A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice

The current study aimed to verify if the safety and effectiveness of inhalation sedation with 50% nitrous oxide in oxygen (N₂O/O₂) is maintained when the premix is administrated by trained general practitioners in their dental surgeries compared to its use in the hospital. Success (completion of planned treatment), cooperation (modified Venham scale), and adverse events were recorded. The acceptability of the technique to the patients, the level of patient cooperation, the ease of use, and the satisfaction of the dentist were also evaluated. Thirty-three general practitioners included 549 patients and recorded 638 sessions of N₂O/O₂ sedation for dental treatment. Of the sessions, 93.7% were successful in terms of both sedation and treatment. Patient cooperation was seen to improve under N₂O/O₂ sedation, and for 91% of the sessions, the patients declared that they would like future treatment to be undertaken in the same way. No serious adverse events were recorded. Minor adverse events were noted for 10% of the sessions (behavioural, vagal, and digestive disorders). These results were similar to those found for sessions undertaken in hospital practice. The main difference was in the type of patient treated—more patients received N₂O/O₂ sedation in general practice for a one-off indication or for dental phobia, and more patients with intellectual disability and more pre-cooperative children were treated in hospital practice. This study gives strong supporting evidence for the safety and effectiveness of inhalation sedation using 50% N₂O/O₂ in general dental practice for healthy patients.     

Outcomes of moderate sedation in paediatric dental patients

Background: The aim of this study was to evaluate the outcomes of moderate sedation with nitrous oxide/oxygen (N₂O/O₂) alone or combined with different dosages and administration routes of midazolam in uncooperative paediatric dental patients using the Bispectral Index System (BIS). Methods: This one‐year clinical study examined first‐visit moderate sedation performed in 240 healthy children aged 4–6 years. Subjects were randomly divided into four groups according to drug, route and dosage, as follows: Group 1 – 0.20 mg/kg midazolam (40 mg/ml) delivered intranasally; Group 2 – 0.75 mg/kg midazolam (15 mg/3 ml) delivered orally; Group 3 – 0.50 mg/kg midazolam (15 mg/3 ml) delivered orally. All children in these three groups also received inhalation sedation with 50%–50% N₂O/O₂, whereas children in Group 4 received inhalation sedation with 50%–50% N₂O/O₂ only. The outcome of sedation was evaluated as either ‘successful’, ‘failed’ or ‘not accepted’. Results: The highest success rate was found in Group 1 (0.20 mg/kg intranasally, 87%), followed by Group 2 (0.75 mg/kg orally, 79%). The overall mean success rate for all groups was 73%. Conclusions: Moderate sedation can be successfully used in the clinical management of paediatric dental patients, with both intranasal and oral sedation using midazolam in conjunction with nitrous oxide found to be effective methods.     

Comparison of Oxygen Saturation Between Nasal High-Flow Oxygen and Conventional Nasal Cannula in Obese Patients Undergoing Dental Procedures With Deep Sedation: A Randomized Crossover Trial

PurposeIn anesthetic management, it is widely accepted that obese patients are more likely to suffer airway obstructions and reductions in arterial oxygen saturation (SpO₂). Therefore, it is important to take special measures to prevent oxygen desaturation during the deep sedation of obese patients. This clinical study examined whether the use of nasal high-flow systems (NHFS) keep higher SpO₂ and reduced hypoxemia than conventional nasal cannula during the deep sedation of obese patients with intellectual disabilities for dental treatment.Materials and MethodsEighteen obese patients (body mass index: >25) with intellectual disabilities who underwent dental sedation were enrolled. In each case, sedation was induced using propofol and maintained at a bispectral index of 50 to 70. The subjects were randomly assigned to the control oxygen administration (5 L/min via a nasal cannula) or NHFS (40% O₂, 40 L/min, 37 °C) arm in alternate shifts as a crossover trial. The primary endpoint was the minimum SpO₂ value, and the incidence of hypoxemia during dental treatment was also evaluated.ResultsThe mean minimum SpO₂ value was significantly higher in the NHFS arm than in the control arm (95.8 ± 2.1 % vs 93.6 ± 4.1 %, P = 0.0052, 95% confidence interval: 0.608-3.947). Hypoxemic episodes (SpO₂: ≤94%) occurred 3 cases (16.7%) in the NHFS arm and 11 cases (61.1%) in the control arm (P = 0.0076, odds ratio: 0.127, 95% confidence interval 0.0324 - 0.630).ConclusionNHFS resulted in higher minimum SpO₂ and reduced hypoxemia than nasal cannula in obese patients during deep sedation for dental treatment.     

Dexmedetomidine Supported Office Based Genioplasty: A Pilot Study

Introduction

Despite the availability of wide variety of pharmacological agents for dental procedural sedation, there has always been a continuous search for newer sedative agents. Dexmedetomidine is a newer sedative agent for provision of short-term sedation (<24 h) in adult patients in the intensive care unit setting. It is a selective α₂ adrenergic receptor agonist. The reports on off-label use of this drug in a variety of settings for invasive and non invasive procedural sedation have provided encouraging results.

Material and methods

The present paper reports a pilot study observing clinical efficacy of the newer drug dexmedetomidine in patients undergoing office based sliding genioplasty for correction of facial asymmetry. Subjects were sedated with dexmedetomidine with a loading dose of 0.5 mcg/kg over 10 min followed by a continuous infusion dose of 0.1 mcg/kg/h, the recovery process was observed for 60 min after the dexmedetomidine infusion was stopped. The patients were observed pre operatively, intra operatively (every 10 min) and postoperatively for the following parameters—oxygen saturation (SpO₂), mean arterial pressure (MAP), heart rate (HR), and Ramsay sedation score (RSS), respiratory rate, pain scale.     

Inhaled methoxyflurane (Penthrox) sedation for third molar extraction: a comparison to nitrous oxide sedation

Background: The aim of this study was to evaluate the use of inhaled methoxyflurane (Penthrox^®) in the reduction of dental anxiety in patients undergoing mandibular third molar removal in a specialist surgical suite and compare it to the conventional nitrous oxide sedation. Methods: A prospective randomized, non‐blinded crossover design study of 20 patients receiving two types of sedation for their third molar extraction who participated in 40 treatment sessions. At first appointment, a patient was randomly assigned to receive either nitrous oxide sedation or intermittent Penthrox^® inhaler sedation, with the alternate regimen administered during the second appointment. Peri‐procedural vital signs (heart rate and blood pressure) were recorded and any deviations from 20% from the baseline values, as well as any drop in oxygen saturation below 92% were documented. The Ramsay Sedation Scale (RSS) score was recorded every five minutes. Patient cooperation during the procedure, patients’ general opinion about the sedation technique, surgeon satisfaction and the occurrence of side effects were all recorded. After the second procedure, the patient was also asked if he or she had any preference of one sedation technique over the other. Results: Levels of sedation were comparable in nitrous oxide and Penthrox^® sedation sessions. However, at 15 minutes of sedation it was significantly lighter (p < 0.05) in Penthrox^®. No patient in both regimens reached a RSS deeper than a score of 4. Parameters measured for assessment of sedation (patient cooperation, surgeon satisfaction and patient general opinion about sedation technique) were all similarly comparable for both nitrous oxide and Penthrox^®. In both sedation sessions, the odour of the inhalational agent was accepted by the patients; half of the patients (10 patients) who received methoxyflurane thought its odour was pleasant. Patients preferred methoxyflurane (Penthrox^®) inhalation over nitrous oxide sedation (Fisher’s Exact test, p < 0.05). Adverse events were minimal. No patient was either deeply sedated or agitated. Blood pressure was within ± 20% from the baseline values. No patient had oxygen saturation less than 92%. Dizziness was the most frequently encountered side effect in both regimens (four patients each). Two patients had bradycardia (HR < 60 beats/minute) when nitrous oxide was used in comparison to one patient with Penthrox^® sedation. Paraesthesia of fingers and heaviness of the chest was encountered only with nitrous oxide sedation (four patients). Mild self‐limited shivering occurred in one patient with Penthrox^® sedation. Conclusions: The Penthrox^® Inhaler can produce a comparable sedation to that of nitrous oxide for the surgical extraction of third molars under local anaesthesia.     

Nitrous oxide inhalation sedation: what do patients, carers and dentists think about it?

AIM: To determine the acceptability and efficacy of nitrous oxide inhalation sedation for dental treatment to children and to compare these results with the responses of both the accompanying adult and the treating dentist. STUDY DESIGN: A prospective, questionnaire-based survey was used. METHODS: Fifty consecutive patients (ASA I and II) attending the Department of Paediatric Dentistry, Edinburgh Dental Institute, between 2002 and 2003 for dental treatment using nitrous oxide inhalation sedation were recruited for the study. Each patient, the accompanying adult and the dental sedationist completed a short questionnaire which sought details about the acceptability and efficacy of the sedation technique. Overall behaviour and the outcome of treatment were assessed by the dentist providing sedation using the Frankl and Houpt Behaviour Rating Scales respectively. RESULTS: Three sets of questionnaires were completed for fifty patients (M:27; F:23), mean age 10.4 years (range: 5.3-15.8 years). Acceptance of both local analgesia and dental treatment was perceived as greater amongst patients and carers compared with treating dentists (chi2 = 11.31, P = 0.004, 2 df and chi2 = 22.52, P < 0.001, 2 df respectively). Furthermore, dentists observed that inhalation sedation helped fewer male patients with local analgesia and fewer female patients with dental treatment (chi2 = 6.83, P < 0.009, 1 df and chi2 = 3.85, p < 0.050, 1 df respectively). A greater proportion of dentists observed that patients would manage treatment without sedation and would not require sedation for future dental treatment than both patients and their accompanying carer (chi2 = 8.00, P < 0.018, 2 df and chi2 = 18.61, P < 0.001, 2 df respectively). In general, the majority of patients were co-operative and successfully completed dental treatment with inhalation sedation. CONCLUSION: Dentists' perception of nitrous oxide inhalation sedation was generally less enthusiastic than that of patients and carers.     

Stato attuale della sedazione cosciente in odontoiatria

ObjectivesAim of this paper is to survey the history of sedation in dentistry in Europe, that is so different to USA because the possibility of American DDS to perform other kind of sedation till general anaesthesia.Materials and methodsA wide historical and bibliographic note is explained. In Europe, dentists are entitled just to conscious sedation, administration. It allows the practitioner to safely perform dental procedures without discomfort for the patient, to relieve and eliminate anxiety and to increase patient acceptance and compliance. Among titrable techniques, inhalation nitrous oxide: oxygen technique and intravenously administered benzodiazepines with prevalent central depression action are the favourite. Among non-titrable techniques we mention the enteral administration.Results and conclusionsTo learn how to use these techniques post-graduation courses, organized by University or by specialized continuing education and training society are required, as stated by the actual laws.     

Nasotracheal Fiberoptic Intubation: Patient Comfort,Intubating Conditions and Hemodynamic Stability During Conscious Sedation with Different Doses of Dexmedetomidine

The study aims to evaluate the efficacy of two doses of dexmedetomidine for sedation during awake fiberoptic intubation (AFOI). The study was designed in a prospective, randomized, double-blinded manner and carried out in an academic medical university. Forty young co-operative patients aged 15–45 years of either sex belonging to ASA class I-II, planned for elective maxillo-facial surgery formed the study group. All patients received midazolam 0.05 mg/kg, glycopyrrolate 0.2 mg, ondansetron 4 mg, and ranitidine 50 mg IV 15 min before as premedication, oxygen by nasal cannula, and topical local anesthetics to the airway. Patients were randomly assigned to one of the groups; dexmedetomedine 1 μg/kg IV (Group L), or dexmedetomidine 1.5 μg/kg IV (Group H). Observer’s Assessment of Alertness/Sedation (OAA/S) was assessed. Primary outcome measurements were: HR, MAP, SpO₂ and EtCO₂ and secondary outcome measurements were: intubation scores by vocal cord movement, coughing and limb movement, fiberoptic intubation comfort score, nasotracheal intubation score and airway obstruction score. On the first post-operative day, recall, level of discomfort during fiberoptic intubation, adverse events and satisfaction score were also assessed. There were no significant hemodynamic differences between the two groups. OAA/S was significantly better with dexmedetomidine 1.5 μg/kg (p < 0.05) and patients were significantly calmer, more cooperative and satisfied during awake fiberoptic intubation with dexmedetomidine 1.5 μg/kg with fewer transient adverse effects. Dexmedetomidine 1.5 μg/kg proved to be more effective for sedation for awake fiberoptic intubation.     

Pharmacologic behavior management of pediatric dental patients diagnosed with attention deficit disorder/attention deficit hyperactivity disorder

PURPOSE: The purpose of this study was to conduct a survey of Texas pediatric dentists to determine: (1) the percentage of patients they treat with attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD); (2) the behavior management techniques that are utilized to treat their patients who suffer from ADD/ADHD; and (3) the relative success rates of these techniques in their practices. METHODS: A 17-question, single-answer, multiple choice survey was mailed to 343 Texas pediatric dentists. The mailing list was obtained from American Academy of Pediatric Dentistry and Texas Academy of Pediatric Dentistry member rosters. One mailing was sent, including a self-addressed stomped envelope, for returned responses. RESULTS: A 54% response rate (186 surveys) revealed that nitrous oxide was the most frequently used pharmacologic behavior management technique; however, demerol/promethazine/nitrous oxide was rated as effective most often for treating ADD/ADHD patients. CONCLUSIONS: Practitioners believe the incidence of attention deficit disorder/attention deficit hyperactivity disorder is increasing, and they are familiar with the medications used to treat the conditions. Texas pediatric dentists are using a variety of sedation techniques and are interested in developing guidelines for sedation of these patients.     

Effects of inhalation sedation with nitrous oxide on intraoral senses

ObjectiveThe dental treatment such as local anesthetic injections are a common source of anxiety and fear during dental procedures. One of the causes of these anxiety and fear are regarded as taste and tactile sensory input. The purpose of this study was to investigate the effects of inhalation sedation with nitrous oxide (IS–N₂O) on intraoral taste and tactile sensory input in human.Materials and methodsWe performed taste testing using electrogustometry and the filter paper disc test in the proglossis region, and precise tactile function testing using the Semmes-Weinstein monofilaments (SWM) test was performed on the mandibular incisor interdental gingival papilla of healthy male and female volunteers.ResultsOn electrogustometry, the 50% IS-N₂O threshold was significantly higher than those of other conditions (vs. room air [RA], 100% O₂, Recovery, vs. 30% IS-N₂O). In the filter paper disc test, the 30%/50% IS-N₂O thresholds were significantly higher than those of other conditions (vs. RA, 100% O₂, Recovery) for all tastes. However, no significant difference in the recognition threshold was noted between 30% IS-N₂O and 50% IS-N₂O. In the SWM test, the 30%/50% IS-N₂O thresholds were significantly higher than those of other conditions (vs. RA, 100% O₂, Recovery), but the 50% IS-N₂O threshold was higher than the 30% IS-N₂O threshold.ConclusionIS-N₂O inhibit the input of taste and tactile sensations and may be an effective tool for patients undergoing dental procedures.     

Investigation of nitrous oxide pollution arising from inhalational sedation for the extraction of teeth in child patients

Objectives. (i) to test whether the exposure of dental staff to nitrous oxide during inhalational sedation with nitrous oxide/oxygen for extractions in children complies with specified occupational exposure standards, and (ii) to assess the atmospheric nitrous oxide concentration at one site close to the breathing zone of the operator/sedationist and to determine which patient- and sedation-related factors affect the level of nitrous oxide pollution. Design. Prospective study. Setting. Dental hospital sedation department, Newcastle Dental Hospital, UK. Sample and methods. 20 inhalational sedation clinics each of 2 hours duration were evaluated, during which a total of 60 children aged 4–15 years had extractions carried out. Nitrous oxide was administered via a nose mask from a Quantiflex MDM inhalational sedation machine and active scavenging was used throughout. Exposure of dental staff was measured using personal dosimetry. Atmospheric nitrous oxide pollution at one fixed point, close to the breathing zone of the operator/sedationist, was assessed using an infra-red gas analyser.Results. Mean exposure of the operator/sedationist to nitrous oxide during a single treatment clinic was 211 ppm, for the close support nurse 77 ppm and for the second nurse 67 ppm. Expressed as an 8 hour time-weighted average, the mean exposures were 39 ppm for the operator/sedationist, 17 ppm for the close support nurse and 15 ppm for the second nurse. The atmospheric nitrous oxide concentration varied during the clinics, with a maximum concentration of 538 ppm and a minimum that exceeded 100 ppm. There was a 71 minute delay following discharge of the last patient before atmospheric levels fell to zero. During sessions the degree of atmospheric pollution was inversely related to patient age (r_c = ?0·61, P < 0·05). There was a positive correlation between atmospheric pollution at the single point and the maximum percentage of nitrous oxide administered to each patient (r_c = 0·57, P < 0·05).Conclusions. In this study, staff exposure to nitrous oxide complied with the national occupational exposure standard but there was still considerable atmospheric nitrous oxide pollution during inhalational sedation for paediatric exodontia.     

A sedation technique for implant and periodontal surgery

OBJECTIVE: Evaluation of a sedation technique which involved titrating intravenous midazolam to an 'ideal' sedation end point, followed by a continuous infusion of propofol. This technique might be a satisfactory alternative to general anaesthesia for implant surgery in anxious patients or when procedures exceed 60-min duration. MATERIAL AND METHODS: 20 patients were treated on 23 occasions. A 2-mg bolus of midazolam was injected intravenously followed after 90 s by 1 mg increments until the patient was adequately sedated. 30 min after this induction with midazolam, a propofol infusion was started at a rate which varied between 0-300 mg/h (0-30 ml/h). The actual infusion rate was adjusted in order to maintain the optimum sedation level which had been achieved using midazolam. The quality of sedation was assessed using Ellis and Sedation scores. RESULTS: Midazolam dosage varied between 5 and 14 mg. The initial propofol infusion rate was 200 mg/h (20 ml/h) for 21 of the 23 implant surgery treatments. CONCLUSION: The sedation technique described takes advantage of the differing pharmacokinetic properties of midazolam and propofol. Initial sedation was achieved using midazolam, this was then maintained using a variable propofol infusion. The shorter distribution and elimination half-lifes of the latter drug made matching the level of sedation to the patient's needs easier and also provided good short-term recovery.     

Non-randomized controlled prospective study on perioperative levels of stress and dysautonomia during dental implant surgery

PurposeThe purpose of this study was to compare pre- and postoperative autonomic activities and changes in salivary stress biomarkers between patients who received only local anesthesia and those who received local anesthesia together with intravenous sedation in dental implant surgery.MethodsA total of 21 patients were enrolled in this non-randomized controlled prospective study; 7 subjects underwent implant surgery under local anesthesia with intravenous sedation and 14 subjects underwent surgery under only local anesthesia. Stress was evaluated by measuring salivary levels of chromogranin A (CgA) and a spectral analysis of heart rate variability (HRV) at baseline (on a day other than the day of surgery), 1 h preoperatively, and 1 h postoperatively. HRV analysis yields low- (LF) and high-frequency (HF) components, the LF/HF ratio, and the component coefficient of variance (CCV[HF]), which provide indices of sympathetic and parasympathetic regulatory activity.ResultsCgA levels were significantly higher (p < 0.05) at baseline in patients who received sedation than those who did not, but CgA levels did not differ prior to surgery. Also, the values of most parameters, including LF, HF, LF/HF (L/H), and CCV(HF), did not significantly differ between groups or among the three time points. Only ΔL/H and ΔCCV(HF) were significantly lower (p < 0.05) at 1 h preoperatively in patients who received sedation than those who received only local anesthesia.ConclusionsCgA levels were high in both groups immediately before surgery, and thus CgA values immediately before surgery may not be a reliable indicator of the need for intravenous sedation. Also, spectral analysis of HRV, especially ΔL/H and ΔCCV(HF), could be useful for assessing tension and anxiety.     

Endodontists' Intravenous Sedation–related Attitudes and Professional Behavior: A National Survey

Introduction

Research shows that a high percentage of endodontic patients are interested in receiving intravenous (IV) sedation. The objectives of this study were to assess endodontists' IV sedation–related education, attitudes, and professional behavior and to explore whether providing versus not offering IV sedation procedures was associated with IV-related education and attitudes and whether background characteristics and education were related with IV sedation attitudes and behavior.

笑气镇静系统与咪达唑仑口服镇静在智障儿童患者牙科治疗中的应用

目的:探讨笑气镇静系统与咪达唑仑口服镇静在智障儿童患者牙科治疗中的临床效果。方法:选取67例对口腔诊疗不配合的智障儿童患者,在门诊环境下实施笑气镇静（笑气浓度为35%~50%）和咪达唑仑口服镇静辅助诊疗（给药剂量为0.50~0.75 mg/kg）,记录各项评价指标,并对治疗效果和安全性进行比较。应用SPSSl3.0软件对2组的治疗成功率、不良反应发生率等行χ²检验。结果:2组治疗总成功率为70% ( 47/67) , 笑气镇静组的成功率为67%（26/39）,咪达唑仑口服镇静组的成功率为75%（21/28）。总不良反应发生率为13%(9/67) ,笑气镇静组不良反应发生率为5%(2/39),显著低于咪达唑仑口服镇静组(7/28,25%,P<0.05)。结论:笑气镇静系统与咪达唑仑口服镇静在智障儿童患者牙科治疗中均有较好的临床效果。笑气镇静系统的成功率稍低于咪达唑仑口服镇静者,但其不良反应明显少于后者。     

Effects of vibration stimulus on lower-jaw-position sensation in patients with cerebral palsy during inhalation of laughing gas

To clarify the effects of a vibration stimulus applied during sedation with nitrous oxide (hereafter referred to as laughing gas) on the ability of muscles attached to the lower jaw to sense lower-jaw position and on the sensation of muscle spindles attached to the lower jaw in patients with cerebral palsy (CP) using healthy adult subjects without functional abnormalities of the jaws and oral cavities as control subjects (hereafter referred to as healthy subjects). Experiments were performed under the following conditions: for each subject, before the application of the vibration stimulus (referred to as S_pre) and after the application of the vibration stimulus (S_post); before the inhalation of laughing gas (LG) and oxygen (air-inhalation condition: referred to as without LG inhalation) and during the inhalation of LG and oxygen (inhalation condition of LG and oxygen under LG-induced sedation: referred to as during LG inhalation). Subjects in the experiments were eight CP patients and eight healthy people as controls. The ability to discriminate lower-jaw position was estimated by asking the subjects to determine whether the diameter of a test stick was larger or smaller than that of a reference stick after performing the following tasks: a) holding a reference stick between the central teeth of their upper and lower jaws for 5 s, and b) replacing the reference stick with a test stick and holding it at the same position for 5 s, and the test stick was then removed. The following findings were obtained.

• 1)In comparing the ability of healthy subjects to discriminate between S_pre and S_post during LG inhalation using different test sticks, when the test stick diameter was 9.5 mm (smaller than the reference stick diameter), the rate of mis-estimation (RME) for Spost was significantly larger than that for Spre (P < 0.05). No significant differences were observed for any other test sticks.
• 2)In comparing the ability of CP patients to discriminate between S_pre and S_post during LG inhalation using different test sticks, when the test stick diameter was 9.5 mm (smaller than the reference stick diameter), the RME for S_post was significantly smaller than that for S_pre (P < 0.05). No significant differences were observed for any other test sticks.

These results suggest the following: the combination of LG for sedation with vibration stimulus further inhibits neuronal functions at the upper level of the central nervous system in CP patients, compared with cases in which each variable is applied separately, and the combination also inhibits the sustained increase in muscle tonus, which is characteristic of CP patients. LG reduces the activity of γ-motor neurons via the upper level of the central nervous system. In addition, tonic vibration reflex (TVR) develops due to the vibration stimulus, which increases the threshold value of sensitive muscle sensation and decreases the activity of γ-motor neurons, and furthermore decreases the activity of muscle spindles attached to the lower jaw. Consequently, a tendency toward increased ability to discriminate lower-jaw position is observed.     

Comparison of general anaesthesia versus regional anaesthesia with sedation in selected maxillofacial surgery: a randomized controlled trial

BackgroundThe airway is the foremost challenge in maxillofacial surgery. The major concerns are difficulty in managing the patient's airway and sharing it between the anaesthetist and surgeons. General anaesthesia, with endotracheal intubation, is the commonly used technique for maxillofacial procedures.We assessed the efficacy and safety of a regional block with sedation technique in certain maxillofacial operations, specifically temporomandibular joint (TMJ) ankylosis and mandibular fracture cases, and compared it with conventional general anaesthesia. We compared the time to discharge from the post anaesthesia care unit (PACU) and the occurrence of side effects, as well as surgeon and patient satisfaction with the anaesthetic technique, between the two groups.Materials & MethodsWe enrolled 50 patients of ASA grade 1 or 2, aged 15–50 years, scheduled for maxillofacial surgery (mandibular fracture or TMJ ankylosis). The patients were divided into two groups of 25 each, to receive sedation with a regional block with the use of a peripheral nerve stimulator in group I and general anaesthesia in group II. We observed haemodynamic parameters, intraoperative and postoperative complications and the amount of surgical bleeding in the two groups. Total anaesthesia time, patient and surgeon satisfaction, time to rescue analgesia, the number of rescue doses required, and the time to discharge from the PACU were compared.ResultsThe groups were comparable with respect to demographic profile, intraoperative haemodynamic parameters, surgical time, and amount of blood loss. Postoperative pain was assessed using the visual analogue score (VAS). Patients in group I had lower VAS scores after surgery and remained pain-free for longer than those in group II. The mean pain-free interval in group I was 159.12 ± 43.95 min and in group II was 60.36 ± 19.77 min (p < 0.005). Patients in group I required lower doses of rescue analgesia than those undergoing the surgery under general anaesthesia (p < 0.005). Patients receiving regional blocks also had fewer episodes of postoperative nausea and vomiting (p = 0.005). These results led to earlier discharge of patients in group I from the PACU.ConclusionsRegional block with sedation is a safe alternative technique for patients undergoing surgery for mandible fracture or TMJ ankylosis, with clear advantages over general anaesthesia.     

Longevity of posterior composite and compomer restorations in children placed under different types of anesthesia: a retrospective 5-year study

Objectives

The aims of this study were (i) to assess cumulative survival rates of class II resin-based composite and compomer restorations in primary molars with a 5-year observation period and (ii) to analyze the influence of different types of anesthesia and different localizations of the restorations in the teeth.

Methods

Patient charts of a private practice for pediatric dentistry were screened for class II resin-based composite (Spectrum TPH3) and compomer (Dyract Posterior; both Dentsply DeTrey) restorations in primary molars with a 5-year observation period used with Adper Prompt L-Pop (3M-ESPE). One restoration per patient (age ≤ 6 years at placement) was randomly selected.

Results

Two hundred sixty restorations were included (43% resin-based composites, 57% compomers). After 5 years, cumulative survival rates were 43% for resin-based composite and 49% for compomer restorations with no statistically significant differences. There was a tendency for higher survival rates for restorations placed under N₂O inhalation sedation or general anesthesia. Distal-occlusal compomer restorations showed significantly lower survival rates (p = 0.003) as compared to mesial-occlusal compomer restorations.

Conclusion

Within the limitations of the study, we conclude that type of restorative material as well as the type of anesthesia do not influence restoration survival rates, although restorations placed in patients receiving N₂O inhalation sedation or general anesthesia tend to perform better as compared with patients receiving no anesthesia or only local infiltration.

Clinical relevance

Resin-based composite and compomer restorations show similar survival rates of more than 43% (annual failure rates less than 11.5%) after 5 years for restoration of primary molars.

     

Measurement of prostaglandin E in crevicular fluid

Abstract A method for the detection of prostaglandin E (PGE) in crevicular fluid has been developed which provides a sensitive, noninvasive technique for measurement of local concentrations of this mediator of inflammation. Assay sensitivity sufficient for the detection of 4 picograms of PGE₂; was achieved by utilizing a high-affinity anti-PGE₂ antibody, a solid-state second antibody and low isotope concentrations. The method permits detection of concentrations equivalent to 10⁸ M PGE₂ in μl of crevicular fluid. Crevicular fluid PGE (CFPGE) concentrations were determined in samples from 12 patients with periodontal disease. Patients with periodontitis had significantly higher mean CFPGE concentrations than patients with gingivitis (179.5±51.4 pg/μl vs 32.1 ± 15.5 Pg/μl, mean ± SEM). Periodontitis sites were selected on the basis of clinical and radiographic evidence of periodontal destruction. Some sites displayed low CFPGE levels, while others had CFPGE concentrations which were elevated tenfold, suggesting the presence of both inactive and active periodontal lesions. CFPGE levels greater than 100 pg/μl were positively associated with gingival erythema and pain on probing.