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Study of Peri-Operative Complications in Persons with Disabilities Undergoing Dental Treatment Under General Anesthesia at the Mount Sinai Hospital

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Study of Peri-Operative Complications in Persons with Disabilities Undergoing Dental Treatment Under General Anesthesia at the Mount Sinai Hospital STUDY OF PERI-OPERATIVE COMPLICATIONS IN PERSONS WITH DISABILITIES UNDERGOING DENTAL TREATMENT UNDER GENERAL ANESTHESIA AT THE MOUNT SINAI HOSPITAL by Vandna Sharma DMD A thesis submitted in conformity with the requirements for the degree of Masters of Science Faculty of Dentistry University of Toronto © Copyright by Vandna Sharma 2011 STUDY OF PERI-OPERATIVE COMPLICATIONS IN PERSONS WITH DISABILITIES UNDERGOING DENTAL TREATMENT UNDER GENERAL ANESTHESIA AT THE MOUNT SINAI HOSPITAL Vandna Sharma Master of Science Faculty of Dentistry University of Toronto 2011 ABSTRACT This was a two part study. Part one was a retrospective chart review to ascertain the prevalence and predictors of peri-operative complications in PWD receiving their dental care under general anesthesia (GA). Part two was a prospective survey of parents/caregivers regarding their satisfaction with the service as well as to ascertain the prevalence of post-operative symptoms incurred by patients. In Part 1, the prevalence of complications in PWD was 4 times higher than the 6% stated in the literature for the general population. Time under GA, and no previous history of dental care under GA were significantly related to complications. In Part 2, 100% of patients experienced post-operative symptoms; nonetheless, 92.7% of parents/caregivers were satisfied with the service provided. There prevalence of complications in the PWD in this study was high. Prior to treatment under GA, adequate pre-operative medical evaluations must be completed and time under GA minimized. ii ACKNOWLEDGMENTS To Dr. M. Sigal, my primary supervisor and director, thank you for all of the guidance and direction you have provided me over the past three years. From you I have learned the value of perseverance and that even when life pushes you down, that we all have the strength within ourselves to get back up and keep going. To my committee members Drs. Haas, Tenenbaum and Friedman, thank you for all of the time and energy you have put in making this project successful. Without all of your feedback and knowledge I would not have been able to complete this project. To Dr. D. Johnston, my director at B.C. Children‟s Hospital, thank you for giving me the confidence to believe that the world is my oyster and that it is never too late to follow my dreams. You have taught me the value of equality for all, empathy and kindness. Without your encouragement, I would not be where I am today. To my friend and colleague Dr. Karen Stallaert, without whom this journey that started in Vancouver 5 years ago would not have been so fun and memorable. Thank you for your support and companionship. To my friends, thank you for standing by my side in the good and bad times. Life‟s journey has been so much better because of you all. To my significant other John, thank you for all of your support and encouragement. You are my pillar of strength and push me to do my best even when I am too tired to push. I am so proud of you for making your dreams into your reality. To my brother Gaurav, thank you for making me laugh and for keeping me grounded. You have always reminded me not to take life too seriously. Your charismatic and vivacious personality makes anyone who has the pleasure of knowing you lucky. Most importantly to my mom and as of recently my late father, there are not enough thanks in this world that I could give you for all of the sacrifices you have made for me, your loving dedication and constant encouragement. It is because of you that I have always believed that I could do anything I put my mind to. You have taught me the value of compassion, hard work, and humility. Without you none of this would be possible. Dad, I hope that from somewhere, you are watching the successes that you have contributed so greatly to. I miss you daddy. iii TABLE OF CONTENTS ABSTRACT .................................................................................................................................................. ii ACKNOWLEDGMENTS ............................................................................................................................ iii LIST OF TABLES ...................................................................................................................................... vii LIST OF FIGURES .................................................................................................................................... viii 1.0 INTRODUCTION ................................................................................................................................... 1 1.1 Definition: Persons With Disabilities ................................................................................................ 3 1.2 Types of Disabilities ............................................................................................................................ 3 1.3 The Prevalence of Disabilities in Canada ........................................................................................... 4 1.4 The Prevalence of Disabilities in Ontario ......................................................................................... 10 1.5 Oral Health Care Needs in Persons With Disabilities ...................................................................... 10 1.6 Access To Dental Care For Persons With Disabilities ..................................................................... 12 1.7 Treatment Options For Dental Care Delivery To Persons With Disabilities ................................... 13 1.8 The Role of Hospital Based Dental Programs in Delivering Oral Health Care to Persons With Disabilities ............................................................................................................................................... 17 1.9 American Society of Anesthesiologists (ASA) Physical Status Classification System .................... 18 1.10 Complications and Risks Associated With GA in Patients With and Without Disabilities ........... 20 1.11 Agents Used During General Anesthesia ....................................................................................... 27 1.12 Satisfaction With Service ................................................................................................................ 30 2.0 OBJECTIVES AND HYPOTHESES ...................................................................................................33 2.1 Objectives .......................................................................................................................................... 33 2.2 Hypotheses ........................................................................................................................................ 33 3.0 MATERIALS AND METHODS ..........................................................................................................34 3.1 Part 1- Retrospective Chart Review .................................................................................................. 34 3.2 Statistical Analysis Part 1- Retrospective Chart Review ................................................................... 35 3.3 Part 2- Prospective Survey ................................................................................................................ 37 3.4 Statistical Analysis Part 2- Prospective Survey ................................................................................. 38 4.0 RESULTS PART 1- RETROSPECTIVE CHART REVIEW ...............................................................40 4.1 Descriptive Statistics ......................................................................................................................... 40 4.2 Age and Sex Distribution of Study Populations (N=147 And N=88) ............................................... 40 4.3 ASA Classification of Study Populations .......................................................................................... 43 4.4 Medication Use at the Time of Surgery ............................................................................................. 44 4.5 Location of the Pre-Operative Anesthesia Evaluation....................................................................... 45 iv 4.6 Restraint During Induction ................................................................................................................ 46 4.7 Difficult Airway ................................................................................................................................ 47 4.8 Day Surgery Versus Planned Elective Admission ............................................................................ 48 4.9 Types of Dental Treatment Provided................................................................................................. 49 4.10 Blood Taken Intra-Operatively Due to Medical Request ................................................................ 50 4.11 Non-Dental Images Taken As Per Medical Request ....................................................................... 51 4.12 Comparing Time Under General Anesthesia and Time Spent in the Post-Anesthetic Care Unit .... 52 4.13 Distribution of All Complications ................................................................................................... 54 4.14 Comparing Complications in Patients With Single Versus Multiple Surgeries During the Study Period ....................................................................................................................................................... 56 4.15 Examining the Total Number of Complications
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