Background: The number of patients with Alzheimer's disease is growing worldwide, and the proportion of patients requiring dental treatment under general anesthesia increases with increasing severity of the disease. However, outpatient anesthesia management for these patients involves great risks, a...
Background: The number of patients with Alzheimer's disease is growing worldwide, and the proportion of patients requiring dental treatment under general anesthesia increases with increasing severity of the disease. However, outpatient anesthesia management for these patients involves great risks, as most patients with Alzheimer's disease are old and may show reduced cardiopulmonary functions and have cognitive disorders. Methods: This study retrospectively investigated 43 patients with Alzheimer's disease who received outpatient anesthesia for dental treatment between 2012-2017. Pre-anesthesia patient evaluation, dental treatment details, anesthetics dose, blood pressure, duration and procedure of anesthesia, and post-recovery management were analyzed and compared between patients who underwent general anesthesia or intravenous sedation. Results: Mean age of patients was about 70 years; mean duration of Alzheimer's disease since diagnosis was 6.3 years. Severity was assessed using the global deterioration scale; 62.8% of patients were in level ${\geq}6$. Mean duration of anesthesia was 178 minutes for general anesthesia and 85 minutes for intravenous sedation. Mean recovery time was 65 minutes. Eleven patients underwent intravenous sedation using propofol, and 22/32 cases involved total intravenous anesthesia using propofol and remifentanil. Anesthesia was maintained with desflurane for other patients. While maintaining anesthesia, inotropic and atropine were used for eight and four patients, respectively. No patient developed postoperative delirium. All patients were discharged without complications. Conclusion: With appropriate anesthetic management, outpatient anesthesia was successfully performed without complications for dental treatment for patients with severe Alzheimer's disease.
Background: The number of patients with Alzheimer's disease is growing worldwide, and the proportion of patients requiring dental treatment under general anesthesia increases with increasing severity of the disease. However, outpatient anesthesia management for these patients involves great risks, as most patients with Alzheimer's disease are old and may show reduced cardiopulmonary functions and have cognitive disorders. Methods: This study retrospectively investigated 43 patients with Alzheimer's disease who received outpatient anesthesia for dental treatment between 2012-2017. Pre-anesthesia patient evaluation, dental treatment details, anesthetics dose, blood pressure, duration and procedure of anesthesia, and post-recovery management were analyzed and compared between patients who underwent general anesthesia or intravenous sedation. Results: Mean age of patients was about 70 years; mean duration of Alzheimer's disease since diagnosis was 6.3 years. Severity was assessed using the global deterioration scale; 62.8% of patients were in level ${\geq}6$. Mean duration of anesthesia was 178 minutes for general anesthesia and 85 minutes for intravenous sedation. Mean recovery time was 65 minutes. Eleven patients underwent intravenous sedation using propofol, and 22/32 cases involved total intravenous anesthesia using propofol and remifentanil. Anesthesia was maintained with desflurane for other patients. While maintaining anesthesia, inotropic and atropine were used for eight and four patients, respectively. No patient developed postoperative delirium. All patients were discharged without complications. Conclusion: With appropriate anesthetic management, outpatient anesthesia was successfully performed without complications for dental treatment for patients with severe Alzheimer's disease.
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문제 정의
Anesthetic management for patients with AD is not familiar with the anesthesiologist due to the scant number of reports on outpatient anesthesia [10]. In this article, this study aims to analyze data on dental care under outpatient GA or IVS for AD patients at the Seoul National University Dental Hospital (SNUDH), in an attempt to contribute to effective outpatient anesthesia management for severe AD patients.
제안 방법
After analyzing the outpatient anesthesia list, we excluded patients with MNCD caused by cerebrovascular dysfunction, such as cerebral infarction, hemorrhage, patients with brain tumor, and searched for patients who were only diagnosed with AD at neurology. Patients with incomplete medical records were excluded from the analysis (Fig.
In the hospital’s electronic medical record database, we also analyzed each patient’s dental treatment record, pre-anesthesia assessment record (sex, age, duration of Alzheimer’s disease or dementia, current stage, and type of comorbidity), anesthesia and recovery room records (drug used for anesthesia induction, cooperation, airway management, total duration of anesthesia, duration of stay in the recovery room, and side effects and complications observed in the recovery room), next-day follow-up record data by phone (presence of complications after returning home), dental treatment details and duration of dental care.
The anesthesia method was determined based on the patient’s general condition and comorbidity, amount of time needed for dental procedure, and type of techniques used.
Vital sign data(blood pressure (BP), ECG, oxygen saturation, and capnography) during anesthesia that were monitored at five-minute intervals (Sola 8000M, GE, USA) and relayed to the hospital’s server were used for analysis.
성능/효과
In conclusion, this study finds that using smaller drug doses and providing adequate anesthetic management would prevent hazards to AD patients undergoing IVS or GA. Although oral health examination is difficult for AD patients, we believe that their oral health has improved with anesthesia consultation.
후속연구
7. This is a markedly lower concentration than those reported in previous studies, and additional studies are needed to substantiate whether AD patients demonstrate resistance to inhalation anesthetics.
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