gray literature from 1984 to 2019. A survey of DS/GA providers was conducted to estimate the number of DS/GA procedures provided.

Results: A total of 3 linked mortality events in which anesthesia could not be ruled out as a contributing factor were identified. No cases of serious morbidity met the inclusion criteria for the study. An estimated 1,019,853 out-of-hospital DS/GA procedures for dental treatment were provided during the study period. This study estimated a period prevalence of mortality and serious morbidity of 2.94 per 1 million out-of-hospital DS/GA procedures for dental treatment when administered by qualified providers over the 36-year study period.

Conclusion: These findings suggest that the provision of out-of-hospital DS/GA for dental treatment in British Columbia carries a low risk of mortality or serious morbidity.

Dravet syndrome (DS) is a rare, severe form of epilepsy characterized by seizures often triggered by fevers and other nonfebrile increases in body temperature. We report the case of a girl aged 3 years 5 months who underwent an intubated general anesthetic for dental treatment using remimazolam (RMZ). After a slow mask induction with sevoflurane, RMZ, remifentanil, and rocuronium were administered to facilitate oral intubation, after which general anesthesia was maintained with air, oxygen, and continuous infusions of RMZ and remifentanil. Intraoperative temperature and other vital signs were stable, and no fever or convulsions were observed during the perioperative period. RMZ is an ultrashort-acting benzodiazepine that may be useful for the anesthetic management of pediatric patients with DS because of its potential to prevent seizures.

We present the anesthetic management of a 32-year-old patient diagnosed with familial Mediterranean fever (FMF) who underwent dental surgery. To minimize the risk of triggering an FMF attack, careful perioperative planning was implemented. Key preventive measures included avoiding known FMF triggers like cold exposure as well as maintaining stable vital signs and ensuring close temperature control throughout the procedure. The patient had shown resistance to colchicine therapy in the past, necessitating careful consideration of alternative treatments, including the potential use of IL-1 inhibitors. General anesthesia was successfully administered without inducing an FMF acute attack. Effective postoperative pain management was provided, and no FMF-related complications arose during the recovery period. This successful outcome highlights the importance of close collaboration and ongoing communication with the patient's primary physician and specialists familiar with FMF. Achieving safe anesthetic management for patients with FMF requires meticulous perioperative planning, proactive avoidance of potential FMF triggers, and a collaborative approach across disciplines. These elements are essential to preventing perioperative FMF exacerbations and ensuring smooth, complication-free recovery for patients.

Objective: Anxious patients report more pain during endodontic therapy. This clinical trial aimed to assess the effect of etizolam vs music distraction on inferior alveolar nerve block (IANB) success in patients with high dental anxiety and symptomatic irreversible pulpitis in a mandibular molar.

Methods: A total of 110 patients participated in this randomized clinical trial. Preoperative anxiety was assessed using the Modified Corah Dental Anxiety Scale (MDAS). Patients were randomly allocated to a placebo, etizolam, or music distraction (MD) group. Patients in the placebo and etizolam groups consumed either a placebo or etizolam (0.5 mg), respectively, 1 hour before local anesthesia delivery. Patients in the MD group listened to their self-selected music via headphones throughout the visit. All patients received a standard IANB with 2% lidocaine with 1:200,000 epinephrine. Intraoperative pain levels were assessed using the Heft Parker visual analogue scale (HP-VAS). No or mild pain (0-54 mm on HP-VAS) was counted as success, whereas moderate to severe pain (55-170 mm) during endodontic procedure was considered as IANB failure.

Results: χ2 test revealed that patients in the MD group exhibited significantly higher local anesthetic success compared to the other 2 groups (P < .01). No significant difference was found in IANB success between the placebo and etizolam groups.

Conclusion: IANB success was significantly higher in patients who listened to music during endodontic therapy than in patients who received etizolam or placebo.

Ankylosing spondylitis (AS) is a chronic disease that causes inflammation in the spine and joints, leading to ankylosis and contracture as the disease progresses. Patients with AS are prone to bone fractures, particularly cervical spine fractures. Therefore, problems such as intubation difficulties, impaired ventilation, and complications related to stabilizing and securing the patient's body position can accompany surgery under general anesthesia. Herein, we report the anesthetic management of a 54-year-old patient with mild AS who underwent orthognathic surgery under intubated general anesthesia. The McGRATH MAC video laryngoscope with an X blade was used for tracheal intubation, and the Magic Cast stabilization device was used to secure the patient's head and neck. The patient remained stable and secure throughout the surgery, which was safely completed. The Magic Cast device was useful for stabilizing the head and neck of a patient with mild AS during orthognathic surgery. However, patients with more severe AS may require additional considerations in preparation for airway and stabilization concerns.

Williams syndrome (WS) is a genetic disorder marked by intellectual disability, distinctive craniofacial features, dental abnormalities, and congenital heart defects, particularly supravalvular aortic stenosis-a narrowing above the aortic valve. Patients with WS are at increased risk of perioperative sudden cardiac death, necessitating thorough cardiovascular assessment. Additionally, craniofacial anomalies such as micrognathia and retrognathia may lead to difficult airway management and often require awake intubation. However, awake intubation and hospitalization can be distressing for patients with WS due to their developmental challenges. These facts indicate the importance of identifying during the preoperative assessment for ambulatory general anesthesia those at low risk for cardiovascular complications and airway difficulties. This case report details the successful anesthetic management of a 9-year-old boy with WS undergoing ambulatory general anesthesia for dental treatment by maintaining a balance between myocardial oxygen supply and demand to minimize cardiovascular fluctuations and by paying careful attention to managing his airway. Our case highlights the feasibility and safety of ambulatory general anesthesia for patients with WS, minimizing hospitalization stress and ensuring patient safety.