Abstract
The authors evaluated the medical emergencies accepted at the ambulatory section of Hokkaido University Dental Hospital (presently Hokkaido University Hospital Center for Dental Practice) which required urgent medical attention of the Department of Dental Anesthesiology during the period from January 1998 to September 2003, a period of five years and nine months.
The number of cases evaluated during this period was 22 cases and the incidence of the medical emergencies among the outpatients was 0.003%. As for the site of occurrence of medical emergency, 4 cases occurred before dental treatment in the waiting rooms, 4 case during transportation from the medical school hospital, 16 cases occurred in the treatment rooms and 1 case after dental treatment at the entrance of the hospital. Among the cases that occurred in the treatment room, local anesthesia was administered in 11 cases and local anesthesia was not administered in 5 cases. As for the causes of medical emergencies: vasovagal reflex (6 cases), epileptic attack (4 cases), and anginal attack (3 cases) were commonly observed. Among the 22 cases, 17 cases were medically compromised.
Before the arrival of dental anesthesiologists, treatments of some sort were performed in 12 cases but no treatments were performed in 10 cases. The treatments performed by dental anesthesiologists were as follows: pharmacological agents were administered in 9 cases by dental anesthesiologists, only venipuncture and/or oxygen therapy was performed in 8 cases, only observation in 3 cases, and foreign body removal was attempted in 2 cases. Improvements in symptoms were comfirmed in all cases and there were no patients that deteriorated into a critical state.
It was clarified in this study that medical emergencies occurred not only in the treatment room but also in the waiting room and in the entrance of the hospital. It is important that all hospital personnel must always be observant with the patient's general condition. Since medical emergencies tend to occur in slightly invasive dental treatment settings without local anesthesia, it is important to prepare preventive measures for medical emergencies for all dental treatments. At the time of occurrence of medical emergency, before the arrival of dental anesthesiologists, no treatments were performed in many cases. It is necessary to educate all hospital personnel that vital signs should be checked during medical emergency no matter where it occurs. In addition, since there were many cases related to anxiety or stress concerned with the dental treatment, more dental treatments should be performed under sedation.
