Comparison of sublingual lorazepam with intramuscular diazepam as sedatives during oral surgery

Sublingual lorazepam (2 to 3 mg) was compared with intramuscular diazepam (0.25 mg/kg) and placebo for sedation during oral surgery under local anesthesia. Sixty patients were randomly allocated into three groups in this double-blind, parallel study. The results from this trial show that sublingually administered lorazepam provided good sedation and anxiolysis. More side-effects, such as giddiness, dizziness, and ptosis, as well as profound and prolonged psychomotor impairment, were, however, found in the lorazepam group than in those patients who had received intramuscular diazepam (0.25 mg/kg) or placebo.     

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.     

Estrogen and progesterone improve scopolamine-induced impairment of spatial memory

This study was conducted to investigate the effects of estrogen and progesterone on spatial memory in ovariectomized female rats, specifically, on memory impaired by the cholinergic antagonist scopolamine. Forty-one female rats were divided into five groups: ovariectomized (OVX), estrogen-treated after ovariectomy (OE), progesterone-treated after ovariectomy (OP), estrogen-progesterone-treated after ovariectomy (OEP), and the sham control group (Control). The animals were trained on an eight-arm radial maze with four arms baited to assess both working and reference memory performances. The OE and OEP groups showed significant improvement in the ability to perform a spatial memory task over the OVX group (P<0.05). Spatial memory in the OP group did not differ from that in the OVX group. After thirty-two trials were conducted and all rats learned the eight-radial maze task, scopolamine hydrobromide (0.2 mg/kg i.p.) was administered prior to retesting. After scopolamine injection, the OVX group showed an increased number of working memory errors, reference memory errors than the other groups (P<0.05). The OE, OEP and OP groups showed significant improvement in spatial impairment induced by scopolamine. These findings suggest progesterone alone or in combination with estrogen, improved scopolamine-induced impairment of working memory and reference memory as effectively as estrogen supplementation.     

Sensory retraining following orthognathic surgery: effect on threshold measures of sensory function

Summary  The purpose of this analysis was to examine the effect of sensory retraining on sensory function after bilateral sagittal split osteotomy (BSSO). A total of 186 subjects were enrolled in a multi-centre double-blind two parallel group stratified block randomized clinical trial. Subjects were randomized to group immediately after surgery. Threshold measures for contact detection, two-point discrimination and two-point perception were obtained on the chin before and 1, 3 and 6 months and 1 and 2 years after surgery. The ratio of each threshold measure (post-surgery value/pre-surgery value) was calculated to characterize subjects' impairment. A general linear mixed model was fit for the impairment to examine the effect of the sensory retraining before and after adjusting for demographic, surgical and psychological factors. On average, two-point perception was less impaired in subjects who were retrained than in those who were not retrained ( P  = 0·04). Significant recovery continued up to 6 months after surgery for contact detection and two-point perception and up to 24 months for two-point discrimination. Older subjects experienced more impairment in two-point discrimination than younger subjects ( P  = 0·009). Subjects who received maxillary surgery in addition to mandibular surgery experienced more impairment on the chin in both two-point discrimination ( P  = 0·0003) and perception ( P  = 0·0013) than subjects who received mandibular surgery only. Psychological factors did not explain additional variability in subjects' impairment post-surgery. These finding indicate that a simple non-invasive exercise programme initiated shortly after orthognathic surgery can alter the way patients experience or respond to tactile stimulation long after the exercise regimen has stopped.     

Use of low-dose ketamine hydrochloride in outpatient oral surgery

This study compares the quality of anesthesia achieved with low-dose ketamine with that of methohexital sodium. In a double-blind study of 40 healthy adult patients undergoing a variety of minor oral surgical procedures, the anesthetic techniques were assessed with respect to the following parameters: patients' subjective evaluation of the anesthesia, the level of response to injection of local anesthetic, psychomotor ability after surgery, recovery times, and the frequency of adverse effects. From these observations, it was deduced that when low-dose ketamine was used with diazepam, meperidine, and nitrous oxide, it proved to be a safe and effective supplement for minimizing pain, discomfort, and anxiety before injection of local anesthetic. Patients' appreciation of the level of anesthetic achieved, psychomotor ability, adverse reactions, and recovery time was not significantly different from the methohexital sodium group.     

Effects of intravenous midazolam and diazepam on patient response, percentage of oxygen saturation, and hemodynamic factors during periodontal surgery

BACKGROUND: The purpose of this double-masked study was to evaluate effects of intravenous sedation (IVS) using midazolam or diazepam during periodontal procedures on patient recall, psychomotor response, oxygen saturation, and hemodynamic factors. METHODS: Seventeen patients received either two or three scheduled periodontal surgeries under IVS with midazolam, diazepam, or placebo control. Patients were monitored throughout the procedure for hemodynamic variables, percent oxygen saturation, level of recall of common objects presented at baseline, and psychomotor function via the perceptual speed test (PST). RESULTS: Fifteen patients completed the study with average titrated dosages of 3.3 and 12.1 mg for midazolam and diazepam, respectively. Within the limitations of the study, there were few differences observed between the drugs with regard to hemodynamic variables, oxygen saturation, and overall percentage of objects recalled by patients sedated with either drug. However, midazolam was found to cause a greater incidence of amnesia lasting up to 30 minutes when compared to placebo. Patients on diazepam required an average of 15 minutes longer to recover accuracy as measured by the PST. CONCLUSIONS: The results suggest that diazepam and midazolam each may have advantages for IVS. In procedures lasting over 45 minutes, diazepam appears to be more clinically advantageous including a wider margin of safety during titration and gradual recovery. Midazolam may be used for shorter procedures for faster onset of action, predictable amnesic effects, and relatively rapid recovery.     

银汞合金充填对机体神经系统影响的调查

目的 了解银汞合金充填对机体神经系统的影响。方法 采用WHO NCTB和神经行为调查表,对银汞充填患者进行流行病学调查,并与对照组进行比较。结果 银充＞20a组数字跨度、数字译码得分明显低于银充1－20a组;认为自己有“记忆力减退”者,银充＞20a组明显多于银充1－20a组,提示长期接触汞合金与人群记忆力下降有某些内在关系。而19－29岁,30－39岁数字跨度,30－39岁数字译码实验组得分明显高于对照组,说明汞合金对记忆力并无不良影响。错误点数实验组得分明显高于对照组。银充＞20a出现“动作不灵活”者显著多于银充1－20a组。但同时,30－39岁,40－49岁两个年龄段,实验组正确点数和总点数得分也较对照组高,故不能确定汞合金对运动神经有负面影响。结论 目前尚不能认为银汞合金充填对人体神经系统有影响。     

Reversal of midazolam sedation with flumazenil following conservative dentistry

The purpose of this double-blind randomized study was to assess recovery of mental function following reversal of midazolam-induced sedation with the specific antagonist flumazenil (R015-1788) or placebo following conservative dental procedures. Recovery was assessed using choice reaction time and critical flicker fusion threshold, both objective tests of psychomotor function; linear analogue sedation scores and simple memory tests. Assessments were repeated up to 3 h after administration of flumazenil or placebo to discover whether recovery was sustained or whether resedation occurred due to the short duration of action of flumazenil. Flumazenil in doses from 0.5 to 1.0 mg rapidly reversed the sedative and amnesic effects of a mean dose of 8.2 mg of midazolam without apparent evidence of subsequent resedation. Since recovery of mental function in the control group had ordinarily occurred 45 min after administration of placebo, routine reversal of midazolam sedation with flumazenil cannot be justified. Nevertheless, in cases of undue sedation persisting after dental treatment, flumazenil may be used with minimal risk of resedation occurring.     

Reversing intravenous sedation with flumazenil

This study was designed to evaluate the effects of flumazenil in reversing sedation from midazolam and meperidine after oral surgical procedures. Of the 35 patients entered, efficacy was evaluated in 33 and safety in 34. Patients were tested for sedation, psychomotor skills, and memory during a 3-hour period and at a 24-hour follow-up. Flumazenil almost totally reversed the effects of sedation for approximately 2 hours, after which some loss of effect was observed. A number of central nervous system-related side effects were observed in the flumazenil group, but none of these was considered serious. One patient in the flumazenil group had an episode of hypotension that precluded further testing.     

Use of orally administered diazepam in the reduction of dental anxiety

A double-blind randomized clinical trial of the effectiveness of orally administered diazepam in reducing dental anxiety was conducted. Forty-one subjects were assigned to a diazepam or placebo group and tested, using the Dental Fear Survey and State-Trait Anxiety Inventory. Diazepam was effective in reducing anxiety scores but not dental fear scores.     

Diazepam (valium) in premedication. Experimental findings

The anxiolytic and analgesic effects of 10 mg of orally administered diazepam (Valium) were assessed on 10 volunteers. The electrodermal activity was recorded during two experimental sessions while cutaneous electrical stimulations were administered to the subjects. On one hand, the anxiolytic activity of diazepam could be observed by a decrease of both autonomic nervous system and anticipatory activities. On the other hand, an increase of the pain threshold could be shown under diazepam by lower responses to the stimulations. These results confirm that diazepam can be useful in anxious patients undergoing dental procedures.     

高血压拔牙患者控制性降压的随机双盲临床研究

目的: 比较高血压患者拔牙术前口服不同药物控制性降压前、后血压和心率的变化,探讨有效控制患者围术期血压的用药方法。方法：对90例高血压拔牙患者随机使用不同药物,即安定、硝苯地平或安定及硝苯地平联合应用,术前进行药物控制性降压,记录拔牙前、后血压、心率变化,采用SPSS17.0软件包,对不同药物的降压效果及拔牙复杂程度、拔牙时间对血压、心率的影响分别进行t检验和χ²检验。结果：经药物控制性降压后,高血压患者拔牙期间血压、心率较平稳,安定与硝苯地平联合应用的降压有效率最高(96.7%)。拔牙难度和拔牙时间对单纯应用安定及安定与硝苯地平联合应用组患者拔牙期血压的变化影响较小,而对单纯应用硝苯地平组患者影响大,但对各组心率均无显著影响。结论：术前药物控制性降压能够达到良好的降压效果,联合用药能更好地提高高血压患者拔牙的安全性。     

Effect of diazepam on temporomandibular joints in rats with increased occlusal vertical dimension

Anxiolytic agents, mainly benzodiazepines, have been used to treat symptomatic disorders of the temporomandibular joint (TMJ). Our aim was to evaluate the effect of diazepam on the TMJ of rats with increased occlusal vertical dimension (iOVD). Forty male rats were randomly assigned to 4 groups: control rats were given sham iOVD plus saline solution daily for 7 days. The first experimental group was given sham iOVD plus diazepam 2.5 mg/kg/intramuscularly daily for 7 days (diazepam alone group); the second had iOVD induced in molars for 7 days plus saline daily for 7 days (iOVD alone group); and the third had iOVD induced in molars for 7 days plus diazepam 2.5 mg/kg/intramuscularly daily for 7 days (iOVD plus diazepam group). At the end of each experiment the animals were killed and their bilateral TMJs were removed, randomly stained with haematoxylin and eosin and sirius-red, and immunoassayed. The thickness of condylar cartilage and of fibrous, proliferating, mature, and hypertrophic layers, number of collagen fibres, and the articular area were measured. Proinflammatory cytokines (interleukin (IL)-1α, IL-1β, IL-6, and tumour necrosis factor (TNF)-α) were also measured. ANOVA and Tukey's tests or the Kruskal–Wallis test were used to compare data among groups (α = 5%). Condylar cartilage was thicker in the control group than in the other groups, the diazepam alone group being thicker than the other 2 experimental groups. There were fewer collagen fibres in the 2 groups given diazepam than in the other 2 groups, and there were no significant differences in the area of cartilage among groups. The controls had lower concentrations of all cytokines (p < 0.05) than the 3 experimental groups, except for IL-6. Both iOVD groups had higher concentrations of IL-1α, IL-1β, and IL-6 than the diazepam alone group. Diazepam alone was associated with increased concentrations of all cytokines except IL-6. We conclude that both iOVD and diazepam induced significant changes in rats’ articular cartilage.     

口腔颌面部恶性肿瘤术后胃肠道营养支持治疗

目的 评价胃肠道营养支持在口腔颌面部恶性肿瘤术后治疗中的价值。方法 48例口腔颌面部恶性肿瘤术后病例随机分为治疗组24例，对照组24例。治疗组采用胃肠道营养膳食，对照组由患者家属自备膳食。对两组病例进行营养监测和术后恢复程度判断。结果 治疗组术后第10天体重无明显减轻，血清白蛋白和运铁蛋白无明显下降；对照组术后第10天体重明显减轻，血清白蛋白和运铁蛋白明显下降。两组比较差异非常显著（P＜0.01)。两组术后恢复情况比较亦有非常显著差异（P＜0.01)。结论 口腔颌面部恶性肿瘤病人术后胃肠道营养支持能有效地防止体重减轻，减少体内蛋白质的消耗，促进手术后的恢复。     

Behavioral influences of rectal diazepam in solution on dental patients with mentally and physically handicapping conditions

The hypothesis of this study was to determine whether the use of rectal diazepam in solution would effectively modify the uncooperative behavior of patients with mentally and physically handicapping conditions during dental treatment. The sample consisted of 42 patients with mild to severe mentally handicapping conditions, 4 to 31 years old, who live in a homecare center. Supragingival and subgingival scaling and prophylaxis were attempted during a 5-minute period and the patient's behavior was assessed. Conscious sedation using a rectal solution of diazepam (Stesolid) was used for those patients with voluntary or involuntary uncooperative behavior that prevented treatment. Twenty-two subjects (52.4%) were treated without diazepam. The rectal solution of diazepam proved to be a significantly (P < .01) effective agent for behavior modification permitting the successful treatment of 16 (80%) of the 20 remaining subjects. The following behaviors were significantly modified: places hand(s) or arm(s) in front of mouth (P < .01); does not open mouth, lips held firmly together (P < 05); turns head to one side or side to side (P < 05); attempts to grab instruments (P < .05). No relationship was found between the results and the variables of medical history, gender, age, weight, quantity of diazepam administered, routine medication, pulse rate, blood pressure, and respiration.     

The occlusal effects of digit sucking habits amongst school children in Northamptonshire (UK)

Abstract

Objective: To compare the occlusal characteristics of persistent digit suckers with those of a group of individuals who reported never to have sucked their thumb or finger.

Setting: School children and regular attenders to four general dental practices in Kettering, UK.

Design: Cross‐sectional, observational.

Outcome measures: Prevalence of anterior open bite, posterior crossbite, size of overjet, overbite and buccal segment relationship.

Subjects and methods: The exposed group consisted of 7–13‐year‐old children with a persistent digit sucking habit or those who had given up the habit less than 2?years previously, compared with an unexposed group of children who had never reported a history of the habit. Upper and lower alginate impressions were taken and the resultant study models were used to measure occlusal differences between the two groups.

Results: Following exclusions, 39 digit suckers were compared to 36 non‐suckers. The odds of a reduced overbite being present were significantly higher in the digit sucking group compared to the non‐suckers (OR: 5·6, 95% CI: 1·6–20·8). The prevalence of anterior open bites was higher in the digit suckers (P<0·001). Although the overjet was slightly increased in the digit suckers compared with the non‐suckers (mean difference: 1?mm, P?=?0·036), this result needs to be interpreted with caution. No significant differences were seen in the presence of posterior crossbites or buccal segment relationships between the two groups.

Conclusions: This study has shown that reduced overbite and anterior open bites were significantly more prevalent in digit suckers. The orthodontic management of anterior open bites can involve complex and prolonged treatment. Early intervention to eliminate digit sucking habits is therefore recommended on both oral health and health economic grounds.     

Upper cervical range of motion is impaired in patients with temporomandibular disorders

Aims:

Clinicians increasingly suggest assessment and treatment of the cervical spine in patients with temporomandibular dysfunction (TMD); however, few studies have investigated upper cervical spine mobility in people who suffer from TMD. The purpose of this study was to investigate whether patients with TMD pain (with or without headache) present with upper cervical spine impairment when compared with asymptomatic subjects.

Methodology:

A single blind examiner evaluated cervical range of motion (ROM) measures including axial rotation during the flexion–rotation test (FRT) and sagittal plane ROM. Twenty asymptomatic subjects were compared with 37 subjects with pain attributed to TMD, confirmed by the Revised Research Diagnostic Criteria. Subjects with TMD were divided according to the presence of headache (26 without headache TMDNHA, 11 with headache TMDHA). One-way analysis of variance and planned orthogonal comparisons were used to determine differences in cervical mobility between groups. All subjects with TMD were positive on the FRT with restricted ROM, while none were in the control group.

Results:

The analysis of variance revealed significant differences between groups for the FRT F(2,54)?=?57·96, P<0·001) and for sagittal ROM [F(2,54)?=?5·69, P?=?0·006]. Findings show that the TMDHA group had less axial rotation than group TMDNHA, and both TMD groups had less ROM than controls. For sagittal ROM, the only difference was between group TMDHA and controls.

Conclusions:

Subjects with TMD had signs of upper cervical spine movement impairment, greater in those with headache. Only subjects with TMD and headache had impairment of cervical spine sagittal plane mobility. This study provides evidence for the importance of examination of upper cervical mobility determined by the FRT in patients who suffer from TMD.     

The effects of midazolam and flumazenil on psychomotor function and alertness in human volunteers

OBJECTIVE: To investigate the effect of midazolam and flumazenil on psychomotor function and alertness in human volunteers. DESIGN: Randomised, double-blind, cross over study. METHODS: Intravenous flumazenil was administered to sedated and non-sedated healthy human volunteers, in doses typical of those used clinically to induce sedation with midazolam and for reversal with flumazenil. Subjective assessment of alertness and objective measures of psychomotor function using light reaction time and the Maddox wing were made over a 1 hour period. RESULTS: Seven males and seven females each attended four experimental sessions. Psychomotor function was impaired by midazolam but there was some individual variation to this response. All sedated subjects receiving flumazenil had significantly improved alertness and psychomotor function when compared with those subjects who received placebo. Mean alertness (P < 0.01) and light reaction time (P < 0.05) showed significant improvement and returned to baseline by 60 minutes. Stability also showed significant improvement (P < 0.05) but did not return to baseline by 60 minutes. There was no significant effect on psychomotor function or alertness when the antagonist flumazenil was administered in the absence of the agonist midazolam. CONCLUSION: An earlier discharge time based on subjective assessment of alertness is not advocated for patients whose intravenous midazolam sedation is reversed with flumazenil.     

Rectal sedation with diazepam or midazolam during extractions of traumatized primary incisors: a prospective,randomized, double-blind trial in Swedish children aged 1.5-3.5 years

The aim of this study was to compare rectal sedation with diazepam and rectal sedation with midazolam with regard to sedative effect, treatment acceptance, and amnesia. Ninety children, 1.5-3.5 years of age, consecutively referred for extractions of traumatized primary incisors were randomly sedated with diazepam (0.7 mg/kg body weight) or midazolam (0.3 mg/kg body weight). The study design was randomized and double-blind. The level of sedation (state of mind) was assessed prior to and 10 and 60 min after administration of the drug by use of a behavioral scale (Wilton). The children's acceptance of procedures was assessed using another behavioral scale (Holst) during administration of the sedative, application of topical anesthesia, injection of a local anesthesia, and extraction. Amnesia was evaluated by the parents on the following day, with the child being asked standardized questions. Parental ratings of the child's and their own distress during and after treatment were made on a visual analog scale (VAS). No differences were found between the sedatives concerning level of sedation during treatment, acceptance of procedures, or amnesia. At discharge, 60 min after administration of the sedative, the children receiving diazepam were significantly more agitated (P = 0.006). Parental rating on a VAS of the child's discomfort after treatment was significantly higher in the diazepam group (P = 0.006). There was a tendency for children with poor acceptance of the rectal administration to display a more negative acceptance of the dental treatment. In conclusion, the present results, in combination with known pharmacological advantages, indicate that midazolam is preferable in outpatients when sedation is needed and amnesia is desirable.     

Comparison of various physiologic and psychomotor parameters in patients sedated with intravenous lorazepam, diazepam, or midazolam during oral surgery

Intravenously administered lorazepam (0.05 mg/kg), diazepam (0.25 mg/kg), and midazolam (0.1 mg/kg) were compared for sedation during oral surgery under local anesthesia. Sixty patients were randomly allocated into three groups in this double-blind, parallel study. The results from this trial show that all three drugs provide satisfactory sedation. Average mean arterial pressures, however, decreased significantly with midazolam and diazepam. Statistically significantly higher heart rates during the entire procedure were also found for lorazepam when compared with diazepam and midazolam. At the postblock stage, the midazolam group had respiratory rates that were significantly higher than those of the other two drug groups. Patients in the diazepam and midazolam groups took significantly longer to complete the pegboard test at the preblock stage than those in the lorzepam group. At 1, 1.5, and 2 hours after arrival in the recovery room, an inversion of groups took place, with the lorazepam group taking significantly longer for their tests than the other two groups. Significantly more improvement in anxiety levels was found at 10 minutes postdrug for the patients who had received diazepam and this tended to remain so on arrival in the recovery room. When compared with the other two groups, significantly more patients in the lorazepam group reported giddiness/dizziness and significantly more in the diazepam group reported pain on injection.