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Office-Based Anesthetic and Oral Surgical Management of a Child With Hereditary Sensory Autonomic Neuropathy Type IV: A Case Report.

Abstract

Hereditary sensory and autonomic neuropathy type IV (HSAN IV), or congenital insensitivity to pain with anhidrosis, is an exceptionally rare genetic disorder that results in the complete loss of pain and temperature sensation as well as anhidrosis. Anesthetic management of these patients can be difficult because of significantly increased risks during general anesthesia. Literature on perioperative anesthetic management is typically written in the context of a hospital setting. As such, our case presents a unique report on the anesthetic management of a HSAN IV patient who presented for extraction of 2 teeth in an office-based setting. In determining how to safely manage the procedure, we decided against general anesthesia as we lacked the facilities and equipment to safely handle previously reported complications. We were successful in providing sedation with nitrous oxide in oxygen and applying 20% benzocaine topical ointment on the surgical site in lieu of administering general anesthesia. We had an anesthesiologist present and obtained intravenous access prior to the surgery to help manage any complications. This report provides support that simple dental extractions can be accomplished safely in the HSAN IV patient in the office-based setting, thereby avoiding unnecessary risk.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Master of Physiology Candidate, North Carolina State University, Raleigh, North Carolina.

    ,

    DMD Candidate, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts.

    ,

    Anesthesiologist; Triangle Implant Center, Durham, North Carolina.

    Oral and Maxillofacial Surgeon, Triangle Implant Center, Durham, North Carolina.

    Source

    Anesthesia progress 65:3 2018 pg 181-186

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    30235436

    Citation

    TY - JOUR T1 - Office-Based Anesthetic and Oral Surgical Management of a Child With Hereditary Sensory Autonomic Neuropathy Type IV: A Case Report. AU - Prabhu,Shamit, AU - Fortier,Kevin, AU - Newsome,Lisa, AU - Reebye,Uday N, PY - 2019/03/01/pmc-release PY - 2018/9/21/entrez PY - 2018/9/21/pubmed PY - 2018/9/21/medline KW - Anesthetic management KW - Congenital insensitivity to pain with anhidrosis KW - Hereditary sensory and autonomic neuropathy type IV SP - 181 EP - 186 JF - Anesthesia progress JO - Anesth Prog VL - 65 IS - 3 N2 - Hereditary sensory and autonomic neuropathy type IV (HSAN IV), or congenital insensitivity to pain with anhidrosis, is an exceptionally rare genetic disorder that results in the complete loss of pain and temperature sensation as well as anhidrosis. Anesthetic management of these patients can be difficult because of significantly increased risks during general anesthesia. Literature on perioperative anesthetic management is typically written in the context of a hospital setting. As such, our case presents a unique report on the anesthetic management of a HSAN IV patient who presented for extraction of 2 teeth in an office-based setting. In determining how to safely manage the procedure, we decided against general anesthesia as we lacked the facilities and equipment to safely handle previously reported complications. We were successful in providing sedation with nitrous oxide in oxygen and applying 20% benzocaine topical ointment on the surgical site in lieu of administering general anesthesia. We had an anesthesiologist present and obtained intravenous access prior to the surgery to help manage any complications. This report provides support that simple dental extractions can be accomplished safely in the HSAN IV patient in the office-based setting, thereby avoiding unnecessary risk. SN - 1878-7177 UR - https://www.unboundmedicine.com/medline/citation/30235436/Office-Based_Anesthetic_and_Oral_Surgical_Management_of_a_Child_With_Hereditary_Sensory_Autonomic_Neuropathy_Type_IV:_A_Case_Report L2 - http://www.anesthesiaprogress.org/doi/10.2344/anpr-65-03-07?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed ER -