2018 Volume 39 Issue 1 Pages 28-32
18p-syndrome is a chromosomal abnormality syndrome caused by deletion of the short arm of chromosome 18, and mental retardation and delayed development of language have been reported in this syndrome. In addition, evaluation of cardiovascular disease is recommended for general anesthesia. Here, we report on the extraction of mandibular impacted wisdom teeth under general anesthesia of 18p-syndrome patient with mental retardation and pulmonary hypertension.
The patient was a 22-year-old man who was diagnosed with pericoronitis of mandibular impacted bilateral wisdom teeth by the primary care dentist. It was difficult for the clinic to control the patient’s behavior, therefore he was referred to the department of oral surgery in our hospital and was scheduled for extraction of his bilateral wisdom teeth under general anesthesia for the purpose of behavior management.
This case was a 18p-syndrome patient with mental retardation and pulmonary hypertension. Therefore, we commissioned cardiologists to evaluate preoperative circulatory dynamics, and carefully examined the management of circulatory dynamics during anesthesia before oral surgery. In addition, in order to prevent deterioration in circulatory dynamics caused by the patient’s excitement due to mental retardation, we fully discussed with pediatricians about the method of behavior management before and after anesthesia.
In order to avoid the patient’s excitement when entering the operating room and to avoid deterioration of pulmonary hypertension due to increased pulmonary vascular resistance, he entered the operating room under sedation. Under anesthesia management pursuant to the management of pulmonary hypertension, mandibular impacted wisdom teeth were extracted.
This case shows that in order to treat a 18p-syndrome patient with mental retardation and pulmonary hypertension under safe general anesthesia, it is important to avoid deterioration in the circulatory dynamics in consideration of mental protection of the patient. We consider that preoperative consultation with each professional medical doctor is indispensable for management planning during the perioperative period.
