Attenuation of anxiety in ambulatory oral surgery patients with oral triazolam

The purpose of this investigation was to determine if the preoperative administration of an oral anxiolytic agent (triazolam) is beneficial in reducing the cardiovascular response to stress and anxiety. Twelve consecutive patients, six who received the drug and six who received a placebo, were monitored from the night before surgery at home until the morning with a Holter monitor. On presentation for surgery, levels of anxiety as well as heart rate and presence of cardiac arrhythmias were determined for the two groups. Patients who received the study medication had an anxiety level on the day of surgery similar to that recorded at an earlier consultation visit, whereas the placebo group showed a tendency toward an increase in anxiety on the day of surgery. There was a significant difference for resting heart rate between the two groups at various intervals associated with the preparation for the surgery. There were no complications related to the medication and, therefore, on the basis of this study, it appears that the administration of an oral anxiolytic agent prior to the patient presenting for surgery is beneficial in reducing the stress and anxiety associated with the operation as well as in reducing some of the cardiac manifestations of this stress.     

Craniofacial growth in unilateral cleft lip and palate: skeletal growth from eight to eighteen years

Sixteen individuals with complete unilateral cleft lip and palate (UCLP) were evaluated for determination of several craniofacial dimensional means and growth rates. Each had undergone primary lip and palatal closure and alveolar bone grafting. Serial cephalographs from ages 8 to 18 years, taken every 2 years, were utilized for determination of six cephalometric dimensions: anterior cranial base, upper and lower facial heights, posterior nasomaxillary height, maxillary horizontal length, and mandibular length. These were then compared to published cephalometric standards of a nonclefted group. All dimensions, except mandibular length, were smaller in the UCLP group. The horizontal maxillary length was the most diminished in mean length and growth rate; it appears to be most affected in UCLP. The remaining dimensions and growth rates are affected by UCLP, but to a lesser degree. These findings indicated that individuals with unilateral cleft lip and palate are primarily and adversely affected by clefting (and the surgery as described) in the horizontal maxilla, both in dimension and growth rate.     

The incidence and relationship of cervical spine anomalies in patients with cleft lip and/or palate

The relationship, incidence, and distribution of cervical spine anomalies were assessed in 468 patients with cleft lip and/or palate. The patients were placed into four groups: lip and/or alveolar; complete unilateral or bilateral; isolated palatal; and soft palate or submucous clefts. Cervical anomalies were observed in 22% of the cleft patients and in 7% of the noncleft group. Patients with soft palate and submucous clefts had the highest incidence of vertebral anomalies (45%), whereas patients with cleft lip and/or alveolus had an incidence similar to the noncleft group. Patients with complete unilateral and bilateral clefts also had a higher incidence (15.6% to 19.0%) of anomalies than the noncleft group. Cervical anomalies occurred primarily in the occipital-C1-C2 region. The possible implications of these findings are discussed.     

Anesthesia for off-pump coronary artery bypass grafting

Off-pump coronary artery bypass presents special challenges for the anesthesiologist and surgeon, who must work closely together to provide optimal care. Displacement and immobilization of the heart for exposure of the coronary arteries, as well as occlusion of these vessels, can result in periods of significant hemodynamic instability. Appropriate preparation, guided therapy, and technical maneuvers can lessen such adverse hemodynamic impact. It is important for anesthesiologists to be aware of the special problems associated with this surgery, as well as the different therapies and maneuvers that can be useful in providing the best possible care. As surgeons develop greater expertise and better devices for the management of these patients, the number of coronary revascularizations without CPB is likely to increase.     

Expansion of heart failure device therapy into a rural indigent population in Louisiana: potential economic and health policy implications

BackgroundResearch regarding the use of implantable devices in patients with congestive heart failure (CHF) has shown mortality benefits. The Center for Medicare and Medicaid Services (CMS) approved new criteria for expanding coverage for such therapies. The purpose of this study was to determine the percentages of CHF patients in a rural, indigent heart failure population that would be eligible for implantable defibrillators (ICD) and cardiac resynchronization therapy (CRT) based on the new CMS criteria.Methods and ResultsThe new CMS guidelines were applied to information compiled in a database for 451 CHF disease management patients, at Leonard J. Chabert Medical Center. Results show that, annually, 32% of the newly identified CHF patient population would be eligible for ICD therapy and 7.3% would be eligible for CRT therapy.ConclusionsProviders of health care to the indigent may lack sufficient resources for the devices and the infrastructure for device implantation and follow-up.     

Nonporous hydroxylapatite in the repair of alveolar clefts in a primate model: clinical and histologic findings

Twelve adult Rhesus monkeys with surgically created alveolar clefts (ACs) underwent repair that used nonporous hydroxylapatite (NPHA) granules on one side and autogenous particulate bone in the contralateral defect. Clinical and radiographic evaluations at 1, 2, 3, 6, and 12 months postoperatively disclosed some displacement of granules initially, but this stabilized by 2 months. Three of 12 sites repaired with NPHA and four of 12 sites repaired with bone dehisced; however, all of these healed by 2 months. No untoward inflammatory or resorptive changes were observed beyond 3 months. The repaired alveolar processes were similar in bulk and contour in sites grafted with NPHA and with bone. Histologically, giant cells were noted at 3 months, but the number decreased at 6 months and remained at that level up to 12 months. The NPHA granules were embedded in mature fibrous connective tissue with osseous ingrowth evident in eight of the 12 defects. It was concluded that NPHA granules are an acceptable implant material for repair of residual alveolar clefts in which erupting teeth and orthodontic movements are not factors.