Перспективи надання амбулаторної стоматологічної допомоги дітям за допомогою загального знеболення та седації

Abstract

Описані види загального знеболення та седації, що використовуються під час надання стоматологічної допомоги дітям. Розглянуті показання та протипоказання, вимоги до цих видів знеболення,проаналізовані позитивні та негативні властивості препаратів.Ксеноновий наркоз у найбільшій мірі відповідає вимогам для наркозу, але доступний тільки в приватній амбулаторній практиці. Коли потрібна седація із анальгезією краще використовувати севофлуран або комбінацію пропофолу з кетаміном. Якщо потрібна тільки седація краще використати пропофол;Описаны виды общего обезболивания и седации, используемых при оказании стоматологической помощи детям. Рассмотрены показания и противопоказания, требования к этим видам обезболивания, проанализированы положительные и отрицательные свойства препаратов. Ксеноновый наркоз в наибольшей мере отвечает требованиям для наркоза, однако доступен только в частной амбулаторной практике. Когда нужна седация с анальгезией лучше использовать севофлуран или комбинацию пропофола с кетамином. Если необходима только седация лучше использовать пропофол;The comfortable conditions of therapeutic treatment are a background of perfected result. The goals of our study are analysis and selection the best kinds of general anesthesia and sedation were used for dental treatment in children. The different types of general anesthesia accompanied with inhalation anesthesia for treatment of teeth. It’s necessary to have a special modern narcosis - respiratory equipment for the Xenon and Sevoran anesthesia. The account types of anesthesia are expensive in comparison with nitrous oxide. The Xenon, Sevoflurane anesthesia has a faster analgesic features and velocity of narcosis is smooth beginning and completion if compared with nitrous oxide. Xenon is considered the "ideal" anesthetic of all drugs for inhalation and intraveus anesthesia. The Isoflurane anesthesia is having a lasting effect and applies during prolonged dental treatment more than half an hour. Sevoflurane combined with Isoflurane for initiation and maintenance of anesthesia, because of Isoflurane has an unpleasant odor and irritates the upper respiratory tract, the patient longer awakes after it. Sedation occupies an intermediate position between the general and local anesthesia, she has the same indications and contraindications for using, but consciousness is kept in contrast of general anesthesia. Sedation is a psychomotor indifference condition in which the patient responds to irritations and he can awake. The psychical pain accompanied by fear depressed in the background of sedation. The protective patient movements and cardiovascular reactions caused by pain are saved. The pathway of sedation introduction is oral, inhalation and intravenous, but the last of these providing a faster effect. Using low doses of sedatives preparations allow that the patient feels much better after sedation than general anesthesia. Such sedation drugs as nitrous oxide, propofol, thiopental sodium, and midazolam have'nt analgesic effectiveness. Therefore, they are combined with such drugs for general anesthesia as sevoflurane, fentanyl, ketamine or local anesthesia for reach of necessary sedation level. Anesthesiologist carries out the sedation after premedication with Atropine solution and Diphenhydramine in Poltava pediatric urban clinic dental policlinic. The inhalation with nitrous oxide and intravenous sedation is used for surgery procedures; only intravenous sedation composed with Thiopental sodium and Ketamine provides for therapeutic manipulations. Adding sedative doses of Thiopental sodium allows decreasing dose of Ketamine. The general anesthesia or sedation provides high speed and precision manipulation during oral cavity treatment of young age children. Using of modern sedation method sensures maximum clinical effect during treatment of pulpitis in one visit, composite filling materials and pressed crowns for the restoration of deciduous teeth, aesthetics and function teeth rehabilitation. The preventive prosthesis may prevent the development of dental anomalies in early childhood if child treats with general anesthesia or sedation. The xenon narcosis is the best kind of anesthesia used to dental treatment. When a dentist is deciding which level of sedation to use, it is important to determine whether the intended goal is sedation or analgesia or both and to consider the adverse reactions of each drug. When the goal is sedation with analgesia it is better to use the Sevoflurane or Propofol-Ketamine combination. It is better to use Propofol if we need only sedation.