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A retrospective analysis of outpatient anesthesia management for dental treatment of patients with severe Alzheimer's disease

  • So, Eunsun (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Kim, Hyun Jeong (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Karm, Myong-Hwan (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Seo, Kwang-Suk (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Chang, Juhea (Special Care Clinic, Seoul National University Dental Hospital) ;
  • Lee, Joo Hyung (Department of anesthesiology and pain medicine, CHA Bundang Medical Center, CHA University)
  • Received : 2017.12.12
  • Accepted : 2017.12.26
  • Published : 2017.12.31

Abstract

Background: The number of patients with Alzheimer's disease is growing worldwide, and the proportion of patients requiring dental treatment under general anesthesia increases with increasing severity of the disease. However, outpatient anesthesia management for these patients involves great risks, as most patients with Alzheimer's disease are old and may show reduced cardiopulmonary functions and have cognitive disorders. Methods: This study retrospectively investigated 43 patients with Alzheimer's disease who received outpatient anesthesia for dental treatment between 2012-2017. Pre-anesthesia patient evaluation, dental treatment details, anesthetics dose, blood pressure, duration and procedure of anesthesia, and post-recovery management were analyzed and compared between patients who underwent general anesthesia or intravenous sedation. Results: Mean age of patients was about 70 years; mean duration of Alzheimer's disease since diagnosis was 6.3 years. Severity was assessed using the global deterioration scale; 62.8% of patients were in level ${\geq}6$. Mean duration of anesthesia was 178 minutes for general anesthesia and 85 minutes for intravenous sedation. Mean recovery time was 65 minutes. Eleven patients underwent intravenous sedation using propofol, and 22/32 cases involved total intravenous anesthesia using propofol and remifentanil. Anesthesia was maintained with desflurane for other patients. While maintaining anesthesia, inotropic and atropine were used for eight and four patients, respectively. No patient developed postoperative delirium. All patients were discharged without complications. Conclusion: With appropriate anesthetic management, outpatient anesthesia was successfully performed without complications for dental treatment for patients with severe Alzheimer's disease.

Keywords

References

  1. Hugo J, Ganguli M. Dementia and cognitive impairment: Epidemiology, diagnosis, and treatment. Clin Geriatr Med 2014; 30: 421-42. https://doi.org/10.1016/j.cger.2014.04.001
  2. Alzheimer's Association. 2017 Alzheimer's disease facts and figures. Alzheimers Dement 2017; 13: 325-73. https://doi.org/10.1016/j.jalz.2017.02.001
  3. Ellefsen B, Holm-Pedersen P, Morse DE, Schroll M, Andersen BB, Waldemar G. Assessing caries increments in elderly patients with and without dementia: A one-year follow-up study. J Am Dent Assoc 2009; 140: 1392-400. https://doi.org/10.14219/jada.archive.2009.0076
  4. Chen X, Clark JJ, Naorungroj S. Oral health in nursing home residents with different cognitive statuses. Gerodontology 2013; 30: 49-60. https://doi.org/10.1111/j.1741-2358.2012.00644.x
  5. Kieser J, Jones G, Borlase G, MacFadyen E. Dental treatment of patients with neurodegenerative disease. N Z Dent J 1999; 95: 130-4.
  6. Kocaelli H, Yaltirik M, Yargic LI, Ozbas H. Alzheimer's disease and dental management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93: 521-4. https://doi.org/10.1067/moe.2002.123538
  7. Lim M, Borromeo GL. The use of general anesthesia to facilitate dental treatment in adult patients with special needs. J Dent Anesth Pain Med 2017; 17: 91-103. https://doi.org/10.17245/jdapm.2017.17.2.91
  8. Caputo AC. Providing deep sedation and general anesthesia for patients with special needs in the dental office-based setting. Spec Care Dentist 2009; 29: 26-30. https://doi.org/10.1111/j.1754-4505.2008.00059.x
  9. Rosenthal RA, Kavic SM. Assessment and management of the geriatric patient. Crit Care Med 2004; 32(4 Suppl): S92-105. https://doi.org/10.1097/01.CCM.0000122069.56161.97
  10. Kim MS, Seo KS, Kim HJ, Han HJ, Shin TJ, Chang J. Dental treatment of a patient with alzheimer disease under ambulatory general anesthesia. J Korean Dent Soc Anesthesiol 2011; 11: 146-52. https://doi.org/10.17245/jkdsa.2011.11.2.146
  11. Reisberg B, Ferris SH, de Leon MJ, Crook T. The global deterioration scale for assessment of primary degenerative dementia. American journal of psychiatry. Am J Psychiatry 1982; 139: 1136-9. https://doi.org/10.1176/ajp.139.9.1136
  12. Seo KS, Shin TJ, Kim HJ, Han HJ, Han JH, Kim HJ, et al. Clinico-statistical analysis of cooperation and anesthetic induction method of dental patients with special needs. J Korean Dent Soc Anesthesiol 2009; 9: 9-16. https://doi.org/10.17245/jkdsa.2009.9.1.9
  13. Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: A systematic review and metaanalysis. Alzheimers Dement 2013; 9: 63-75 e2. https://doi.org/10.1016/j.jalz.2012.11.007
  14. Kim YJ, Han JW, So YS, Seo JY, Kim KY, Kim KW. Prevalence and trends of dementia in korea: A systematic review and meta-analysis. J Korean Med Sci 2014; 29: 903-12. https://doi.org/10.3346/jkms.2014.29.7.903
  15. Rocchi A, Pellegrini S, Siciliano G, Murri L. Causative and susceptibility genes for alzheimer's disease: A review. Brain Res Bull 2003; 61: 1-24. https://doi.org/10.1016/S0361-9230(03)00067-4
  16. Selkoe DJ. Alzheimer's disease: Genes, proteins, and therapy. Physiol Rev 2001; 81: 741-66. https://doi.org/10.1152/physrev.2001.81.2.741
  17. Warren JJ, Chalmers JM, Levy SM, Blanco VL, Ettinger RL. Oral health of persons with and without dementia attending a geriatric clinic. Spec Care Dentist 1997; 17: 47-53. https://doi.org/10.1111/j.1754-4505.1997.tb00866.x
  18. Turner LN, Balasubramaniam R, Hersh EV, Stoopler ET. Drug therapy in alzheimer disease: An update for the oral health care provider. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: 467-76. https://doi.org/10.1016/j.tripleo.2008.06.009
  19. Mancini M, Grappasonni I, Scuri S, Amenta F. Oral health in alzheimer's disease: A review. Curr Alzheimer Res 2010; 7: 368-73. https://doi.org/10.2174/156720510791162359
  20. Zuo C, Zuo Z. Spine surgery under general anesthesia may not increase the risk of alzheimer's disease. Dement Geriatr Cogn Disord 2010; 29: 233-9. https://doi.org/10.1159/000295114
  21. Choi KM, Park HS, Han JH, Lee JS, Lee J, Ryu OH, et al. Prevalence of prehypertension and hypertension in a korean population: Korean national health and nutrition survey 2001. J Hypertens 2006; 24: 1515-21. https://doi.org/10.1097/01.hjh.0000239286.02389.0f
  22. Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: A guideline from the american college of physicians. Ann Intern Med 2006; 144: 575-80. https://doi.org/10.7326/0003-4819-144-8-200604180-00008
  23. Kalia M. Dysphagia and aspiration pneumonia in patients with alzheimer's disease. Metabolism 2003; 52(10 Suppl 2): 36-8. https://doi.org/10.1016/S0026-0495(03)00300-7
  24. Allan LM, Ballard CG, Allen J, Murray A, Davidson AW, McKeith IG, et al. Autonomic dysfunction in dementia. J Neurol Neurosurg Psychiatry 2007; 78: 671-7.
  25. Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil. II. Model application. Anesthesiology 1997; 86: 24-33. https://doi.org/10.1097/00000542-199701000-00005
  26. Bianchi SL, Caltagarone BM, Laferla FM, Eckenhoff RG, Kelz MB. Inhaled anesthetic potency in aged alzheimer mice. Anesth Analg 2010; 110: 427-30. https://doi.org/10.1213/ANE.0b013e3181b5a292
  27. Culley DJ, Baxter MG, Yukhananov R, Crosby G. Longterm impairment of acquisition of a spatial memory task following isoflurane-nitrous oxide anesthesia in rats. Anesthesiology 2004; 100: 309-14. https://doi.org/10.1097/00000542-200402000-00020
  28. Aranake A, Mashour GA, Avidan MS. Minimum alveolar concentration: Ongoing relevance and clinical utility. Anaesthesia 2013; 68: 512-22. https://doi.org/10.1111/anae.12168
  29. Nickalls RW, Mapleson WW. Age-related iso-mac charts for isoflurane, sevoflurane and desflurane in man. Br J Anaesth 2003; 91: 170-4. https://doi.org/10.1093/bja/aeg132
  30. Schultz A, Grouven U, Zander I, Beger FA, Siedenberg M, Schultz B. Age-related effects in the EEG during propofol anaesthesia. Acta Anaesthesiol Scand 2004; 48: 27-34. https://doi.org/10.1111/j.1399-6576.2004.00258.x
  31. Papon MA, Whittington RA, El-Khoury NB, Planel E. Alzheimer's disease and anesthesia. Front Neurosci 2011; 4: 272.
  32. Rudolph JL, Marcantonio ER. Review articles: Postoperative delirium: Acute change with long-term implications. Anesth Analg 2011; 112: 1202-11. https://doi.org/10.1213/ANE.0b013e3182147f6d
  33. Fernandez CR, Fields A, Richards T, Kaye AD. Anesthetic considerations in patients with alzheimer's disease. J Clin Anesth 2003; 15: 52-8. https://doi.org/10.1016/S0952-8180(02)00483-X

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