J Dent Anesth Pain Med.  2017 Dec;17(4):271-280. 10.17245/jdapm.2017.17.4.271.

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

• So E
• Kim HJ
• Karm MH
• Seo KS
• Chang J
• Lee JH

• KMID: 2399797
• DOI: http://doi.org/10.17245/jdapm.2017.17.4.271

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 ≥ 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.

Keyword

Alzheimer Disease; Dementia; Dental Treatment; Outpatient Anesthesia

MeSH Terms

Alzheimer Disease*
Anesthesia*
Anesthesia, General
Anesthesia, Intravenous
Anesthetics
Atropine
Blood Pressure
Delirium
Dementia
Diagnosis
Humans
Outpatients*
Propofol
Retrospective Studies*
Anesthetics
Atropine
Propofol

Figure

• 

  Fig. 1 A flow chart of the study population is presented.GA = general anesthesia; IV = intravenous sedation.

• 

  Fig. 2 Trends of monitoring values are shown. Patients were divided into three groups according to the anesthetics used, and trends were observed for each group. Only the one-hour period after induction is presented to all patients. (A) Changes in systolic blood pressure during a one-hour period are shown. The total intravenous anesthesia (TIVA) GA group showed significant changes in systolic blood pressure (SBP) until 30 minutes after the induction (ANOVA test). There was no significant difference in SBP between the GA group and intravenous sedation (IVS) group, (B) Changes in anesthetic dosage during a one-hour period are shown. When viewed in terms of propofol and remifentanil, the two anesthetics used for TIVA GA, remifentanil dose was reduced in response to a drop in SBP about 10 minutes after induction, after which the SBP was restored, (C) Changes in BIS during a one-hour period are shown. The IVS group maintained a high BIS compared to that of the GA group (ANOVA test). GA = general anesthesia, BP = blood pressure. *P < 0.05, ANOVA.

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