خلفية البحث و هدفه: أصبح التركين الوريدي بديلاً مهماً للتخدير العام في المعالجة السنية لمرضى الإعاقة العقلية.
أجريت هذه الدراسة لتقييم فعالية البروبوفول الوريدي و سلامته بوصفه مركناً عميقاً عند المرضى المعوقين، و دراسة تأثير تغيرات الجنس و العمر و مدة المعالجة في مدة الصحو اللازمة لتخريج المريض.
مواد البحث و طرائقه: تضمنت الدراسة 28 معوقاً بمختلف الإعاقات كالشلل الدماغي و التخلف العقلي و داون من الصنف الأول بحسب تصنيف ASA (ذكرا 15 و 13 انثى ) و تراوحت أعمارهم بين 3 و 34 عاماً، بلغت أوزانهم 10-60 كغ أعطِي البربوفول الوريدي 2.5 ملغ/كغ كجرعة وحيدة قبل العمل. أُجرِيتْ المعالجة السنية لهؤلاء المرضى في
غرفة العمليات في مشفى جراحة الفم و الفكين في كلية طب الأسنان- جامعة دمشق، ثم جرت المتابعة في غرفة الإنعاش في المشفى بقياس العلامات الحيوية.
النتائج: كان التركين الوريدي بالبربوفول فعالاً للمعالجة السنية في المرضى كّلهم، و نُفِّذَتِ الإجراءات السنية العلاجية الآتية: القلع و التركين بالطريقة اللارضية و التقليح، و متوسط مدة المعالجة 21 دقيقة. لا توجد علاقة ارتباط خطية دالة إحصائياً (p<0.05) بين زمن الصحو (بالدقائق) و كل من جنس المريض و عمره و وزنه و مدة المعالجة.
الخلاصة: أظهرت نتائج هذه الدراسة أن التركين الوريدي للمعوقين باستخدام البربوفول يبدو آمناً و فعالاً من أجل المعالجة السنية للمعوقين عندما يدخلُ ويراَقب من قبل طبيب تخدير كفء، مما يدفع لاستخدامه كبديل عن التخدير العام.
Background & Objective: IV sedation has become established as an alternative to general anesthesia in dental treatment of patients with intellectual disability.
AIM: This study was designed to evaluate analgesic efficacy and clinical safety of intravenous propofol sedation for handicapped, and determine the effect of gender, age, time of treatment on the recovery time for the patient.
Methods & Materials: Twenty eight handicapped patients with cerebral palsy, intellectual disability, Down syndrome, classified as ASA 1(15 males, 13 females) in the age-group of 3-34 years, and in the weight group of 10-60 kg were selected, Who had undergone deep intravenous sedation using a mean dose
of 2.5 mg/kg as only one dose before treatment. The handicapped were treated at maxillio-facial hospital
at Faculty of dentistry - Damascus University in the hospital setting then in the recovery room were observed for vital signs.
Results: IV sedation with propofol was effective for dental treatment in all cases. The dental proucedures were: extraction, ART, and scaling. The mean treatment time was 21 minutes. There was no significant effect for recovery time (p<0.05) with gender, age, weight of the patient and the time of treatment.
Conclusions: The results of this study showed that intravenous propofol sedation appears to be a safe and effective method for dental treatment of handicapped patients, when administered and monitored by a qualified anesthetist, offering the practitioner an alternative to general anesthesia.
References used
Malamed S F, SEDATION A Guide to patient Managment , Fourth edition. 2001.Mosby
Folayan M O,AFapolen A,Lamikanara A .Areview of the pharmacological approach to the management of dental anxiety in children. International Journal of Paediatric Dentistry. 2002 ;12:347-354
Hosey M T ,Makin A ,Jones R M , et al .Propofol intravenous conscious sedation for anxious children in a specialist paediatric dentistry unit .I International Journal of Paediatric Dentistry. 2004; 14:2-8
American Academy of Pediatric Dentistry . Clinical Guideline on the Elective Use of minimal moderate and deep sedation and general an Anesthesia in Pediatric Dental patients. Pediatric Dentistry . 2004; 26(7):95-103
Lee J Y, Roberts M W .Mortality risks associated with pediatric dental care using general anesthesia in a hospital setting . The Journal of Clinical Pediatric Dentistry 2003. 27(4):381-38
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