Abstract
Many patients with chronic hemodialysis have electrolyte disorders, cardiovasc-ular disease, hypertension, renal osteodystrophy, develop infections, anemia and hemorrhagic tendency.
Therefore, oral surgeons must be aware of any risk of hemodialysis at surgers. We encountered two cases underwent hemodialysis who died after operation for oral lesion.
Case1; A 58-year-old man with a history of hypertension and chronic hemodialysis was admitted to our hospital on April 2, 1990. because of operation of left mandibular cyst.
On April 4, under general anesthesia the left mandibular second and third molars were extracted and the mandibular cyst was removed without complication. The postoperative courses were satisfactory. Sixth day postoperative, directly after the hemodialysis, bloood pressure elevated at the level of 216/120mmHg.
The patient suddenly have a convulsive fit and so lose consciousness. A CT scan of the brain showed a large right thalamus hemorrhage. After a consultation with the internist, the patient was transferred to the ICU. Three weeks after operation, the patiant diet of cerebral hemorrhage.
Case 2; A 60-year-old man with a history of angina pectoris, gout, chronic renal failure, an aneurysm of the abdominal aorta, liver cirrhosis, anemia and thrombocytopenia was admitted to our hospital. The patient has been undergoing dialysis treatment since 7 years ago. The patient has noticed intermittent oral bleeding for about eight months. But the patient complains of oral bleeding all the time in the last week. So, the patient was firmly wished to extraction of teeth as causal treatment.
On Novenber 11, the maxilla right first molar, second molar and the mandibular right second molar were extracted under local anesthesia. We were used the insertion of Gelatin into the socket and the closure of the wound by suture, and used the application of surgical packs and hemostatic splint.
After the extraction induced persistent oozing. Pressure packes of gauze spoonges saturated with topical thrombin were effective for a time, but bleeding recurred. Mental activity was reduced and the patient became drowsy. The blood pressure elevated 176mmHg systaltic. Next morning, the patient died of massive hemorrhage because of exprosion of aneurysm of the abdominal aorta.
