鼻罩吸入全麻在儿童舌系带延长术中的应用

目的:回顾性分析鼻罩吸入全麻在日间门诊儿童舌系带延长术中的应用效果,探讨其临床应用特点和安全性。方法:对符合手术适应证的儿童,术前6 h禁食禁水,术中以鼻罩吸入5%七氟醚+50%笑气+氧气进行全麻,完成舌系带延长术,术中动态监测心率、血氧饱和度等生命体征,术后留院观察2 h,以离院评分系统进行评价,得分超过12分者准予离院,术后随访手术和麻醉相关并发症的发生情况。结果:共收集25个病例,男21例,女4例,平均年龄(3.1±1.2)岁,平均手术时间(19.8±7.3)min,离院评分系统平均得分14.2±0.65。所有患者术中各项生命体征平稳,术后随访未发现麻醉或手术不良并发症。结论:鼻罩吸入全麻可以为日间门诊儿童舌系带延长手术提供理想的麻醉效果,并且安全可靠。     

特殊需求患者气管插管全麻下拔牙病例的回顾性分析

目的 探讨特殊需求患者全麻下拔牙的必要性以及安全性.方法 收集口腔颌面外科手术室2014年、2015年气管插管全麻下拔牙病例,分析并评价特殊需求患者选择气管插管全麻下拔牙的原因、麻醉效果、手术安全性、患者术后评价等资料.结果 共收集到符合条件病例54例,其中严重张口受限11例、严重心脑血管疾病10例、癫痫病史2例、严重的牙科恐惧症13例、年龄或智力局限不能配合治疗18例,经气管插管全麻下拔牙后,按照出院评价标准均大于9分,安全出院,出院1d、1周、1月回访均无拔牙及麻醉并发症.结论 气管插管全麻下拔牙对于一些有特殊需求的患者是一种安全的选择.     

第三磨牙双生四例报告

例1:男性,24岁,在外院拔除后拔牙创持续疼痛。检查:拔牙创空虚,形态较小,仔细检查,颊侧见一牙冠,拍牙片示颊侧低位阻生,局麻下拔除,冠为磨牙形态,锥形根。 例2:男性,23岁,因左下牙床反复肿疼,症状缓解后求拔。查:牙冠半露,局麻下拔除,为一畸形牙,锥形牙冠,冠根比3:2,检查拔牙创,仍有一牙,完整拔除,为磨牙形态,双根牙,冠根比1:1.5左右。     

老年人一次多个牙拔除的体会

目的：通过对60岁以上老年人进行局麻下一次多个牙拔除的临床观察，研究老年病人安全、有效的一次多个牙拔除方法。方法：将心理治疗手段用于拔牙全过程，结合无痛麻醉、快速拔牙技术，进行老年人患牙的一次性拔除。结果：59例病人进行无监测局麻下拔牙，除个别病人出现短暂的头晕、心慌外，所有病人均顺利完成拔牙手术。结论：当老年人无全身性疾病或处于心血管疾病的相对稳定期时，都可以经受一次多个牙的拔除。     

全麻下拔除多个阻生第三磨牙200例临床分析

目的 :评估全麻下拔除阻生第三磨牙的临床效果。方法 :回顾性分析2008-01—2013-12期间,全麻下拔除阻生第三磨牙的病例200例,分析患者拔牙原因、临床特征及并发症。结果:200例患者共645颗阻生第三磨牙被拔除,最常见的拔牙原因是冠周炎;无全麻并发症发生,发生术后干槽症1例,感染2例,暂时性下牙槽神经损伤4例。结论:全麻下拔除阻生第三磨牙舒适、安全,并发症发生率低,值得向有适应证的患者推荐。     

冷光源反角涡轮机在上颌埋伏多生牙微创拔除中的应用体会

目的通过分析微创拔除上颌埋伏多生牙,探讨微创理念、提高临床技术应用。 方法应用X线偏心投照法或锥形束CT（CBCT）定位埋伏多生牙;采用局部麻醉、唇颊侧或腭侧个性化手术进路;使用冷光源反角涡轮机+微创拔牙刀,拔除21例上颌埋伏多生牙。 结果麻醉效果良好,手术过程顺利,无邻牙及邻近结构损伤,无并发症或后遗症发生,切口愈合良好。 结论埋伏多生牙好发于上颌前部腭侧;CBCT图像可从任意角度直观地显示埋伏多生牙在颌骨内的位置,对麻醉和手术方案制定、微创手术实施有益,可作为术前常规检查;精确定位、个性化手术进路、冷光源反角涡轮手机及微创拔牙刀的应用,可降低手术创伤、缩短手术时间,对低龄儿童在局麻下完成手术有益;同时降低手术对儿童牙槽骨、颌骨发育影响的风险。     

心血管病患者拔牙心肌氧耗量的临床分析

目的分析心血管病患者在局麻下拔牙过程中五个时段的心肌氧耗量。方法随机抽取在门诊拔牙的心血管病患者132例，对拔牙全过程进行心电监护，以心率动脉收缩压乘积(Cardiacrate—pressure product RPP)描述局麻注射前、注射中、注射后、牙拔除术中、术后各时段的心肌氧耗量，并进行统计分析。结果心血管病患者拔牙每个时段，差异非常显著。结论对心血管病患者拔牙除强调拔牙全过程心电监护外，宜采取有利措施，降低心肌氧耗量，减少心肌缺血的危险性，尤其在局麻注射中、牙拔除术中两个时段，确保拔牙手术安全顺利完成。     

氧化亚氮吸入和异丙酚静脉超浅麻醉在拔牙应用中的比较

目的研究氧化亚氮吸入与异丙酚静脉超浅麻醉在拔牙中的效果。方法选择门诊ASAI级（美国麻醉学会组1组）下颌智齿拔除患者40例，随机分为两组，一组为氧化亚氮组，年龄20～36岁，另一组为异丙酚组，年龄21～35岁，在超浅麻醉辅以局麻下拔牙。结果两组患者，术前、术中、术后的血压、脉搏、呼吸、血氧饱和度维持平稳，治疗操作在患者配合下顺利完成，术后有一定的遗忘作用，副作用小，30min内都达到了离院回家标准。结论两组患者拔牙过程中均获得了满意的效果，但氧化亚氮组的止痛作用优于异丙酚组。     

氧化亚氮/氧气混合气吸入镇静镇痛在口腔门诊小手术中的临床应用研究

[摘要] 目的 观察比较氧化亚氮/氧气混合气吸入镇静镇痛在口腔门诊小手术中的临床应用情况。方法 对口腔颌面外科门诊就诊的患者,分别采用氧化亚氮/氧气混合气吸入配合局麻和单纯局部麻醉,进行治疗。通观察患者心率,血氧饱和度等临床指标的变化。结果 2组患者在整个手术过程中的心率及血氧饱和度的变化情况,注射局麻时的VAS疼痛评分比较,术中疼痛程度和镇静程度比较,差异均有显著性。结论 氧化亚氮/氧气混合气吸入配合局麻具有安全、有效的特点,对于复杂牙拔除、阻生牙拔除等口腔门诊小手术具有很好的辅助效应。     

微创拔牙技术在学龄期儿童骨埋伏多生牙拔除中的应用

目的:探讨微创拔牙技术在学龄期儿童骨埋伏多生牙拔除术中的应用效果。方法:选择72例学龄期儿童共76颗骨埋伏多生牙,使用微创拔牙技术拔除患牙。结果:76颗患牙均在30 min内拔除,术后未出现感染、干槽症及邻牙损伤等并发症。结论:微创拔牙技术缩短了手术时间,减少了术后并发症的发生,减轻患儿的牙科畏惧情绪,是拔除学龄期儿童骨埋伏多生牙的好方法。     

自体牙移植术的临床应用研究

目的：评价正畸治疗中自体牙移植的临床效果,并探讨移植牙成功的影响因素。方法：选择17例17颗牙齿异位或埋伏阻生的病例,先行正畸治疗以拓展出合适间隙,局麻下进行自体牙移植,术后固定,移植术后4周行根管治疗并正畸加力,精细调整咬合关系后拆除固定矫治器。结果：经1～3年的随访,17颗移植牙均未发现牙根吸收、松动、疼痛和根骨粘连等并发症。结论：自体牙移植的临床效果满意。对于异位或埋伏阻生牙的正畸治疗,联合自体牙移植术能快速纠正个别牙错位,缩短正畸治疗疗程。     

General anesthesia for developmentally disabled dental care patients: a comparison of reinforced laryngeal mask airway and endotracheal intubation anesthesia

Providing dental care for developmentally disabled patients who require general anesthesia is challenging for both dentists and anesthesiologists. This study aimed to compare the efficacy of two anesthetic methods for dental care. The researchers retrospectively analyzed morbidity data following anesthesia using either a reinforced laryngeal mask airway (LMA) or endotracheal intubation anesthesia for a two-year time period. The subjects were developmentally disabled patients receiving dental care. Statistical analyses were by unpaired student t -tests and chisquare tests. Patients were who anesthetized with a reinforced laryngeal mask airway had a significantly shorter recovery period and lower postanesthetic complication rates when compared to patients undergoing endotracheal intubation anesthesia. Although hypoxemia (SPO₂ 90%) during dental care occurred more frequently when using the reinforced laryngeal mask airway, the difference was not significant. Nausea and vomiting were the major complications in the postanesthetic care unit and after discharge. When complication rates were compared in the two patient groups, nausea and vomiting were significantly higher during postanesthetic care and after discharge in the intubated group. In conclusion, reinforced laryngeal mask airway provides general anesthesia with less risk of side effects for developmentally disabled patients undergoing dental care.     

Postoperative Morbidities Following Dental Care Under Day-Stay General Anesthesia in Intellectually Disabled Children

PURPOSE: The objective of this study was to compare the postoperative morbidities for 24 hours following dental care under day-stay general anesthesia using sevoflurane or halothane in intellectually disabled children. MATERIALS AND METHODS: Eighty-six premedicated patients with intellectual disabilities underwent general anesthesia for their dental treatment. They were randomly given anesthesia maintained with sevoflurane (2% to 3%) or halothane (1% to 1.5%) after receiving inhalation induction either with sevoflurane (8%) or halothane (5%) and nitrous oxide in oxygen (50:50). The patients' age, gender, weight, ASA Class, type of dental treatment, and duration of anesthesia and operation were recorded as well as the time required for recovery (Aldrete Scale) and the length of time taken before they were discharged (postanesthetic discharge scoring system) from the hospital. Pain and agitation were recorded using a visual analog scale (0 to 10). Other postoperative morbidities, which include crying, nausea and vomiting, bleeding, and drowsiness, were also noted for 24 hours after the operation. RESULTS: The most common morbidities during the postoperative 24 hours were agitation and pain, and their occurrence was significantly more common in the sevoflurane group than in the halothane group (P < .05). The recovery time was shorter in the sevoflurane group, but it was not statistically significant. There was no difference between the groups in the discharge time. CONCLUSIONS: Apart from more postoperative agitation and pain after awakening from sevoflurane, the quality of recovery was similar for both sevoflurane and halothane.     

Acceptance and side effects of nitrous oxide oxygen sedation for oral surgical procedures.

Two hundred and forty-one treatment sessions with nitrous oxide oxygen sedation were performed in 194 patients undergoing ambulatory oral surgery procedures. Removal of mesiodentes and tooth transplants were the most frequent procedures in age groups under 13 years, while removal of impacted teeth was predominant in older age groups. Local anesthesia was used in addition to inhalation sedation in 238 sessions. Median gas volume rate was 10 l/min, median concentration 50% and median duration of procedures 31 min. In 10 sessions (4.1%) sedation was not accepted, while in 25 (10.4%) sessions the procedure could be completed with some difficulty. No potentially dangerous complications were noted. Side effects occurred in 18 sessions in 16 patients. All side effects were minor and easily handled. Logistic regression analysis revealed that failure, defined as poor acceptance and/or presence of side effects, was associated with ASA class 2 and general apprehension, especially based on previous negative experience with medical or dental treatment. Nitrous oxide oxygen sedation is a reliable, efficient and safe adjunct to local anesthesia in both healthy children and adults undergoing ambulatory oral surgery procedures.     

心血管病患者拔牙阿替卡因肾上腺素局麻临床效果观察

目的 比较局部麻醉剂阿替卡因肾上腺素和利多卡因用于老年心血管疾病患者拔牙时,对患者血压和心率等变化的影响,探寻阿替卡因肾上腺素用于老年心血管疾病患者拔牙的安全性.方法 本研究包括 228 例老年心血管疾病患者的 239 颗牙齿,随机分组为阿替卡因肾上腺素组(实验组)和利多卡因组(对照组),分别记录麻醉注射前3min,麻醉注射即刻,麻醉注射后3min、拔牙手术中、拔牙手术后3min患者的血压、心率.对数据进行统计分析.结果 与利多卡因相比,阿替卡因肾上腺素在麻醉注射即刻、拔牙手术中心率明显加快,差异具有统计学意义(P<0.05).在麻醉注射后3min收缩压升高,差异具有统计学意义(P<0.05).在任何时点舒张压均无明显升高.两组在麻醉注射后、拔牙手术后血压、心率均回复到麻醉注射前水平.结论 局部麻醉剂阿替卡因肾上腺素对无心动过速、经过全身系统治疗的、病情稳定的心血管疾病患者拔牙是安全可行的.     

斯康杜尼与肾上腺素利多卡因在老年拔牙麻醉中的临床效果比较

目的:比较斯康杜尼与利多卡因在老年拔牙麻醉中的临床效果。方法:将584例进行拔牙治疗的老年患者随机分成2组,分别采用斯康杜尼和1/10万u肾上腺素利多卡因进行局部麻醉,观察分析患者注射时疼痛度、拔牙时麻醉效果,并监测麻醉前后患者血压、心率的变化。结果:斯康杜尼在注射时的疼痛VAS分值低于利多卡因(P<0.05)。对于上颌前牙、前磨牙、磨牙,下颌前牙、前磨牙斯康杜尼的局部麻醉效果优于利多卡因(P<0.05);对于下颌磨牙利多卡因的的局部麻醉效果优于斯康杜尼(P<0.05)。利多卡因和斯康杜尼注射后,患者的血压、心率与注射前无显著性差异(P<0.05)。结论:对于老年拔牙患者,1/10万u肾上腺素利多卡因与斯康杜尼均具有较高的安全性,斯康杜尼局部浸润麻醉效果较好,利多卡因传导阻滞麻醉效果较好。     

Reasons for dental extractions in children

PURPOSE: The purpose of this study was to investigate the principal reason for primary tooth extraction and the tooth type most frequently extracted in children aged 3-13 years. METHODS: The patients selected for this retrospective study were identified by analyzing dental records of children receiving treatment at Franciscan Children's Hospital & Rehabilitation Center, Boston, MA (FCH & RC). In total, 2,000 records were reviewed, and 567 extracted primary teeth were analyzed from 277 patients who had at least one primary tooth extracted under local anesthesia. The criteria for inclusion in this study included children between the ages of 3 and 13 years. RESULTS: First primary molars were the most common tooth type extracted and comprised 30% of teeth removed. Central incisors were the next common tooth type extracted and accounted for 25% of the extractions. There was no difference, by gender, in the extraction of tooth type but there were striking differences according to age. Almost half of the primary teeth extracted in subjects 3 to 5 years were incisors, and in patients 6 to 9 years the first primary molar was the most common tooth type extracted. Molars were the tooth type most frequently extracted from those patients aged 10 to 13 years. There were significant differences in the reasons for extraction of various tooth types, and, while extractions due to caries predominated overall, this was not the case for all tooth types. CONCLUSIONS: This study has concluded that despite the dramatic improvements in pediatric oral health over the last decades, caries and the resulting pulpal pathology remains the most common reason for extraction of primary teeth.     

Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications

OBJECTIVES: The aim of this study was to identify risk indicators for extended operation time and postoperative complications after removal of mandibular third molars. STUDY DESIGN: There were 388 molars included in the study. The teeth were removed using the buccal approach under local anesthesia. Four hours postoperatively the patient recorded his or her pain perception on a visual analogue scale (VAS). After surgery a surgeon recorded parameters regarding the tooth and if the mandibular nerve had been visible during the operation. One week postoperatively the postoperative pain and complications were recorded. Logistic regression models were made to identify risk indicators for extended operation time, postoperative pain, and complications. RESULTS: Females were at higher risk for postoperative pain and dry socket than males. Older patients were at higher risk for extended operation time than younger patients. Radiographically fully impacted molars increased the risk of postoperative general infection. If the nerve was visible during surgery there was a higher risk of a high VAS score, postoperative pain, and general infection than if the nerve had not been visible. CONCLUSION: Several indicators were found to increase the risk of postoperative complications, but a visible alveolar inferior nerve during the operation was repeatedly found to be the highest single risk indicator.