J Korean Dent Soc Anesthesiol.  2008 Jun;8(1):22-28. 10.17245/jkdsa.2008.8.1.22.

Dental Treatment of a Patient with Cerebral Palsy under General Anesthesia

• Chung JM
• Seo KS
• Yi YE
• Han HJ
• Han JH
• Kim HJ
• Shin TJ
• Kim HJ
• Yum KW
• Chang J

• KMID: 2345123
• DOI: http://doi.org/10.17245/jkdsa.2008.8.1.22

Abstract

BACKGROUND
Cerebral palsy (CP) is non-progressive disorder of motion and posture. In CP patient, there are difficulties in dental treatment because of uncontrolled movement of limb and head, and conjoined disabilities such as cognitive impairment, sensory loss, seizures, communication and behavioral disturbances. It is reported that CP patients have high incidence in caries and a higher prevalence of periodontal disease. But, despite the need for oro-dental care, these patients often are unlikely to receive adequate treatment without sedation or general anesthesia because of uncontrolled movements of the trunk or head.
METHODS
We reviewed the 58 cases of 56 patients with CP who underwent outpatient general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital.
RESULTS
The mean age was 19 (2-54) years. The number of male patient was 40 and that of female was 18. They all had severe spastic cerebral palsy and 22 had sever mental retardation, 15 epilepsy, 8 organic brain disorder, 1 blindness, 2 deafness and cleft palate. For anesthesia induction, 14 cases was needed physical restriction who had sever mental retardation and cooperation difficulty, but 44 cases showed good or moderate cooperation. Drugs used for anesthesia induction were thiopental (37 cases), sevoflurane (14 cases), ketamine (3 cases ) and propofol (4 cases). All patients except one were done nasotracheal intubation for airway management and 4 cases were needed difficult airway management and 1 patient already had tracheostomy tube. Mean total anesthetic time was 174 ± 56 min and staying time at PACU was 88 ± 39 min. There was no death or long term hospitalization because of severe complications.
CONCLUSION
If general anesthesia is needed, pertinent diagnostic tests and workup about anomaly, and appropriate anesthetic planning are essential for safety.

Keyword

Cerebral palsy; General anesthesia; Dental treatment; Disabilities

MeSH Terms

Airway Management
Anesthesia
Anesthesia, General*
Blindness
Brain Diseases
Cerebral Palsy*
Cleft Palate
Cognition Disorders
Deafness
Diagnostic Tests, Routine
Epilepsy
Extremities
Female
Head
Hospitalization
Humans
Incidence
Intellectual Disability
Intubation
Ketamine
Male
Outpatients
Periodontal Diseases
Posture
Prevalence
Propofol
Seizures
Seoul
Thiopental
Tracheostomy
Ketamine
Propofol
Thiopental