Amnesia,pain experience,and patient satisfaction after sedation with intravenous diazepam

Recovery time, the effect of sedation or amnesia on postoperative pain, and patients' opinions of the sedation were studied. Forty operations were performed on 20 patients. Each patient had four impacted third molars removed in two sessions, one in which a new emulsion form of diazepam (Diazemuls^®) was used, and one in which no sedation was used. The recovery from sedation was found to be very individual and not related to the dose administered, as assessed by a simple, easy-to-use method. There was no difference in postoperative pain between the sedated and unsedated groups, and we found no correlation between postoperative pain and amnesia. Eighty-five per cent of the patients preferred sedation during surgery, even though none of them had a preoperative indication for sedation.     

An evaluation of the amnesic effects of diazepam sedation

Twenty subjects, 13 female and 7 male, aged 16 to 37 years, were studied to determine the effects on memory of intravenous sedation with diazepam (Valium). Three tests were performed: 1) the Weschler Logical Memory Scale; 2) memory of three geometric shapes; and 3) memory of three objects presented in a drawing. Logical memory items were presented before and after sedation; other tests were presented after sedation. Anterograde amnesia was produced by diazepam sedation. No retrograde amnesia was observed. A significant drug effect was found between the pre-drug and post-drug retention intervals (T+ = 2; P less than 0.005). Post-drug recognition scores were found to be approximately 42% of pre-drug recognition scores. The anterograde amnesia produced with diazepam was probably due to decreased arousal of the subject, and decreased attention to rehearsal of short-term memory stimuli, resulting in a lack of storage of the stimuli.     

Mandibular gingival metastasis from a rectal adenocarcinoma

A rare case of adenocarcinoma of the rectum with involvement of the mandibular gingiva is presented.     

General anesthesia for the pediatric patient

The pediatric patient is not physiologically and anatomically a small adult. Comparisons and specific distinctions are presented with emphasis on the anesthetic management of children in the office. Modifications of the Bain circuit with a nasal inhaler have simplified the problem of waste gas scavenging and assisted ventilation.     

Osteomyelitis of the mandible in a patient with osteopetrosis

A 14-year-old boy had had recurrent abscesses and fistulae in the mandible for four years. Tooth extractions, performed by the local dentist, failed to improve his condition. The radiographs taken upon admission to hospital showed dense jaw bone. A subsequent skeletal survey revealed hypermineralized bones, and skeletal scintography demonstrated infected foci in the tibia and femur in addition to those in the mandible. Blood tests proved severe anemia. The diagnosis of osteomyelitis superimposed on osteopetrosis was established. Treatment consisted of blood transfusions and local and systemic antibiotics. Removal of the sequestra and implantation of tubes for local jaw irrigation were surgically performed.     

Postoperative nutritional supplementation for the orthognathic surgery patient

Twenty-four orthognathic surgery patients were studied to determine the impact of a high-calorie liquid supplement on preventing or minimizing catabolism commonly associated with surgery. The experimental group of 12 subjects, chosen at random, consumed blenderized foods ad libitum and a high-calorie dietary supplement providing a minimum of 50% of energy requirements. The remaining 12 subjects consumed only blenderized foods and served as the control group. The nutritional status of all patients was assessed one day before surgery and on Day 7 of the first, third, and sixth postoperative week. In general, nutrient intake in the experimental group remained similar to that before surgery, whereas intake in the control group decreased significantly, particularly at the one-week postoperative evaluation. It was concluded that the addition of a high-calorie liquid supplement to the dietary regimen of orthognathic surgery patients helped maintain nutrient intake at a level comparable to that before surgery. This resulted in better maintenance of body weight and somatic protein compartments compared with the control group.     

Evaluation by thoracic impedance cardiography of diazepam, placebo, and two drug combinations for intravenous sedation of dental outpatients

The cardiovascular and respiratory effects of three common intravenous premedicants were examined noninvasively in a population of 20 dental outpatients scheduled for surgical removal of third-molars. Two third molars from one side of the mouth were removed at each appointment. Group 1 received a diazepam titration (mean dose = 25.6 mgs) at one appointment and placebo at the other appointment. Group 2 received a combination of diazepam (12.5 mg), fentanyl (0.1 mg), and methohexital (mean dose = 18.0 mg) at one appointment and the combination of diazepam (15.0 mg) and methohexital (mean dose = 27.0 mg) at the other appointment. Noninvasive measurement of cardiac output revealed little change during intravenous drug administration, but a significant increase was seen in all groups following local anesthesia and during surgery. Heart rate was elevated and stroke volume decreased during administration of the two-drug combinations. Oxygen saturation was greatly decreased following the combination of diazepam, fentanyl, and methohexital. These findings indicate that the combination of diazepam, fentanyl, and methohexital results in decreased oxygen saturation, a transient decrease in stroke volume, and an elevated heart rate when used as an intravenous premedicant for dental outpatients.     

Dental extraction in a patient with congenital deficiencies of factors V and VIII

A case of combined congenital deficiencies of factors V and VIII is reported. The patient's right mandibular first molar was extracted and a combination of local hemostatic treatment and the transfusion of fresh plasma resulted in healing of the socket without further postoperative bleeding.     

Preoperative nutritional supplementation for the orthognathic surgery patient

Orthognathic surgery patients were studied to determine the nutritional adequacy of a high-calorie liquid supplement. The supplements were given for one month before surgery in an attempt to achieve a 5% weight gain and/or for six weeks after surgery to approximate 50% of the estimated caloric requirements of the patients. It was concluded that preoperative supplementation to achieve weight gain before surgery is of no apparent value. However, balanced nutrient intake can be achieved for patients when supplementation is given postoperatively at a level of 50% of estimated caloric requirements, and can result in improved nitrogen retention and protein sparing.     

The use of hyperbaric oxygen therapy in bony reconstruction of the irradiated and tissue-deficient patient

Eighteen bony reconstructions of the mandible or maxilla using a newly defined and specific hyperbaric oxygen protocol are reported. Eleven of 12 grafts in irradiated tissue met six rigid criteria for a 91.6% rate of success. All six grafts into scarred and deficient tissue beds also met the same criteria, for an overall success rate of 94%. The rationale for emphasizing preoperative tissue preparation using hyperbaric oxygen is discussed, as are the mechanisms of action of hyperbaric oxygen on a biochemical, cellular, and tissue level. Neovascularity and neocellularity are demonstrated histologically by human biopsy specimens, and this is suggested as being the reason for the excellent results of reconstruction in irradiated and/or deficient tissue beds.     

Ameloblastoma of the mandible treated by resection, preservation of the inferior alveolar nerve, and bone grafting

The results of five cases of ameloblastoma of the mandible treated by resection, preservation of the inferior alveolar nerve, and immediate bone grafting are reported. The incisions in all cases healed by first intention. Lip sensation on the operated side returned to normal in four to six weeks in four cases and slight numbness persisted to the eighth week in one case. All patients were followed postoperatively for 13-15 years. In one case the tumor recurred in the mucous membrane seven years after surgery at the original intraoral site and invaded the underlying bone graft. The indications and contraindications for surgery and details of the procedures, including measures to prevent recurrence, are presented.     

Kaposi's sarcoma in a patient with acquired immune deficiency syndrome

A case of Kaposi's sarcoma, which first appeared as an erythematous oral lesion, in a patient with AIDS is presented. Current concepts regarding these disease entities are reviewed, and recommendations for protection of personnel when providing care for AIDS patients are outlined.     

Venous complications of intravenous diazepam

In an attempt to clarity the confusion about venous complications from intravenous diazepam, a study of 2,468 consecutive oral surgery and general dentistry cases in which diazepam was used was undertaken. It was found that 7.9% of the patients experienced local phlebitis and 4.5%, thrombophlebitis during the week after the injection. These findings were correlated with age, weight, sexual gender, dosage, type and duration of procedure, and degree of apprehension experienced by the patient.     

Total mandibular replacement in a patient with Hand-Schüller-Christian disease

An unusual case of mandibular agnathia due to Hand-Schüller-Christian disease reconstructed using a combination of a titanium mandibular appliance and autologous corticocancellous bone is reported.     

Comparison of silastic and proplast implants in the temporomandibular joint after condylectomy for osteoarthritis

This study was undertaken to compare the long-term stability of Silastic and Proplast when used as alloplastic implants following high condylectomy. Twelve patients with osteoarthritis of the temporomandibular joint (TMJ) were treated either unilaterally or bilaterally. The follow-up period ranged from one to four years. In all ten TMJs that received Silastic implants and in ten that received Proplast implants, there were no discernible differences relative to comfort, masticatory function, or TMJ mobility. Although Silastic and Proplast had similar functional characteristics, Proplast implants had better long-term stability than the Silastic implants.     

Use of activated prothrombin complex concentrate in a severely hemophilic patient with Factor VIII inhibitor

The successful use of an activated PCC in combination with a fibrinolytic agent in a patient with severe hemophilia and inhibitor to Factor VIII has been described. Activated prothrombin complex concentrate effected rapid hemostasis, and no complication occurred. In comparison with other materials currently used to achieve hemostasis in such patients, this concentrate appears to be safer and more effective, if properly administered.     

Prolonged recovery after intravenous diazepam

Prolonged recovery from intravenous diazepam after the day of administration has been examined in 2,468 consecutive patients who underwent oral surgery and general dentistry. Patients ranged in age from 2 to 94 years and received a mean diazepam dose of 19 mg, either by itself or with small amounts of methohexital sodium. Recovery was assessed by use of a questionnaire, and the answers were related to sexual gender, age, weight, dosage, procedure, duration, level of apprehension, and results of the sedation.     

Perforations of the temporomandibular joint meniscus: Arthrographic,surgical, and clinical findings

Arthrographic examination of the temporomandibular joint for perforations of the meniscus was found to be a reliable diagnostic test in a retrospective review of 45 surgical cases. Clinically palpable crepitus was also found to be an accurate indicator of the existence of perforations in patients who could open beyond 26 mm. The combination of palpable crepitus and a positive arthrogram was found to be complementary in diagnosing perforations and was confirmed by surgical observations.     

Suspension and traction appliance for nasal,zygomatico-maxillary complex,and zygomatic arch fractures

The early reduction of fractures of the nasal bones, zygomatico-maxillary complex, and zygomatic arch is relatively simple in most cases. Frequently, however, patients suffer from concomitant head injuries that make immediate therapy inadvisable. Reduction after fibrosis has formed is not only difficult but often unsuccessful. Extraoral traction, suspension, supportive packing, or maxillomandibular fixation may be required in order to effect a good reduction.The traction or suspension appliances that have been used to date have been extraoral devices such as a plaster head cap, Kazanjian splint, and extraskeletal pin fixation with or without head frames.¹ The appliance to be discussed is different from those in that intraoral anchorage is used for extraoral suspension or traction.