這一篇專門給你看：-）4. 麻醉

 

我們國人一聽到麻醉這個字眼， 都有點恐懼， 特別是對小孩子做麻醉， 當家長簽一堆術前協議時， 常常會被一些字眼嚇到。家長們覺得麻醉會影響孩子未來的智力發育和記憶力而且有很高的風險性。而我們做兒童牙科的， 麻醉卻是我們一種常用的手段。

在診所裏， 經常有家長會說“醫生，給我的孩子動手術可以不上麻醉藥嗎？我的孩子很配合，手術的時候你們按住他不讓他亂動行嗎？”家長的心情我可以理解， 但在多數情況下， 麻醉還是要用。
其實兒童牙科的麻醉分很多種， 不僅僅是大家想像的送到OR的那種。
先來講一下麻醉的作用。小兒麻醉最基本的可以說是：睡眠+止痛=麻醉。睡眠對小兒手術非常重要，因為小兒對於手術會有高度的恐懼感，特別是牙科會用到很多工具， 如果孩子的蛀牙很多， 要拔，做根管， 作冠， 會時間比較長。如果孩子一直在清醒的狀態， 會對他的心理造成極大的恐懼和傷害， 可能以後都會懼怕看牙， 這是我們不願意看到的。同時小孩很難耐受疼痛以及術中因固定姿勢而造成的不舒服感覺， 如果不停掙紮的話， 手術操作中萬一造成誤差， 我想也沒有家長願意這種事情發生。特別是如果孩子有很多問題， 年齡幼小的話， 醫生一般會建議去OR一次做完。
再說一下麻醉的種類， 我以前有個帖子講過， 但被刪了， 我就再講一遍。
兒童牙科的麻醉分很多種， 分在診所麻醉和去醫院麻醉兩大種。（這部分還是抄抄書更加準確一點:-)
http://www.chp.edu/CHP/dental+sedation+patient+procedure）
在診所麻醉指Sedation Dentistry，通常有口服和IV兩種。
--Sedation dentistry is the use of a mild sedative (calming drugs) to manage special needs or anxiety while your child receives dental care.
--Sedation also may be used when several procedures need to be done at the same time, when the safety of a child may be compromised, or if your child has a strong “gag” reflex.
--Your child’s dentist will give the sedation.It is important to note that the sedation medication can not control pain or discomfort during dental treatment. Once your child has received sedation, the dentist will give him or her an injection (shot) or injections in the treatment area to keep it pain-free during and after the procedure.
--The sedation medicine may last up to 6 hours after the treatment is done. (parents need to monitor child after treatment, no physical activity)

口服是指 taken by mouth or through the nose. This type of medicine will make your child a little drowsy, and will keep him or her relaxed and calm during the procedure. Some medicine begins to work within 20 minutes, some work within 45mins. Your dentist will have your child take the medicine once you arrive at the appointment. If your child is having sedation, he or she should have nothing (a sippy of water might be OK, but absolutely no juice, no milk) to eat or drink after midnight the night before the appointment.

IV是指a needle to be inserted into your child's vein, usually in the arm or hand. The biggest advantage to IV sedation is that the dentist can give your child more medicine during a longer procedure to keep him or her relaxed.
IV 通常需要專業的麻醉師來診所做， 保險公司一般不會付這一部分費用。

還有一種就是Nitrous Oxide， 也就是通常說的笑氣。 nitrous oxide is a very safe, mild sedative that will help your child remain relaxed during dental procedures. Your child’s dentist will give the sedation with the use of a “space mask,” which carries air (oxygen) mixed with the medication. Your child will be asked to breathe through the nose, not the mouth, and will sense a faint, sweet smell. The sedation will take effect in about 5 minutes. The mask will remain in place until the procedure is done. Your child will be awake during the entire procedure and may have a “happy” feeling. When the procedure is complete, the nitrous oxide will be turned off and your child will breathe in pure oxygen for about 5 minutes to clear out any remaining gas.You should limit your child to a very light meal before this procedure, such as toast or a bagel.

送OR一般就是大家理解的全麻了（general anesthesia）， which is proceeded in hospital within intubation. Child has not any memory about the dental procedures. All dental Treatment can be done one time, especially for child who have dental problems in many teeth. It is safe in hospital. The dentist should request
medical clearance from your child's pediatrician. The Medical Insurance should cover the cost in hospital.




注： 我的這些帖子屬於科普帖。 有些具體的病例， 由於沒有看到病人， 隻能根據家長的描述給出建議， 具體治療還要和自己的醫生商議。

所有跟帖： 

• 謝謝。 想知道您對這兩種藥是否了解。因為以前用過一種sedation 藥，沒用，still very alert. -boostcourage- ♀ (34 bytes) () 06/30/2013 postreply 06:31:14