Laparoscopic Cholecystectomy

1.AUTHOR Chidyllo-S-A, Zukaitis-J-A
INSTITUTIONDepartment of General Surgery, New York Infirmary, Beekman Downtown Hospital.
TITLE Dental examinations prior to elective surgery under anesthesia.
SOURCE N-Y-State-Dent-J 1990 Nov, VOL: 56 (9), P: 69-70, ISSN: 0028-7571.
Abstract:It is important to involve the patient's general dentist in the preoperative management, since routine dental examinations are performed more frequently than surgery. If the dentist learns from the patient that he or she will be undergoing surgery, the dentist should stress the importance of stabilizing or removing any loose teeth or prostheses prior to surgery. In most medical centers today, patients undergoing elective surgery are seen by the anesthesiologist prior to their date of surgery for preadmission testing. A review of the patient's medical history is obtained and physical examination is performed. The anesthesiologist examines the patient for difficulty with opening the mouth, and for any loose crowns or dentures. If there are dental problems that should be corrected, the patient should be requested to visit his/her dentist prior to surgery. This will help prevent problems during the administration of general anesthesia. Reviewing the literature, it is difficult to obtain definite statistics on the incidence of dental complications secondary to general anesthesia. Most references agree that damage to the teeth and dental appliances is the most common complication of intubation. Damaged teeth result in the largest number of lawsuits filed against anesthesiologist. One review of anesthesia-related claims reports that 17 percent of the claims are due to damage to the teeth or dental prosthesis. Several authors had advocated the use of devices to help protect the dentition during the surgery.
Most of these devices temporarily splint or protect the teeth from trauma during intubation and extubation.(ABSTRACT TRUNCATED AT 250 WORDS) Author.

2.AUTHOR Chadwick-R-G, Lindsay-S-M.
INSTITUTIONDepartment of Conservative Dentistry, Dental School, Dundee.
TITLE Dental injuries during general anaesthesia (see comments).
SOURCEBr-Dent-J 1996 Apr 6, VOL: 180 (7), P: 255-8, ISSN: 0007-0610 21 Refs.
CMCM Comment in: Br-Dent-J 1996 Jul 6; 181(1):11.
Abstract:Although most anaesthetic textbooks cite dental injury as a complication of endotracheal intubation few studies have examined the extent and nature of the problem. Such damage however, formed the basis for one-third of all confirmed or potential anaesthetic claims notified to the Medical Protection Society between 1977 and 1986. This article seeks to explore the extent of the problem, outline predisposing factors, summarise current prophylactic measures and make recommendations to reduce the overall incidence. Increased awareness of the problem, by both anaesthetists and dental surgeons, coupled with appropriate prophylactic measures may result in a reduced incidence of dental injury arising from general anaesthesia. Given the high incidence of dental damage we recommend that all patients undergoing a surgical operation under endotracheal intubation should have a pre-operative dental check wherever possible. Clearly, the first dental examination would be conducted by an anaesthetist familiar with the predisposing factors. Where he/she considers there to be a higher than average risk of dental damage occurring during intubation a more specialised examination should be conducted by a dental surgeon. It may, where appropriate, be possible for remedial dental treatment to be carried out and customised mouth guards to be constructed prior to the operation. Obviously such recommendations have certain financial implications and would have to be subject to controlled cost-benefit analysis before their widespread application. Author.
3.AUTHOR Chen-J-J, Susetio-L, Chao-C-C.
INSTITUTIONDepartment of Dentistry, National Taiwan University Hospital.
TITLE Oral complications associated with endotracheal general anesthesia.
SOURCEMa-Tsui-Hsueh-Tsa-Chi 1990 Jun, VOL: 28 (2), P: 163-9, ISSN: 0254-1319.
Abstract:A series of 745 consecutive cases of endotracheal anesthesia were collected at the National Taiwan University Hospital. Evaluation of the oral conditions was performed before, during and after the anesthesia. Injuries to oral structures were recorded. An 18% incidence of oral injuries was noted and the frequency for dental damage was 12.1%. Maxillary incisors, especially the left ones, were accident-prone. Risk factors identified in this study included large decay or restoration, advanced periodontitis, presence of dental prosthesis, shedding deciduous tooth, class II jaw relationship and anterior crowding. More than one third of the complications occurred during the maintenance or emergence stage of the anesthesia. Recommendations for prevention and
management of this problem were given. Author.
4.AUTHOR Burton-J-F, Baker-A-B.
INSTITUTIONOtago University, Dunedin, New Zealand.
TITLE Dental damage during anaesthesia and surgery.
SOURCEAnaesth-Intensive-Care 1987 Aug, VOL: 15 (3), P: 262-8, ISSN: 0310-057X.
Abstract:A review of the Accident Compensation Corporation (ACC) files on dental damage following anaesthesia or surgery was undertaken along with a survey of New Zealand anaesthetists asking about their practice with respect to protection of teeth during anaesthesia. These results confirm that damage is relatively common and that the majority of damaged teeth (62%) were known to have been previously restored, or weakened through periodontal disease prior to the damage occurring. The anaesthetists surveyed thought that dental damage was even more common than shown from the ACC records, and yet the vast majority of them did not routinely use specific protective guards and 45% of them did not ever use protective guards of any type. Author.
5.AUTHOR Benumof-J-L.
TITLE Clinical procedures in anesthesia and intensive care.
SOURCEPhiladelphia : Lippincott, 1992.
Abstract:(Page 127) Chapter 6 How to do Conventional (Laryngoscopic) Orotracheal and Nasotracheal Intubation Conventional Laryngoscopy with a Curved Blade...After the blade has been applied to the base of the tongue, the laryngoscope is lifted to expose the epiglottis. Hereafter, the left wrist of the operator should remain straight, all lifting being done by the left shoulder and arm. If the laryngoscopist follows a natural inclination to rotate and flex the wrist further, thereby raising the laryngoscope like a lever whose fulcrum
is the upper incisor or gum, broken teeth or gum bleeding is likely to result.
6.AUTHOR Aromaa-U, Pesonen-P, Linko-K, Tammisto-T.
INSTITUTIONDepartment of Anaesthesiology, Helsinki University Central Hospital, Finland.
TITLE Difficulties with tooth protectors in endotracheal intubation.
SOURCEActa-Anaesthesiol-Scand 1988 May, VOL: 32 (4), P: 304-7, ISSN: 0001-5172.
Abstract:The suitability of three tooth protectors for routine use during endotracheal intubation was studied in 300 consecutive patients undergoing elective operations under general anaesthesia. The main disadvantages of the protectors were lack of space and the consequent difficulty of guiding the endotracheal tube into the larynx, and poor visibility, especially when the Camo protector was used. These difficulties could be avoided in most cases by cutting off the right angle of the Camo protector. The less experienced anaesthesiologists especially had difficulties with the protectors: 20% of patients in the Camo group were considered impossible to intubate unless the protector was removed. The silicone inlay of the Camo protector melts and becomes adhesive at body temperature, which makes its prolonged use hazardous. Two patients lost a maxillary incisor despite the proper use of a protector (Denex). Thus the use of a tooth protector alone does not guarantee avoidance of dental trauma. Better results could be obtained by improving the design of the protectors and by careful pre-anaesthetic dental examination. Author.
7.AUTHOR Bory-E-N, Goudard-V, Magnin-C.
INSTITUTIONUniversite Claude-Bernard, Lyon.
TITLE (Tooth injuries during general anesthesia, oral endoscopy and vibro- massage). TT Les traumatismes dentaires lors des anesthesies generales, des endoscopies orales et des sismotherapies.
SOURCEActual-Odontostomatol (Paris) 1991 Mar, VOL: 45 (173), P: 107-20, ISSN: 0001-7817.
Abstract:It is generally recognized that dental injury during and after tracheal
intubation is a significant problem. Damage may occur during oro-tracheal intubation, oral endoscopy or seismotherapy. The incidence was reported in a study conducted in the contentious department of Lyon hospitals, in France, from 1978 to 1988. Results confirm that damage is relatively common and that the majority of damaged teeth (67%) were known to have been previously restored, or weakened through periodontal disease prior to the damage occurring. Maxillary incisors were the most frequently injured teeth. Fracture of crowns and roots of natural teeth (44,8%), followed by partial luxation (20,8%) and avulsion (20,8%) were the most common injury. Several cases are presented which reveal the clinical value of dental damages that occur during orotracheal intubation, oral endoscopy or seismotherapy. Besides dental or gingival complications can appear immediately but also after a few days or weeks. Some of the most recent development in dental therapy such as the butterfly bridge, titanium implants and porcelain laminate veneers are described. Tooth protective guards must be put into widespread use. Legal implications of dental lesions occurring during oro-tracheal intubation, oral endoscopy or seismotherapy are presented. Author.
8.AUTHOR Watanabe-S, Suga-A, Asakura-N, Takeshima-R, Kimura-T, Taguchi-N, Kumagai-M.
INSTITUTIONDepartment of Anesthesia, Mito Saiseikai General Hospital, Ibaraki, Japan.
TITLE Determination of the distance between the laryngoscope blade and the upper incisors during direct laryngoscopy: comparisons of a curved, an angulated straight, and two straight blades.
SOURCEAnesth-Analg 1994 Oct, VOL: 79 (4), P: 638-41, ISSN: 0003-2999.
Abstract:We compared visibility and dental complications from a variety of blades during tracheal intubation. Ninety-eight patients who received tracheal intubation were enrolled. They were divided into two groups: Study 1 (n = 50) and Study 2 (n = 48). Four laryngoscopic evaluations were planned for each patient using Miller and Wisconsin straight blades with different heel heights, a Macintosh curved blade, and a Belscope angulated straight blade (Study 1: Miller No. 3, Wisconsin No. 3, Macintosh No. 4, and Belscope medium; and Study 2: Miller No. 2, Wisconsin No. 2, Macintosh No. 3, and Belscope medium, respectively). All laryngoscopies were performed by the same anesthesiologist. The distance between the blade and the upper central incisors was measured when the optimum visibility of the glottis was obtained. The visibility was determined according to the Cormack and Lehane grading. Analysis of the distance between the blade and upper incisors was performed using the results of the 44 patients (166 distances) in Study 1 and the 48 patients (181 distances) in Study 2 who had a visibility of two or better. The Belscope blade provided a significantly greater visual field than the other types of blade. Two patients sustained a fracture of the central incisor and subluxation of the central incisor, respectively, during laryngoscopy in which a Wisconsin blade was used. The average incidence of dental injury was 1/191. The Belscope blade may contribute to a reduced likelihood of upper dental injuries during laryngoscopy. Author.

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