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

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

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

Instructions for perioperative period

10 points instructions list

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Continuïty of dental anaesthesia care

in CBT Rijnmond

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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

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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