Traumatic dental injuries during anaesthesia: part I: clinical evaluation

Gaudio, Rosa Maria; Feltracco, Paolo; Barbieri, Stefania; Tiano, Letizia; Alberti, Marco; Delantone, Massimiliano; Ori, Carlo; Avato, Francesco Maria

doi:10.1111/j.1600-9657.2010.00935.x

Cited by 44 publications

(17 citation statements)

References 20 publications

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“…Dental injury is one of the frequent adverse events of intubation and the most common claim against intubators. 15 Previous research has shown that the complete arch of the incisors has maximum bite force ranging from 150 to 200 N. 16 Based on this information, the peak force on the maxillary incisors of more than 150–200 N might be a risk factor for dental injury during intubation attempts. Although some studies have reported that the use of VLs (ie, GlideScope, McGrath and V-MAC) were associated with less force applied on maxillary incisors, 8 17 our results showed the applied force was higher in the C-MAC group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the force applied on oral structures during intubation attempts by novice physicians between the Macintosh direct laryngoscope, Airway Scope and C-MAC PM: a high-fidelity simulator-based study

Nakanishi

Shiga²,

Homma³

et al. 2016

BMJ Open

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ObjectiveWe examined whether the use of Airway Scope (AWS) and C-MAC PM (C-MAC) decreased the force applied on oral structures during intubation attempts as compared with the force applied with the use of Macintosh direct laryngoscope (DL).DesignProspective cross-over study.ParticipantsA total of 35 novice physicians participated.InterventionsWe used 6 simulation scenarios based on the difficulty of intubation and intubation devices.Outcome measuresOur primary outcome measures were the maximum force applied on the maxillary incisors and tongue during intubation attempts, measured by a high-fidelity simulator.ResultsThe maximum force applied on maxillary incisors was higher with the use of the C-MAC than with the DL and AWS in the normal airway scenario (DL, 26 Newton (N); AWS, 18 N; C-MAC, 52 N; p<0.01) and the difficult airway scenario (DL, 42 N; AWS, 24 N; C-MAC, 68 N; p<0.01). In contrast, the maximum force applied on the tongue was higher with the use of the DL than with the AWS and C-MAC in both airway scenarios (DL, 16 N; AWS, 1 N; C-MAC, 7 N; p<0.01 in the normal airway scenario; DL, 12 N; AWS, 4 N; C-MAC, 7 N; p<0.01 in the difficult airway scenario).ConclusionsThe use of C-MAC, compared with the DL and AWS, was associated with the higher maximum force applied on maxillary incisors during intubation attempts. In contrast, the use of video laryngoscopes was associated with the lower force applied on the tongue in both airway scenarios, compared with the DL. Our study was a simulation-based study, and further research on living patients would be warranted.

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Section: Discussionmentioning

confidence: 99%

Comparison of the force applied on oral structures during intubation attempts by novice physicians between the Macintosh direct laryngoscope, Airway Scope and C-MAC PM: a high-fidelity simulator-based study

Nakanishi

Shiga²,

Homma³

et al. 2016

BMJ Open

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“…Although the use of force applied on the oral structures are surrogates of intubation-related complications, there is a linkage between the force applied on the oral structures and intubation-related complications [ 19 ]. For example, excess force on the maxillary incisors increases the risk of dental injury—a frequent adverse event of intubation, and is the most common claim against intubators [ 20 ]. According to the prior study, force on the maxillary incisors greater than 150 N could be a risk factor for dental injury [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal acquisition of endotracheal intubation skills in novice physicians

et al. 2017

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Little is known about the acquisition of intubation skills among novice physicians during their one-year clinical training. Our primary objective was to determine the changes in the intubation skills of novice physicians between prior to the clinical training and after completion of the clinical training. We used data of a prospective longitudinal multicenter data registry developed to investigate factors associated with the improvement of intubation skills among novice physicians. The study participants included 90 postgraduate year 1 physicians in 2015–2016. We used 4 simulation scenarios based on the devices used (direct laryngoscope [DL] and Airway scope [AWS]) and difficulty of intubation (normal and difficult scenarios). As a marker of the intubation skills, we used the force applied on the maxillary incisors and the tongue with each intubation. We compared the data obtained prior to clinical training with those obtained after completion of one-year clinical training. When using DL, compared to prior, significantly less force were applied on the maxillary incisors and the tongue after clinical training in the normal scenario (28.0 N vs 19.5 N, p < 0.001, and 11.1 N vs 8.4 N, p = 0.004). Likewise, when using AWS, compared to prior, significantly less force were applied on the tongue after clinical training in the normal scenario (22.0 N vs 0 N, p < 0.001). The force on the tongue decreased after clinical training but not significant. These associations persisted in the difficult airway scenario. These findings suggest that force applied on oral structures can be quantified as a marker of intubation skills by using high-fidelity simulators, and the assessment of procedural competency is recommended for all novice physicians prior to performing intubation in the clinical setting to improve the quality of emergency care.

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“…In previous reports, perioperative dental injuries occur with relatively high incidence (0.13%), especially for patients with dental problems. 15) Once dental injuries occur during anesthesia, the cost of treatment and compensation is problematic, and the patient-doctor relationship can deteriorate. 16) A tooth protector is useful for preventing dental injuries and can sometimes improve intraoral conditions after oral injuries.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Management Center (PERIO) for Neurosurgical Patients

Yasuhara

Hishikawa

Agari

et al. 2016

Neurol. Med. Chir.(Tokyo)

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Perioperative management is critical for positive neurosurgical outcomes. In order to maintain safe and authentic perioperative management, a perioperative management center (PERIO) was introduced to patients of our Neurosurgery Department beginning in June 2014. PERIO involves a multidisciplinary team consisting of anesthesiologists, dentists/dental hygienists/technicians, nurses, physical therapists, pharmacists, and nutritionists. After neurosurgeons decide on the course of surgery, a preoperative evaluation consisting of blood sampling, electrocardiogram, chest X-ray, and lung function test was performed. The patients then visited the PERIO clinic 7–14 days before surgery. One or two days before surgery, the patients without particular issues enter the hospital and receive a mouth cleaning one day before surgery. After surgery, postoperative support involving eating/swallowing evaluation, rehabilitation, and pain control is provided. The differences in duration from admission to surgery, cancellation of surgery, and postoperative complications between PERIO and non-PERIO groups were examined. Eighty-five patients were enrolled in the PERIO group and 131 patients in the non-PERIO group. The duration from admission to surgery was significantly decreased in the PERIO group (3.6 ± 0.3 days), compared to that in the non-PERIO group (4.7 ± 0.2 days). There was one cancelled surgery in the PERIO group and six in the non-PERIO group. Postoperative complications and the overall hospital stay did not differ between the two groups. The PERIO system decreased the duration from admission to surgery, and it is useful in providing high-quality medical service, although the system should be improved so as not to increase the burden on medical staff.

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Traumatic dental injuries during anaesthesia: part I: clinical evaluation

Cited by 44 publications

References 20 publications

Comparison of the force applied on oral structures during intubation attempts by novice physicians between the Macintosh direct laryngoscope, Airway Scope and C-MAC PM: a high-fidelity simulator-based study

Comparison of the force applied on oral structures during intubation attempts by novice physicians between the Macintosh direct laryngoscope, Airway Scope and C-MAC PM: a high-fidelity simulator-based study

Longitudinal acquisition of endotracheal intubation skills in novice physicians

Perioperative Management Center (PERIO) for Neurosurgical Patients

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