这一篇专门给你看：-）4. 麻醉

 

我们国人一听到麻醉这个字眼， 都有点恐惧， 特别是对小孩子做麻醉， 当家长签一堆术前协议时， 常常会被一些字眼吓到。家长们觉得麻醉会影响孩子未来的智力发育和记忆力而且有很高的风险性。而我们做儿童牙科的， 麻醉却是我们一种常用的手段。

在诊所里， 经常有家长会说“医生，给我的孩子动手术可以不上麻醉药吗？我的孩子很配合，手术的时候你们按住他不让他乱动行吗？”家长的心情我可以理解， 但在多数情况下， 麻醉还是要用。
其实儿童牙科的麻醉分很多种， 不仅仅是大家想像的送到OR的那种。
先来讲一下麻醉的作用。小儿麻醉最基本的可以说是：睡眠+止痛=麻醉。睡眠对小儿手术非常重要，因为小儿对于手术会有高度的恐惧感，特别是牙科会用到很多工具， 如果孩子的蛀牙很多， 要拔，做根管， 作冠， 会时间比较长。如果孩子一直在清醒的状态， 会对他的心理造成极大的恐惧和伤害， 可能以后都会惧怕看牙， 这是我们不愿意看到的。同时小孩很难耐受疼痛以及术中因固定姿势而造成的不舒服感觉， 如果不停挣扎的话， 手术操作中万一造成误差， 我想也没有家长愿意这种事情发生。特别是如果孩子有很多问题， 年龄幼小的话， 医生一般会建议去OR一次做完。
再说一下麻醉的种类， 我以前有个帖子讲过， 但被删了， 我就再讲一遍。
儿童牙科的麻醉分很多种， 分在诊所麻醉和去医院麻醉两大种。（这部分还是抄抄书更加准确一点:-)
http://www.chp.edu/CHP/dental+sedation+patient+procedure）
在诊所麻醉指Sedation Dentistry，通常有口服和IV两种。
--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 通常需要专业的麻醉师来诊所做， 保险公司一般不会付这一部分费用。

还有一种就是Nitrous Oxide， 也就是通常说的笑气。 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： 我的这些帖子属于科普帖。 有些具体的病例， 由于没有看到病人， 只能根据家长的描述给出建议， 具体治疗还要和自己的医生商议。

所有跟帖： 

• 谢谢。 想知道您对这两种药是否了解。因为以前用过一种sedation 药，没用，still very alert. -boostcourage- ♀ (34 bytes) () 06/30/2013 postreply 06:31:14