The Level of Anesthesia Resident Training Does Not Affect the Risk of Dental Injury
The Level of Anesthesia Resident Training Does Not Affect the Risk of Dental Injury
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麻醉住院医师培训水平不会影响牙齿损伤的风险
DOI：
10.1213/00000539-199808000-00004
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发表时间：
1998
影响因子：
5.7
通讯作者：
A. Castro
中科院分区：
文献类型：
--
作者：
R. Gaiser;A. Castro
牙外伤是全身麻醉最常见的并发症。回顾性分析报告了1：1000气管插管的发生率（l），但前瞻性分析报告了更高的发生率。Chen等人（2）研究了745名接受气管内麻醉的患者，麻醉前后均检查了他们的牙齿。牙体缺损发生率为12.1%。基于这份报告，Chadwick和林赛（3），都是牙科医生，主张在进行任何涉及气管插管的麻醉之前，由牙科医生进行牙科检查。可以采取预防措施，术前可以定制护齿器。然而，这一行动并非对所有患者都具有成本效益。重要的是要在术前识别风险因素，以有效地利用这些信息。牙齿损伤的风险因素包括牙周病和假牙（4）。一些作者引用牙齿创伤作为诉讼的常见原因。Chadwick和林赛（3）报告说，在1977年至1986年期间，向医疗保护协会报告的所有确认或潜在的麻醉剂索赔中，牙齿损伤占三分之一。在7年的时间里，哈佛风险管理基金会发现，牙齿损伤是与医疗事故索赔相关的最常见的伤害，占所有案件的29%（5）。对新西兰事故赔偿公司档案的审查发现，牙齿创伤相对常见（6）。因此，牙齿创伤不仅是患者的烦恼，而且在时间和报销方面可能对麻醉师产生经济影响。没有研究检查提供麻醉的个人的培训水平对牙齿损伤风险或风险患者特征的影响。Lockhart等人（7）报告，当由麻醉住院医师提供全身麻醉时，牙齿损伤的频率为1：1000。这项研究依赖于
D ental trauma is the most common complication of general anesthesia. Retrospective analysis reports an incidence of 1:lOOO endotracheal intubations (l), but prospective analysis reports a higher incidence. Chen et al. (2) studied a series of 745 patients undergoing endotracheal anesthesia whose dentitia was examined both before and after the anesthetic. The frequency of dental damage was 12.1%. Based on this report, Chadwick and Lindsay (3), both dental surgeons, advocated a dental examination by a dental surgeon before any anesthetic involving endotracheal intubation. Precautionary measures could be taken, and customized mouth guards could be made before the surgery. However, this action is not costeffective for all patients. It is important to identify risk factors preoperatively to effectively use this information. Risk factors for dental injury include periodontal disease and dental prostheses (4). Several authors cite dental trauma as a frequent cause of litigation. Chadwick and Lindsay (3) reported that dental injury accounted for one third of all confirmed or potential anesthetic claims reported to the Medical Protection Society between 1977 and 1986. Over a 7-yr period, the Harvard Risk Management Foundation found that dental damage was the most common injury associated with malpractice claims, accounting for 29% of all cases filed (5). A review of the Accident Compensation Corporation files in New Zealand found dental trauma to be relatively common (6). Thus, dental trauma not only is an annoyance for the patient, but also has possible financial implications for the anesthesiologist in terms of time and reimbursement. No study has examined the influence of the level of training of the individuals providing the anesthesia on the risk of dental injury or the characteristics of at-risk patients. Lockhart et al. (7) reported a frequency of dental injury of 1:lOOO when general anesthesia was provided by an anesthesia resident. This study relied