[General anesthesia in mentally disabled patients undergoing dental surgery].
OBJECTIVE
To describe the anesthetic technique used, the evaluation of airway patency, and the perioperative complications in patients with lower than average intelligence (mentally disabled) who are administered general anesthesia for dental surgery.


METHODS
We carried out a prospective, descriptive, comparative study of mentally disabled ASA 2-3 patients. The patients were distributed in 2 groups: mild to moderate mental disability and severe to very severe mental disability. Induction was via intravenous or inhaled anesthesia depending on availability of venous access. Maintenance was with sevoflurane in oxygen and air at variable concentrations in order to maintain a bispectral index (BIS) between 40 and 60. Statistical comparisons were based on the chi2 test, the log-rank test and the t test.


RESULTS
Forty-seven patients were enrolled. The anesthetic technique maintained hemodynamic stability in both groups. No statistically significant differences were found in Mallampati classification, Cormack-Lehane classification, or level of disability. The incidence of complications was higher in the group with more severe disability; the most common complication was difficult tracheal intubation. Bradycardia was the most common complication in the group with mild to moderate mental disability.


CONCLUSIONS
The anesthetic technique used in this study proved to be safe and effective in this type of patient. A higher degree of mental disability led to less effective examination of the airway and more difficult direct laryngoscopy. BIS was as effective for monitoring in this population as it is in the general population.
Mirón Rodríguez
M F
MF
Servicio de Anestesiología, Reanimación y Terapdutica del Dolor, Complejo Hospitalario Universitario de Badajoz, Hospital Universitario Materno-Infantil "La Paz", Madrid. mfmiron@gmail.com
García-Miguel
F J
FJ
Becerra Cayetano
A
A
Cojo Del Peces
E
E
Rueda García
J
J
Gilsanz Rodríguez
F
F
D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000150:complications; D000769:Anesthesia, Inhalation / Q000379:methods* / Q000706:statistics & numerical data; D000771:Anesthesia, Intravenous / Q000379:methods* / Q000706:statistics & numerical data; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects; D001919:Bradycardia / Q000139:chemically induced; D002648:Child; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000150:complications*; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D019647:Oral Surgical Procedures; D011446:Prospective Studies; D012720:Severity of Illness Index; D000077149:Sevoflurane; D014076:Tooth Diseases / Q000150:complications / Q000601:surgery*
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane