Objective: Most dental procedures can be performed with local anaesthesia, however noncompliant paediatric patients, patients with mental retardation or psychiatric disorders, severe anxiety, severe craniofacial anomalies and orofacial trauma may need general anaesthesia. In these patients accompanying central nervous system diseases and airway problems increase the risk of complications. Anaesthesia records of 467 cases of dental surgery performed under general anaesthesia between 2011-2014 is reported with information from the recent literature.
Methods: In the study, 467 cases of dental procedures performed under general anaesthesia were taken from the İnönü University of Medicine, Dentistry Disabled Treatment Centre, after approval of the İnönü University Faculty of Medicine Ethics Committee. Demographic data, ASA classification, Mallampati (MP) score, duration of surgery, type of intubation and difficulties, comorbid diseases, premedication application, endocarditis prophylaxis, recovery time, analgesia and reasons for general anaesthesia were recorded as mean±standard deviation (SD) or as a number.
Results: The mean age of the patients was 16.78±12 years and the female/male ratio was 277/190 (59.3%/40.7%). Of the 467 patients, 219 (46.9%) were classified as ASA I, 234 (50.1%) as ASA II and 14 (3%) as ASA III. Furthermore, 182 (38.9%) patients with mental retardation, 33 (7.1%) with cerebral palsy and 28 (6%) with autism were identified. The mean operative time was 114.53±35.4 min, and the average recovery time 40.4±6 was min. Of the endotracheal intubations 277 (59.3%) were oral, 82 (17.6%) were nasal, and 108 (23.1%) were nasal with the help of fibreoptics. Difficult intubation was observed in 20 (4.3%) patients. The MP score was 1 in 397 (85%) patients, 2 in 50 (10.7%) patients, 3 in 18 (3.9%) patients and 4 in 2 (0.4%) patients. General anaesthesia was applied because of cooperation difficulties in 213 (45.6%), mental retardation in 182 (38.9%), autism in 28 (5.9%), schizophrenia in 7 (1.7%) and jaw surgery in 37 (7.9%) patients. Local infiltration was used for analgesia in 141 (30.2%), morphine in 12 (2.6%), tramadol in 3 (0.6%) and paracetamol in 311 (66.6%) patients. Endocarditis prophylaxis was employed in 36 (7.7%) cases.
Conclusion: General anaesthesia in dental procedures is becoming increasingly common. Anaesthetic management is important due to the frequency of genetic syndromes and mental retardation. In the anaesthetic management of these patients, strategies for the patient should be identified, the process should be implemented in the operating room and preparations should be made with risk analyses.
Keywords: Dental procedure; airway; general anaesthesia.