Intra-operative patient-controlled sedation

The quality of sedation and postoperative recovery have been assessed for intra-operative sedation provided by either patient-controlled sedation with propofol or a standard method using divided doses of midazolam and fentanyl, in 40 ASA 1 day surgery patients undergoing extraction of third molar teeth under local analgesia. Patient-controlled sedation with propofol produced sedation no deeper than full eyelid closure with prompt response to verbal command, but deeper levels were seen in three patients in the midazolam and fentanyl group. Patient satisfaction was higher in the patient-controlled sedation propofol group for both subjective intra-operative feelings (p less than 0.01) and willingness to have the procedure again in the same manner (p less than 0.05). Amnesia was more limited to intra-operative events (rather than extending into the postoperative period) in the patient-controlled sedation propofol group (p less than 0.05). Drug dose was correlated with duration of procedure and surgical difficulty in the patient-controlled sedation propofol group but not in the midazolam and fentanyl group. Postoperative testing included a new computerised test, the FAST index, which indicated a dose-dependent reduction in cognitive function in the midazolam and fentanyl group, which persisted until the time of discharge. Changes in cognitive function in the patient-controlled sedation propofol group in the same postoperative interval were significantly less and not related to propofol dose.     

Device closure of paravalvular defects following transcatheter aortic valve replacement with the Edwards Sapien valve

Paravalvular aortic insufficiency (AI) is observed in the majority of patients undergoing transcatheter aortic valve replacement (TAVR). While paravalvular AI is most commonly modest following TAVR, moderate or severe AI was seen in 10.5% and 6.8% of the PARTNER inoperable and high‐risk cohorts at 1 year and has been reportedly associated with dyspnea and diminished survival. We report two cases of transcatheter heart valve (THV) associated paravalvular defects closed using catheter delivered devices. Both patients derived hemodynamic and symptomatic improvement from device closure. Additional research is warranted to define the adverse consequences of THV associated AI, indications for treatment, and risks associated with device closure of these defects. © 2012 Wiley Periodicals, Inc.     

Follow-up Evaluation of a Series of Dentin-Bonded Ceramic Restorations

Purpose : The results of a retrospective evaluation of 60 dentin-bonded full-coverage restorations with an average time in service of 2.4 years previously have been reported. The purpose of this study was to evaluate the crowns after a further 2 years in service.
Materials and Methods : The 23 patients in the initial study whose restorations were found to be intact in June 1996 were contacted by mail and invited to present for review in October 1998. The restorations of 20 respondents were assessed by two examiners using modified United States Public Health Service criteria.
Results : The patients had received a total of 53 restorations (mean age of restorations, 4.4 years; range, 5.5–3 yr). At the time of examination, 48 restorations were found to be intact. No secondary caries was detected in these restorations, and optimal scores for gingival health, anatomic form, and marginal discoloration were recorded for 39, 47, and 33 crowns, respectively. Color match was assessed as being very good in 43 of the 48 restorations assessed. The reasons for replacement of the failed restorations were gingival recession (n = 1), restoration fracture (n = 1), core fracture (n = 1), and unknown (n = 2). Each patient's perception of his or her restorations was recorded by means of a questionnaire, with the responses indicating that all but two patients were satisfied. Only one patient had experienced any discomfort.
CLINICAL SIGNIFICANCE
The dentin-bonded full-coverage restorations assessed in this study had provided satisfactory service and a high level of patient satisfaction over the period of the evaluation.