Traumatic dental injuries during anaesthesia: part I: clinical evaluation
Traumatic dental injuries during anaesthesia: part I: clinical evaluation
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DOI：
10.1111/j.1600-9657.2010.00935.x
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发表时间：
2010-12-01
影响因子：
2.5
通讯作者：
Maria, Avato Francesco
中科院分区：
文献类型：
--
作者：
Maria, Gaudio Rosa;Paolo, Feltracco;Maria, Avato Francesco
牙齿损伤是针对麻醉师的最常见的索赔。牙科损伤是经口气管插管的常见并发症，主要原因是（i）牙列不良，（ii）侵入性喉镜检查，（iii）麻醉和curarization不足，（iv）紧急干预和（v）麻醉师缺乏经验。材料与方法：我们对2000年至2008年间83例需要全麻气管插管的择期、急诊和紧急手术中发生的牙科病变进行了回顾性分析。术前评估牙齿状态是从麻醉图表中获得的，由经验丰富的麻醉师在术前访视期间填写。麻醉记录由法律的医学部的医生检查，目的是确定损害的责任并管理潜在的赔偿。还注意到与所需牙齿修复有关的费用。结果如下：在全麻下进行的总计60，000例外科手术（无日间手术）中，有83例患者受到牙齿病变的影响（0.13%）。75%的病变发生在择期大手术的插管操作过程中，15%发生在小手术的气管插管过程中，10%与急诊手术有关。牙齿撕脱占病变的50%，其次是冠桥损伤（14%），脱位和骨折（> 15%）。讨论内容：在我们的回顾性研究中，牙齿损伤的总体发生率为1.38/1000麻醉剂，这略高于一些报告的发生率，而低于其他报告的发生率。拔牙的恒牙发生在病人谁是受严重的流动性的天然牙，而接受手术。尽管大多数麻醉师在使用气道器械方面接受了足够的培训，并意识到过度用力可能造成的损害，但一些意想不到的困难可能导致病变。众所周知，即使没有疏忽，牙齿也会受到损害。
Dental injuries represent the most common claims against the anaesthesiologist. Dental lesions are frequent complications of oro-tracheal intubation and major causal factors are (i) poor dentition, (ii) aggressive laryngoscopy, (iii) insufficient anaesthesia and curarization, (iv) emergency interventions and (v) lack of experience by the anaesthesiologist. Materials and methods: We conducted a retrospective analysis of 83 cases of dental lesions occurring during elective, emergent and urgent surgery requiring general anaesthesia with tracheal tube placement in the years between 2000 and 2008. Preoperative evaluation of dental status was obtained from the anaesthesiology chart, filled by an experienced anaesthesiologist during the preoperative visit. Anaesthesiological records were inspected by physicians of Legal Medicine Department with the aim to attribute responsibility for the damage and manage potential reimbursements. Costs related to the required dental repair were also noted. Results: Eighty-three patients of a total of 60.000 surgical procedures (no day surgery) under general anaesthesia were affected by dental lesions (0.13%). Seventy-five per cent of lesions occurred during intubation manoeuvres for elective major surgery, 15% occurred at tracheal intubation for minor surgery and 10% were related to emergency surgery. Teeth avulsions accounted for 50% of lesions, followed by damage to crowns and bridges (14%), luxations and fractures (> 15%). Discussion: The overall incidence of dental injury in our retrospective study was 1.38 per 1000 anaesthetics, which is slightly higher than those reported by some and lower with respect to others. Avulsion of a permanent tooth occurred in patients who were affected by severe mobility of native teeth while undergoing surgery. Even though the majority of anaesthesiologists were trained enough in the use of airway devices and aware of the potential damage while using excessive forces, some unexpected difficulties may have led to lesions. It is known that damage to teeth can occur even in the absence of negligence.