日间全麻下儿童牙病治疗麻醉管理规范
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摘要
日间全麻下儿童牙病治疗是指在全身麻醉下对儿童复杂牙病进行一次性治疗并保证儿童在麻醉当天可以回家。因医疗条件、技术和观念等限制,我国全麻下儿童牙病治疗起步晚,但临床需求大。日间全麻下儿童牙病治疗难点在于麻醉。充分掌握准确的患儿选择标准,完善的场地、设备及人员配置,全面的麻醉前准备,细节化的麻醉管理,认真的麻醉记录和随访等才能保障麻醉安全、提高麻醉质量和舒适度。目前,我国尚无日间全麻下儿童牙病治疗相关的麻醉选择及规范。本文根据第四军医大学口腔医院麻醉科对于儿童牙病舒适化治疗日间麻醉选择及各方面的规范做一系统总结。
Children's dental treatment under ambulatory general anesthesia is to treat all the decayed teeth and the children can go home safely at the same day. Owing to the restriction of medical condition,technology and conception,children's dental treatment under general anesthesia started late in our country but it has large demand. The difficult part of children's dental treatment under ambulatory general anesthesia lies in the anesthesia. In order to guarantee the safety of anesthesia and improve the quality and comfort,it's essential to have the criteria of patient selection,thorough configuration of facility and staff,well-prepared,detailed anesthesia management,complete records and follow-ups. Nowadays,there are no selection and guideline of anesthesia related to children's dental treatment under general anesthesia. The aim of this work is to summarize the experience we had,and try to make standardized management for children's dental treetment under ambulatory general anesthesia.
Children's dental treatment under ambulatory general anesthesia is to treat all the decayed teeth and the children can go home safely at the same day. Owing to the restriction of medical condition,technology and conception,children's dental treatment under general anesthesia started late in our country but it has large demand. The difficult part of children's dental treatment under ambulatory general anesthesia lies in the anesthesia. In order to guarantee the safety of anesthesia and improve the quality and comfort,it's essential to have the criteria of patient selection,thorough configuration of facility and staff,well-prepared,detailed anesthesia management,complete records and follow-ups. Nowadays,there are no selection and guideline of anesthesia related to children's dental treatment under general anesthesia. The aim of this work is to summarize the experience we had,and try to make standardized management for children's dental treetment under ambulatory general anesthesia.
引文
[1]BURNAP R W.General anesthesia and analgesia for dental and oral surgery[J].Curr Res Anesth Analg,1946,25(6):243-249.
[2]American Academy of Pediatric Dentistry.Guidelines for the elective use of conscious sedation,deep sedation,and general anesthesia in pediatric patients[S].Pediatric Dentistry,1985,7:334-337.
[3]刘燕.学龄前儿童患龋情况调查分析[J].中国妇幼保健,2011,26(19):3035-3036.
[4]DARWIN L,CHUNG F.Patient selection for day surgery[J].Anaesthesia&Intensive Care Medicine,2013,14(3):114-118.DOI:10.1016/j.mpaic.2013.01.003
[5]陈晓贤,葛立宏,张红梅,等.全身麻醉下儿童口腔治疗[J].中华临床医生杂志(电子版),2014,8(14):146-150.
[6]DESLOOVERE K,MOLENAERS G,FEYS H,et al.Gait pattern classification of children with cerebral palsy using cluster analysis:link with diagnosis,age and clinical measurements[J].Developmental Medicine&Child Neurology,2005,47(102):39.
[7]BUCKLEY H,PALMER J.Overview of anaesthesia and patient selection for day surgery[J].Anaesthesia&Intensive Care Medicine,2010,11(4):147-152.DOI:10.1016/j.mpaic.2010.01.003
[8]MATHIS M R,NAUGHTON N N,SHANKS A M,et al.Patient selection for day case-eligible surgery:identifying those at high risk for major complications[J].Anesthesiology,2013,119(6):1310-1321.DOI:10.1097/ALN.0000000000000005
[9]卢博一,刘冰,徐浩,等.口服药物镇静的实际操作及注意事项[J].实用口腔医学杂志,2015,1(1):141-144.
[10]KIM M S,MOON B E,KIM H,et al.Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevofluraneanaesthesia in children[J].Br J Anaesth,2013,110(2):274-280.DOI:10.1093/bja/aes382
[11]ABDULLAH H R,CHUNG F.Postoperative issue:discharge criteria[J].Anesthesiol Clin,2014,32(2):487-493.DOI:10.1016/j.anclin.2014.02.013
[12]DRUM E,HERLICH A,LEVINE B,et al.Sedation of children[J].Pediatrics,2001,107(4):808.
[13]LEE H H,MILGROM P,STARKS H,et al.Trends in death associated with pediatric dental sedation and general anesthesia[J].Paediatri Anaesth,2013,23(8):741-746.DOI:10.1111/pan.12210
[14]BOSACK R,LIEBLICH S.Anesthesia complications in the dental office[M].New Jersey,Wiley-Blackwell,2015.
[2]American Academy of Pediatric Dentistry.Guidelines for the elective use of conscious sedation,deep sedation,and general anesthesia in pediatric patients[S].Pediatric Dentistry,1985,7:334-337.
[3]刘燕.学龄前儿童患龋情况调查分析[J].中国妇幼保健,2011,26(19):3035-3036.
[4]DARWIN L,CHUNG F.Patient selection for day surgery[J].Anaesthesia&Intensive Care Medicine,2013,14(3):114-118.DOI:10.1016/j.mpaic.2013.01.003
[5]陈晓贤,葛立宏,张红梅,等.全身麻醉下儿童口腔治疗[J].中华临床医生杂志(电子版),2014,8(14):146-150.
[6]DESLOOVERE K,MOLENAERS G,FEYS H,et al.Gait pattern classification of children with cerebral palsy using cluster analysis:link with diagnosis,age and clinical measurements[J].Developmental Medicine&Child Neurology,2005,47(102):39.
[7]BUCKLEY H,PALMER J.Overview of anaesthesia and patient selection for day surgery[J].Anaesthesia&Intensive Care Medicine,2010,11(4):147-152.DOI:10.1016/j.mpaic.2010.01.003
[8]MATHIS M R,NAUGHTON N N,SHANKS A M,et al.Patient selection for day case-eligible surgery:identifying those at high risk for major complications[J].Anesthesiology,2013,119(6):1310-1321.DOI:10.1097/ALN.0000000000000005
[9]卢博一,刘冰,徐浩,等.口服药物镇静的实际操作及注意事项[J].实用口腔医学杂志,2015,1(1):141-144.
[10]KIM M S,MOON B E,KIM H,et al.Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevofluraneanaesthesia in children[J].Br J Anaesth,2013,110(2):274-280.DOI:10.1093/bja/aes382
[11]ABDULLAH H R,CHUNG F.Postoperative issue:discharge criteria[J].Anesthesiol Clin,2014,32(2):487-493.DOI:10.1016/j.anclin.2014.02.013
[12]DRUM E,HERLICH A,LEVINE B,et al.Sedation of children[J].Pediatrics,2001,107(4):808.
[13]LEE H H,MILGROM P,STARKS H,et al.Trends in death associated with pediatric dental sedation and general anesthesia[J].Paediatri Anaesth,2013,23(8):741-746.DOI:10.1111/pan.12210
[14]BOSACK R,LIEBLICH S.Anesthesia complications in the dental office[M].New Jersey,Wiley-Blackwell,2015.