국소마취 중 갑작스러운 움직임은 주사바늘 파절을 야기할 수 있으며, 특히 예기치 못한 움직임을 보이기 쉬운 아동에게서는 더욱 신중한 접근이 필요하다. 주사바늘 파절이 발생한 경우 합병증을 최소로 하기 위하여 의료진의 신속한 대처가 중요하며, 환자 및 보호자에게 충분한 상황 설명과 진심 어린 유감표명을 하는 등의 의사소통을 위한 노력이 필요하다. 하지만 무엇보다 중요한 것은 이러한 사고가 일어나지 않도록 하는 것이며, 이를 위하여 의료진은 사고 예방에 필요한 주의사항을 충분히 인지하고 있어야 한다. 본 증례는 의식하 진정하에 하치조신경 전달마취 시 갑작스러운 움직임으로 인해 주사바늘이 파절된 어린 아동에 대한 내용이다. 구강 내 존재하는 주사바늘 파절편의 위치를 방사선 사진을 통하여 확인하였고, 전신마취 하에 파절편을 성공적으로 제거하였기에 이를 보고하며, 주사바늘 파절 원인에 대한 고찰과 이를 예방하기 위한 방법을 논의하여 주사바늘 파절 예방에 대한 관심을 증대시키고자 한다.
국소마취 중 갑작스러운 움직임은 주사바늘 파절을 야기할 수 있으며, 특히 예기치 못한 움직임을 보이기 쉬운 아동에게서는 더욱 신중한 접근이 필요하다. 주사바늘 파절이 발생한 경우 합병증을 최소로 하기 위하여 의료진의 신속한 대처가 중요하며, 환자 및 보호자에게 충분한 상황 설명과 진심 어린 유감표명을 하는 등의 의사소통을 위한 노력이 필요하다. 하지만 무엇보다 중요한 것은 이러한 사고가 일어나지 않도록 하는 것이며, 이를 위하여 의료진은 사고 예방에 필요한 주의사항을 충분히 인지하고 있어야 한다. 본 증례는 의식하 진정하에 하치조신경 전달마취 시 갑작스러운 움직임으로 인해 주사바늘이 파절된 어린 아동에 대한 내용이다. 구강 내 존재하는 주사바늘 파절편의 위치를 방사선 사진을 통하여 확인하였고, 전신마취 하에 파절편을 성공적으로 제거하였기에 이를 보고하며, 주사바늘 파절 원인에 대한 고찰과 이를 예방하기 위한 방법을 논의하여 주사바늘 파절 예방에 대한 관심을 증대시키고자 한다.
The fracture of a needle during local anesthesia in dental treatment is rare; however, when it occurs, the needle should be removed without damage to surrounding structures as soon as possible. A fractured needle fragment that is buried in soft tissue would be difficult to remove, and a careful surg...
The fracture of a needle during local anesthesia in dental treatment is rare; however, when it occurs, the needle should be removed without damage to surrounding structures as soon as possible. A fractured needle fragment that is buried in soft tissue would be difficult to remove, and a careful surgical procedure under general anesthesia is recommended in such cases. Children who require dental treatment are often not capable of cooperative behavior, thus unexpected movements can increase the risk of needle fracture. Clinicians can reduce the incidence of needle fracture accidents with a few precautions. In the present case report, we report a case of needle fracture due to abrupt movement during inferior alveolar nerve block anesthesia in a young child, with the purpose of drawing attention to needle fracture incidents. This report describes the possible causes and prevention methods of local anesthetic needle fracture, and the localization methods and surgical procedure for needle fragment removal.
The fracture of a needle during local anesthesia in dental treatment is rare; however, when it occurs, the needle should be removed without damage to surrounding structures as soon as possible. A fractured needle fragment that is buried in soft tissue would be difficult to remove, and a careful surgical procedure under general anesthesia is recommended in such cases. Children who require dental treatment are often not capable of cooperative behavior, thus unexpected movements can increase the risk of needle fracture. Clinicians can reduce the incidence of needle fracture accidents with a few precautions. In the present case report, we report a case of needle fracture due to abrupt movement during inferior alveolar nerve block anesthesia in a young child, with the purpose of drawing attention to needle fracture incidents. This report describes the possible causes and prevention methods of local anesthetic needle fracture, and the localization methods and surgical procedure for needle fragment removal.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
제안 방법
CT scans with three-dimensional reconstruction are recommended to localize the needle fragment and the surrounding structures before operation. Here, we conducted the operation after confirming that the exact location of the needle fragment was is in the pterygomandibular space adjacent to the parapharyngeal space, through CT scans with three-dimensional reconstruction. However, there is a possibility of migration of the needle fragment since the CT scans were obtained, thus imaging techniques with the purpose of locating the needle fragment during the operation is necessary.
대상 데이터
A healthy three-year, five-month-old boy with severe early childhood caries came to Department of Pediatric Dentistry of Gangneung-Wonju National University Dental Hospital in order to receive dental treatment in January 2015. His body weight was 17 kg and he was administered 1100 mg chloral hydrate and 25 mg hydroxyzine by a dental assistant.
후속연구
If the needle is bent, the preset breaking point will be activated. In addition, the quality of the needle may affect the needle fracture, however, there have been no studies regarding needle quality, and further research is needed.
참고문헌 (14)
Augello M, von Jackowski J, Gratz KW, Jacobsen C : Needle breakage during local anesthesia in the oral cavity-a retrospective of the last 50 years with guidelines for treatment and prevention. Clin Oral Investig, 15:3-8, 2011.
BR Chrcanovic, DC Menezes Jr, AL Custodio : Complication of local dental anesthesia - a broken needle in the pterygomandibular space. Braz J Oral Sci, 8:159-162, 2009.
Ram D, Peretz B : Administering local anaesthesia to paediatric dental patients -- current status and prospects for the future. Int J Paediatr Dent, 12:80-89, 2002.
Zeltser R, Cohen C, Casap N : The implications of a broken needle in the the bandit needle prior to injection should be avoided.pterygomandibular space: clinical guidelines for prevention and retrieval. Pediatr Dent, 24:153-156, 2002.
Shah A, Mehta N, Von Arx DP : Fracture of a dental needle during administration of an inferior alveolar nerve block. Dent Update, 36:20-22, 25, 2009.
Rao LP, Peter S : Modification of the dingman mouth gag for better visibility and access in the management of cleft palate. Cleft Palate Craniofac J, 52:250-253, 2015.
※ AI-Helper는 부적절한 답변을 할 수 있습니다.