The management of the behavior of mentally challenged adults when providing required
dental care is often a problem, whether in the dental office or in a hospital setting. Our institution has a designated program to provide required
dental care to this group of patients. Because of the high incidence of poor cooperation, which may include aggressive antagonistic behavior, many of these patients are scheduled for
dental care under
general anesthesia with an incomplete preoperative medical assessment. The purpose of this study was to determine the impact and limitations that an incomplete medical assessment may present in the delivery of dental care under
general anesthesia to these adults with
developmental disability. After approval from the institutional review board, the medical records of 139 patients treated in this program between 1992 and 1994 were reviewed to determine the patient profiles,
anesthesia management, and complications. The charts of these patients, who underwent dental and radiographic examination, scaling and prophylaxis, and restoration and extraction of teeth under
general anesthesia, were reviewed. There were 149 procedures performed on these patients, some more than once. The mean age was 29.5 yr. Males predominated females by a ratio of 2:1. All had multiple diagnoses, medical problems, and medications. Twenty-three patients had
Down's Syndrome, four had
schizophrenia disorders, 42 had
seizure disorders, 11 had
hypothyroidism, seven had
heart disease, and 14 had central nervous system and neuromuscular disorders. The remainder had a variety of diagnoses, including rare syndromes. One hundred had intravenous (i.v.), 25 had mask inhalation, and 24 had intramuscular
ketamine (
Ketalar) induction. Nasotracheal intubation was uneventful in 139 patients, five had difficult visualization of the larynx and intubation. Ten patients experienced
intraoperative complications, including nonfatal ventricular
arrhythmia, slight fall in blood pressure and
hypertension (greater than 20% of preoperative value), and four individuals developed
laryngospasm. In the Post
Anesthetic Care Unit, five patients experienced minor airway problems resulting in a desaturation of
oxygen to a level below 85%. Adults with
developmental disabilities can be safely managed under
general anesthesia for dental treatment in a hospital setting with minimal morbidity and without extensive preoperative investigations.