office-based anaesthesia for the disabled dental patient...7 cat : results & status praesens...
TRANSCRIPT
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Office-based Anaesthesia
for the disabled dental patient
The Rotterdam approachPrague, October 7th 2011
J. Rupreht, M.D. Ph.D. Erasmus Medical Center Rotterdam
ECM Bouvy-Berends & AE Kraaijenhagen-Oostinga, DDS
CBT Rijnmond Rotterdam, CBT Haga Teaching Hospital The Hague
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Erasmus Medical Center
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publications
In: Anest. Neodkl. Péče, 13, 2002, No. 3, p.103-105
In: In: Anest. Inteziv. Med., 15,2004, č. 5, s. 224-2283
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Erasmus Medical Center , Rotterdam
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Dr. B. Dworacek
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Institute for the intellectually disabled
IPSE/ Craeyenburch, Nootdorp
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Center for Special Care Dentistry
CBT Rijnmond Rotterdam
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July 1989
Restricted hospital facilities in
dental anaesthesia care for the
disabled
First “extramural” dental
anaesthesia for the severely
intellectually disabled
4 anaesthetists (2 professors)
2 dentists
1 dental assistant
and 1 patient
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september 1989
Symposium at ACTA:
Academic Center for Dentistry Amsterdam
“where dentistry meets anaesthesiology”
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Anno 2011, CBT Rijnmond
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Overview of this presentation ( 1)
Patient characteristics
Comorbidity
Some syndromes
Down syndrome e.g.
Characteristics of anaesthesia
Time-course parameters
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Overview of this presentation (2)
Quality criteria
personnel and teaching
Instructions for perioperative period
Training of team members
Course on Anaesthesia for Dentists
( CAT I - VII )
CAT , results , status praesens
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Disabilities in Special Care Dental patients
Psychomotor retardation
Intellectual disability
Epilepsy
Cerebral palsy
Autism, automutilation
Psychiatric disorder
Gagging reflex
Extreme dental anxiety
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Comorbidity in disabled dental
patients
Upper airway infection
Recurrent bronchitis
Asthma, CARA
Hypertension
Adipositas
Gastrooesophageal
reflux
Hypothyroidism
Palatoschizis
Encephalopathy
Cardiac morbidity
Micrognathy
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( Rare) syndromes in our patients
Down syndrome
Fragile-X syndrome
Cornelia de Lange
Angelmann
Rett
Rubinstein Taybi
EEC syndrome
Cri du Chat
Moebius
Pierre Robin sequence
Smith Lemli Opitz
Gilles de la Tourette
S. Filippo
Turner
etc.
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Co-morbidity in Down syndrome *
Congenital heart defects
Higher susceptibility to
infections
Autoimmune diseases
Joint laxity
Atlanto-axial instability
Oversensitivity to
sedatives
Quickly aging ; early signs
of dementia
Prospect of sudden death
* 12 % of patient group
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Anaesthetic approach
No opiates
N2O , propofol,
sevoflurane
Rocuronium
PCM, diclofenac, local
dental block
Always decurarization
Preferentially oro-tracheal
intubation
Children: above 15 kg or
4 years of age,
max 2 hours
Adults : also ASA III,
maximum 4-5 hours
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Average Time-Course Parameters
Anesthesia 143 min. ( 5- 320 )
Recovery I 4,1 min ( 0,5 -90 )
Home fitness 28,6 min ( 2-90 min)
5500 procedures 2 hospitalizations
(anaphylaxis, aspiration)
1 cardioversion
no nausea
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Quality criteria
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Pre-assessment obligatory
Dedicated team:
3 senior anaesthesiologists
5 senior anaesthesia
assistants
One patient – one
anaesthetist approach
Protocols,
oral and written instructions
Training and teaching of
dental team
Practice for senior
anaesthesia residents
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Instructions for perioperative period
10 points instructions list
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Continuïty of dental anaesthesia care
in CBT Rijnmond
21
year pat. nr. dental
hrs
Anaesth.
hrs
anaest.
pat
perc.
%
Avarage
traetm.
hrs
2000 /
2006
2219 4240 603 222 14,2 1,8
2007 2740 5215 635 208 12,1 2,4
2008 2955 5695 756 243 13,3 2,6
2009 - - - - -
2010 3132 6157 844 288 13.7 2,9
5.3. Continuïteit van zorg
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Care tailored to the individual need
challenging behaviour
extreme autistic behaviour
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Parallel and medical procedures
( presumably simple ) hair or nail cut, pedicure
for the severely disabled
medical procedures
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“You may proceed … “
optimal working conditions
for the dentist
comprehensive & technically high level dentistry
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Training of team members
Anaesthetists 2 days
An. assistants 2 days
Dentists
N2O sedation certificate
oral sedation certificate
Post-master training in dentistry
for the disabled
CAT: Course on Anaesthesia
for Dentists
Dental assistants 14 days
( protocols, practice, CAT)
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7 CAT : Course on Anaesthesia for Dentists
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7 CAT : results & status praesens
Participants :
164 dentists, 66 dental
assistants, 4 dental hygienists,
1 maxillofacial surgeon,
2 anaesthesia residents
Theory & practice
Basic life support training
MCQ „s , certificate
Course obligatory part of 3-
year post-master training in
dentistry for the disabled
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Office-based Anaesthesia
for the disabled dental patient
Safe course, minimal complications, short recovery
time
“Surplus value” : high patient/parents satisfaction
Optimal working conditions for the dentists
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