Patients with special needs often undergo general anesthesia for dental treatment as a way to avoid risks of injury and excessive stress. A new study assessed the safety of general anesthesia for dental treatment of special needs patients as it related to the American Society of Anesthesiology Physical Status (ASAPS) classification, procedure, and other factors, finding that it is safe. The study is published in Anesthesia Progress. Patients with mental and physical limitations often pose a challenge when needing dental treatment. Lack of cooperation, combative behavior, and physical limitations can make conventional treatment under local anesthesia very difficult and sometimes impossible. To avoid injury and excessive stress as well as the inability to provide high-quality and well-delivered dental care, dentists often resort to the management of their special needs patients under general anesthesia. Although comprehensive dental rehabilitation (CDR) is usually described as a minimally invasive procedure, the study’s researchers said that the special needs population has its own unique challenges, which may not necessarily correlate with the general agreed criteria for anesthetic risks. In the study, data from 363 records were analyzed and tabulated. The researchers chose to highlight 2 case studies that illustrated some of the issues for the special needs population. Some of the unexpected anesthetic challenges were limited preanesthesia assessment of airway and general physical condition; limited medical risk assessment due to lack of cooperation or lack of access to medical support systems; lack of compliant caretaker network to ensure preanesthesia; and postanesthesia compliance. Surgical complications included surgical “surprises,” making the stratification of risk and the estimate of procedure time difficult to assess; undiagnosed dental and oral diseases requiring more aggressive intervention; poor after-care; and lack of compliance, which can complicate what otherwise would be considered routine care. Despite the “surprises” and complications, the researchers found that general anesthesia for CDR performed in a major teaching medical center is safe and necessary. It is important to compare the level of risk-versus-benefit and make this clear to the patient or family member, the researchers said.
(Source: American Dental Society of Anesthesiology. Five-year outcomes study of dental rehabilitation conducted under general anesthesia for special needs patients. Anesthesia Progress. 2007; 54(4):170-174)
