Premedication in children: a comparison of oral midazolam and oral clonidine

BACKGROUND: Oral premedication is widely used in pediatric anesthesia to reduce preoperative anxiety and ensure smooth induction. Midazolam is currently the most commonly used premedicant, but good results have also been reported with clonidine. The aim of the present study was to compare clinical effects of oral midazolam and oral clonidine. METHODS: We performed a prospective open study in 64 children who were randomly assigned to receive either oral midazolam 0.5 mg.kg (-1) (group M) or oral clonidine 4 microg.kg (-1) (group C) prior to mask induction. Drug acceptance, preoperative sedation and anxiolysis, quality of mask acceptance, recovery profile and parental satisfaction were evaluated. RESULTS: The taste of oral clonidine was judged as significantly better; 14% of children rejected oral midazolam. Onset of sedation was significantly faster after premedication with midazolam (30+/-13.1 min) than with clonidine (38.5+/-14.6 min), but level of sedation was significantly better after premedication with clonidine. Quality of mask induction was equally successful in both groups. A steal-induction was performed in 66% of patients of group C, but none in group M. We observed a trend towards an increased incidence of emergence agitation after premedication with midazolam. Parental satisfaction was significantly higher in group C. CONCLUSIONS: In this study, premedication with oral clonidine appeared to be superior to oral midazolam. Quality of mask acceptance was comparable between groups, but oral clonidine was better accepted by the child, produced more effective preoperative sedation, showed a trend towards better recovery from anesthesia and had a higher degree of parental satisfaction.     

A comparison of oral transmucosal fentanyl and oral midazolam for premedication in children

Oral transmucosal fentanyl citrate (OTF) was compared with midazolam as a premedicant in a prospective, randomised, placebo-controlled, double-blind trial. Eighty children (ASA grade 1 or 2, aged 3-9 years) who presented for tonsillectomy were randomly allocated to receive either 2.5 ml OTF (15-20 microg.kg(-1)) in a lollipop format and 0.5 ml.kg(-1) placebo syrup, or midazolam syrup (0.5 mg.kg(-1)) and a placebo lollipop (2.5 ml). The acceptability of sedation, anxiety and compliance with anaesthetic induction were assessed. The children were given an 'emergence' score for their recovery. Analgesia requirements, the incidence of vomiting, itching and any behavioural changes were assessed for 6 h postoperatively. Oral transmucosal fentanyl citrate was as effective as midazolam in aiding compliance with anaesthesia, but is significantly better in its appeal to children (p < 0.001) and emergence (p < 0.001) characteristics. In conclusion, OTF may be particularly useful as a premedicant in paediatric practice.     

Implications of xerostomia in oral dis-homeostasis

Xerostomia represents the main symptom in several secretor dysfunctions, but can be also met as a stand alone disease. The goal of the current study is to remark the oral cavity changes in patients with xerostomia and the incurring factors. The research was carried on two groups : a study group (76 xerostomia clinical cases) and a control group (72 clinically healthy patients). The xerostomia diagnosis was based on anamnesis data, clinical examination of oral tissues and salivary tests for measuring the salivary flow rate at rest and in stimulation conditions. The results of the study showed changes in oral tissues: dry lips with angular cheilitis, pale oral mucosa, with frequent congestion, dryness, partially no papilla tongue, atrophied papilla and even deep fissures and ulcerations, and increasingly frequent carious lesions. In our study the value of the salivary rate flow was 0.60 +/- 0.01 ml/min in the control group vs 0.30 +/- 0.04 ml/min in the study group (p < 0.01). After stimulation the value of the salivary rate flow was 1.0 +/- 0.15 ml/min in the control group vs 0.7 +/- 0.18 ml/min in the study group. Xerostomia represents a reality encountered in every day dental medicine practice, with an essential role in protecting the oral tissue, and which can significantly affect the life quality.     

Aspects of complex oral rehabilitation with oral osseointegrated implants

Dentists and patients become increasingly aware of the complex and predictible results offered by implant-supported dentures. These alternatives fulfill the demands of modern dentistry to rehabilitate the oral health condition according to the highest standards. A deficient residual crest represents a great challenge for the healing and osseointegration of the implants. Dental implants have an essential effect on stopping bone atrophy in the edentulous crest and preserving its condition. Function and esthetics and the patients comfort can be rehabilitated within normal limits. The prosthetic reconstruction based on osseointegration implants has better long-term prognosis if the therapeutic option is judiciously selected. The risk of relative movements at the bone-implant interface decreases according to the difference in value between the elasticity module of the implant and the bone. Prosthetic reconstruction based on implants has a better long-term prognosis if the therapeutic option is judiciously selected from all possibilities according to the osteointegration of an adequate number of implants.     

不同口腔护理液对口咽置管患者口腔内环境的影响

目的探讨4种口腔护理液对口腔内环境的影响。方法将120例口咽置管脑卒中患者随机分为四组各30例,分别采用生理盐水、0.3%过氧化氢、口洁液、2%碳酸氢钠作为护理液进行口腔护理。分别统计口腔pH及口臭和口腔炎发生率。结果过氧化氢组和口洁液组口腔护理后口腔平均pH值在正常范围。碳酸氢钠组、过氧化氢组、口洁液组口臭发生率相对低于生理盐水组。口洁液组口腔感染发生率最低。结论口咽置管患者可首选口洁液进行口腔护理。     

口腔口咽肿瘤切除术后较大缺损修复的研究

目的总结口腔口咽肿瘤切除后较大缺损的修复方法，讨论影响组织瓣相关并发症的因素。方法回顾性分析2004年12月～2006年4月我院头颈外科收治的部分口腔口咽肿瘤患者64例，肿瘤切除后出现较大缺损，使用组织瓣66块进行修复，其中带蒂组织瓣39块，游离组织瓣27块。结果27例游离组织瓣中，2例前臂皮瓣坏死，成功率92．6％；39例带蒂组织瓣中，4例胸大肌肌皮瓣出现部分坏死。成功率90％。64例患者中，除1例死亡外，全部恢复经口进食。带蒂或游离组织瓣的选择及术前放疗与否不影响组织瓣相关并发症的发生。结论对口腔口咽部肿瘤切除后的较大缺损，应视缺损的范围、大小及患者的一般情况、术前放疗、颈部手术史等综合考虑，选择最合适的组织瓣进行修复。如果出现皮瓣相关井发症，尤其对术前放疗者应积极处理。     

自制漱口液用于重症药疹伴口腔黏膜炎患者口腔护理

目的探讨自制漱口液(内含四氢叶酸钙、维生素B12、利多卡因)在重症药疹伴口腔黏膜炎患者口腔护理的应用效果。方法将60例重症药疹伴口腔黏膜炎患者按连续数字编号,单号为干预组(30例),双号为对照组(30例),对照组按常规进行口腔护理,即每日给予生理盐水、口泰含漱液交替漱口,每6小时1次。干预组在对照组基础上加用自制漱口液含漱。结果干预组治疗效果显著优于对照组,治愈时间显著短于对照组(P0.05,P0.01)。结论采用自制漱口液进行口腔护理,能有效减轻重症药疹口腔炎患者的口腔黏膜炎症反应程度,缩短愈合时间,减轻患者痛苦。     

Transtracheal ventilation in oral surgery

The use of transtracheal ventilation as a routine method of ventilation during anaesthesia for 60 patients with gross pathology requiring oral surgery is reported. Theoretical hazards of the technique and protection of the airway are discussed. There were no serious complications in this series. The technique is recommended as a simple and safe alternative to blind nasal intubation.     

口腔冲洗器在经口气管插管患者口腔护理中的应用

目的观察口腔冲洗器在经口气管插管患者口腔护理中的应用效果,了解其对口腔感染和呼吸机相关性肺炎发生的影响。方法将经口气管插管行机械通气治疗的108例患者按入住ICU时间分为观察组和对照组各54例,观察组采用口腔冲洗器对患者进行口腔冲洗;对照组采用传统的棉球擦拭法进行口腔护理,观察两组口腔护理效果。结果观察组口腔异味评分、咽拭子阳性率和VAP发生率显著低于对照组(P<0.05,P<0.01)。结论经口气管插管患者应用口腔冲洗器进行口腔护理,能较好地控制口腔异味的形成,降低口腔感染和呼吸机相关性肺炎的发生率,是经口气管插管患者口腔护理安全、易行的方法。     

Application of irrigator to oral care for oral intubation patients

目的 观察口腔冲洗器在经口气管插管患者口腔护理中的应用效果,了解其对口腔感染和呼吸机相关性肺炎发生的影响.方法 将经口气管插管行机械通气治疗的108例患者按入住ICU时间分为观察组和对照组各54例,观察组采用口腔冲洗器对患者进行口腔冲洗;对照组采用传统的棉球擦拭法进行口腔护理,观察两组口腔护理效果.结果 观察组口腔异味评分、咽拭子阳性率和VAP发生率显著低于对照组(P＜0.05,P＜0.01).结论 经口气管插管患者应用口腔冲洗器进行口腔护理,能较好地控制口腔异味的形成,降低口腔感染和呼吸机相关性肺炎的发生率,是经口气管插管患者口腔护理安全、易行的方法.