Effect of reinforced laryngeal mask airway or endotracheal intubation anesthesia on adverse events: quality of life issues for dental patients requiring general sedation.

This study tested whether the use of a reinforced laryngeal mask airway (LMA) compared to endotracheal intubation (El) anesthesia diminished adverse events and improved the post-operative quality of life for 146 dental patients who required general anesthesia due to developmental disabilities. In this randomized, crossover trial, patients received either reinforced LMA or El anesthesia during an initial dental treatment visit; the other anesthetic method was used during a second visit scheduled after six months or more. Data were assessed with Student's t-test, chi-square test and McNemar's test to evaluate the affect on quality of life by analyzing disturbances in daily activity, such as eating patterns and sleeping behaviors after the procedure. Although the reinforced LMA anesthesia was associated with a significantly lowered incidence of adverse events (p = .04), neither method significantly disturbed quality of life activities.

Anesthetic management of dental procedures in mentally handicapped patients.

BACKGROUND: Providing dental care to a mentally handicapped patient is a challenge to both dentist and anesthesiologist. This study was aimed to describe the anesthetic methods which were used to facilitate dental treatments in mentally handicapped patients at a medical university hospital in Taiwan during a three-year period. METHODS: The data referring to anesthetic techniques to facilitate dental treatments during the period from Dec. 1, 1997 to Nov. 30, 2000 were retrospectively collected. In the period, there were four different anesthetic techniques in application: nasal mask technique combined with intravenous sedation, total intravenous anesthesia, laryngeal mask intubating general anesthesia and endotracheal intubating general anesthesia. Basic characteristics of patients were compared with student t-test between groups according to anesthetic technique used. Intraoperative and postoperative complications and complaints collected were analyzed by chi-square test between anesthetic techniques. P value less than 0.05 was considered statistically significant. RESULTS: The anesthetic records of 1201 mentally handicapped patients who underwent dental procedures over the three-year period were reviewed. Anesthesia was accomplished with nasal mask technique combined with intravenous sedation in 10 patients, with intravenous anesthesia in 112 patients, with endotracheal intubation anesthesia in 249 patients and with reinforced laryngeal mask anesthesia in 826 patients. Four patients were excluded from study because of changing of anesthetic method during the dental procedure. The use of nasal mask combined with intravenous sedation and intravenous anesthesia caused a higher incidence of intraoperative hypoxemia (P < 0.05) in comparison with the groups of endotracheal intubation anesthesia and reinforced laryngeal mask anesthesia. Although patients anesthetized by intravenous anesthetics had less postoperative complaints or complications but the difference was not statistically significant (P > 0.05) when group comparison was made. Patients who were anesthetized by volatile agents through endotracheal tube had the highest rate of postoperative complication although the difference was of no significance (P > 0.05) when comparison between groups was made. CONCLUSIONS: We provided four different anesthetic methods for 1197 mentally handicapped patients who underwent dental procedures in three years. All anesthetic methods had their advantages and disadvantages. Using reinforced laryngeal mask or endotracheal intubation for general anesthesia to facilitate dental procedures for such patients had greater intraoperative safety than other two methods. However, less postoperative complaints or complications were revealed with the methods of nasal mask combined with intravenous sedation and intravenous anesthesia.