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N M Girdler

Publications and source records attributed to N M Girdler.

At least 19 recordsLinked to original sources
PubMed2004

A survey of the opinions of consultant anaesthetists in Scotland of sedation carried out by dentists.

OBJECTIVES: To elicit the attitudes and opinions of consultant anaesthetists working in Scotland, with regard to conscious sedation carried out by dental practitioners. METHOD: A questionnaire was designed to gauge opinion of consultant anaesthetists in Scotland on the practice of conscious sedation by dentists. The questionnaire was sent to 353 consultant anaesthetists working in 49 hospitals within the 15 health boards in Scotland. RESULTS: Of the 366 questionnaires sent, 249 were returned of which 235 were valid. This gave a response rate of 64%. In general, those questioned felt that the provision of sedation in a hospital setting was more appropriate than in general dental practice. A majority (65%) thought that it was unrealistic for anaesthetists to provide all sedation for dental treatment, although many (58%) felt that anaesthetists should take more responsibility in this area. Again, a majority (60%) agreed that dentists should be trained to use sedation techniques for their patients but a significant number (63%) disagreed with the practice of operator/sedationist. CONCLUSION: It is of concern to the dental profession that a significant number of anaesthetists do not feel that it is appropriate for dentists to be administering even the most simple methods of sedation. At present there are no clear, recognised guidelines as to the level of formal training required for the practice of conscious sedation by dentists. It is in the interests of the dental profession and the public to ensure that those choosing to practice sedation do so safely by following recognised guidelines in the training and practice of sedation.

Anesthesia Department, Hospital↗
PubMed2004

A randomised controlled trial of paediatric conscious sedation for dental treatment using intravenous midazolam combined with inhaled nitrous oxide or nitrous oxide/sevoflurane.

Failure of dental treatment due to anxiety is a common problem in children. The aim of this study was to establish whether the use of a combination of intravenous midazolam with inhalation agents (nitrous oxide alone or in combination with sevoflurane) was any more likely to result in successful completion of treatment than midazolam alone. A further aim was to evaluate the clinical viability of these techniques as an alternative to general anaesthesia. In total, 697 children too anxious for management with relative analgesia and requiring invasive dental procedure for which a general anaesthetic would usually be required, were recruited and randomly assigned to one of three groups given the following interventions: group 1 - a combination of inhaled medical air and titrated intravenous midazolam, group 2 - a combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam, and group 3 - a combination of an inhaled mixture of sevoflurane 0.3% and nitrous oxide 40% in oxygen with titrated intravenous midazolam. The primary outcome measure was successful completion of the intended dental treatment with a co-operative child responsive to verbal commands. In group 1, 54% (94/174 children) successfully completed treatment. In group 2, 80% (204/256 children) and in group 3, 93% (249/267 children) completed treatment. This difference was significant at the 1% level. Intravenous midazolam, especially in combination with inhaled nitrous oxide or sevoflurane and nitrous oxide, are effective techniques, with the combination of midazolam and sevoflurane the one most likely to result in successful treatment.

Adolescent↗
PubMed2003

Randomized, controlled, cross-over clinical trial comparing intravenous midazolam sedation with nitrous oxide sedation in children undergoing dental extractions.

BACKGROUND: The use of benzodiazepines for paediatric dental sedation has received limited attention with regard to research into clinical effectiveness. A study was therefore designed to investigate the use of midazolam, for i.v. sedation in paediatric dental patients. METHOD: The aim of the study was to assess the effectiveness of i.v. midazolam in a randomized, controlled, cross-over trial. Children aged 12-16 yr (ASA I and II), requiring two appointments for equivalent but contralateral dental extractions for orthodontic purposes, were recruited. Conscious sedation with either i.v. midazolam titrated at 0.5 mg x min(-1), to a maximum of 5 mg, or nitrous oxide/oxygen titrated to 30%/70% inhalation sedation was used at the first visit, the alternative being used at the second visit. Vital signs including blood pressure, arterial oxygen saturation and ventilatory frequency, as well as sedation levels and behavioural scores, were recorded every 2 min. RESULTS: Forty patients, mean age 13.2 yr (range 12-16 yr), participated in the trial. A mean dose of midazolam 2.8 mg was administered in the test group. The median time to the maximum level of sedation was 8 min for midazolam compared with 6 min for nitrous oxide (P<0.001). Vital signs for both treatments were comparable and within acceptable clinical limits and communication with the patient was maintained at all times. The median (range) lowest arterial oxygen saturation level recorded for midazolam was 97 (91-99)% compared with 97 (92-100)% for nitrous oxide. The mean (range) recovery time for midazolam was 51.6 (39-65) min and 23.3 (20-34) min for nitrous oxide (P<0.0001). Fifty-one per cent said they preferred i.v. midazolam, 38% preferred nitrous oxide, and 11% had no preference. CONCLUSION: I.V. midazolam sedation (0.5 mg x min(-1) to a maximum of 5 mg) appears to be as effective as nitrous oxide sedation in 12-16-yr-old healthy paediatric dental patients.

Adolescent↗
PubMed2002

A study of the effectiveness of oral midazolam sedation for orthodontic extraction of permanent teeth in children: a prospective, randomised, controlled, crossover trial.

OBJECTIVES: To assess the safety, effectiveness and acceptability of o:ral midazolam sedation for orthodontic extraction of permanent teeth in children. DESIGN: A prospective, randomised, controlled, crossover trial. METHODS: A total of 26 children aged 10-16 (ASA I), referred for orthodontic extraction of premolar or canine teeth under sedation, were included in the study. Each child required two treatment sessions for the extraction of equivalent teeth on opposite sides of the mouth. Each subject was sedated with either ora midazolam (0.5 mg/kg) or nitrous oxide and oxygen (30%/70%) at the first visit and the alternative form at the second visit. At each visit two teeth were extracted, one upper and one lower. Heart rate, arterial oxygen saturation, respiration rate, sedation and behavioural scores were recorded every five minutes. Overall behaviour, patient acceptance and patient satisfaction were recorded at the end of treatment. RESULTS: Of the 26 children included in the study there were 12 males and 14 females. The mean age was 12.5 years. The mean heart rate and respiratory rate for both groups were similar and within acceptable clinical limits. The lowest mean arterial oxygen saturation levels for nitrous oxide and midazolam sedation were 97.7% and 95.0% respectively. Although midazolam caused greater oxygen desaturation, the range (91%-100%) was within safe limits for conscious sedation. The mean level of sedation was greater in the midazolam group compared with the nitrous oxide group and all but one case completed treatment. A total of 23 patients (88%) said they would be prepared to have ora midazolam sedation again and 17 (65%) actually preferred oral midazolam to nitrous oxide sedation. CONCLUSION: Oral midazolam (0.5mg/kg) appears to be a safe and acceptable form of sedation for 10-16 year old paediatric dental patients.

Administration, Oral↗
PubMed2002

A randomised, controlled, crossover trial of oral midazolam and nitrous oxide for paediatric dental sedation.

A randomised, controlled, crossover trial was designed to assess the safety and effectiveness of oral midazolam sedation for orthodontic extractions. Forty-six ASA physical status I children aged 10-16 years were recruited. Each child required two treatment sessions. Sedation with either oral midazolam 0.5 mg.kg-1 or nitrous oxide in oxygen was used at the first visit, the alternative being used at the second visit. Blood pressure, heart rate, arterial oxygen saturation, and sedation and behavioural scores were recorded every 5 min. Anxiety levels and postoperative satisfaction were also recorded. Blood pressure, heart rate and arterial oxygen saturation in both groups were similar and within acceptable clinical limits. The median [range] lowest arterial oxygen saturation levels for subjects in the midazolam and nitrous oxide groups were 95 [90-100]% and 98 [93-100]%, respectively. The median [range] time to the maximum level of sedation in the midazolam group was 20 [5-65] min compared with 5 [5-10] min in the nitrous oxide group (p < 0.001). The median [range] duration of treatment was similar in both groups (midazolam group: 10 [5-30] min, nitrous oxide group: 10 [5-25] min). Seventy-four per cent of subjects were prepared to have oral midazolam sedation again, 54% preferring it. Oral midazolam appears to be a safe and acceptable form of sedation for 10-16-year-old paediatric dental patients.

Adolescent↗
PubMed2002

A randomised, controlled trial of cognitive and psychomotor recovery from midazolam sedation following reversal with oral flumazenil.

Flumazenil is traditionally administered intravenously to reverse the adverse effects of over sedation with benzodiazepines. The aim of this study was to test postoperative cognitive and psychomotor recovery from midazolam conscious sedation, following reversal with orally administered flumazenil. It was hypothesised that when administered by the oral route, flumazenil may enhance recovery over a prolonged period, thus increasing safety. Eighteen patients requiring intravenous midazolam sedation for dental treatment completed a randomised, double-blind, crossover trial. Following treatment the patients' sedation was reversed using either flumazenil or saline (as placebo), administered orally, on alternate appointments. Assessment of mood and cognitive function were undertaken using ClinPhone.cdr(R), a highly sensitive and specific computerised battery of cognitive tests administered by telephone prior to sedation and every hour for seven hours post reversal. Results indicate that within 20 min of administration, oral flumazenil is capable of partially reversing some cognitive and psychomotor impairments but the attentional and stimulus discrimination effects of midazolam sedation still remain.

Administration, Oral↗
PubMed2001

Competency in sedation.

Conscious sedation has become an integral part of the undergraduate dental curriculum. The attributes of the competent graduate in sedation are defined and all providers of sedation education should be aiming towards this standard. It is important that students receive appropriate theoretical and practical training which must include hands-on clinical experience in sedation techniques.

Anesthesia, Dental↗
PubMed2001

A randomised, double-blind, placebo-controlled, comparative study of topical skin analgesics and the anxiety and discomfort associated with venous cannulation.

OBJECTIVES: To compare the effect of topical skin anaesthetic agents on the discomfort and anxiety associated with venous cannulation. DESIGN: Randomised, double-blind, placebo-controlled, within subject, volunteer trial. METHODS: 20 healthy volunteers underwent venous cannulation on three separate occasions having received topical skin application of either 4% amethocaine gel (Ametop), 5% eutectic mixture of lidocaine and prilocaine (EMLA) or E45 cream (placebo). Visual analogue and verbal rating scales were used to assess pain and anxiety associated with the venous cannulation, and anticipated anxiety for future cannulation, under each drug condition. RESULTS: Subjects were aged 22-53 years (mean 32.8 years). The mean visual analogue scores (VAS) for discomfort were found to be significantly lower (p< 0.001) with Ametop (VAS = 18mm) and EMLA (VAS = 29mm) compared with the control (VAS = 38mm). There was a positive correlation (R2 = 72%, p<0.001) between discomfort and the predicted anxiety if cannulation was to be repeated with the same cream. With the placebo a positive correlation (R2 = 19.8%, p = 0.05) was found between the level of anxiety before cannulation and the level of discomfort recorded. CONCLUSIONS: Ametop and EMLA topical anaesthetic agents produce effective skin analgesia for venous cannulation. The use of topical analgesia can reduce perceived anxiety about future cannulation procedures. This has application in the management of anxious patients undergoing intravenous sedation, suggesting that topical analgesia prior to venous cannulation may significantly aid anxiolysis.

Administration, Cutaneous↗
PubMed2000

Dose-dependent effects of flumazenil on cognition, mood, and cardio-respiratory physiology in healthy volunteers.

OBJECTIVES: To assess the possible effects of flumazenil on cognitive processing, physiology, and mood. Design A double-blind, placebo controlled, four-way cross-over study, using healthy volunteers. METHODS: On each of 4 separate visits, 16 participants received 0.5 mg, 2.5 mg, 5.0 mg of flumazenil, or normal saline. They then performed a computerised test battery assessing cognitive function. Measures of pulse rate, arterial oxygen saturation and mean arterial pressure were also taken. Finally, participants completed visual analogue scales assessing their subjective mood state. RESULTS: The majority of cognitive tasks showed dose-dependent declines in performance. Mean arterial pressure was significantly reduced, as was pulse rate. Subjective alertness showed a similar decline. CONCLUSIONS: Flumazenil has been clinically described as an agent with few intrinsic properties, whose primary effect lies in its ability to reverse benzodiazepine-induced states. This study has shown that flumazenil does possess intrinsic activity which have a significant effect on cognition, cardiovascular physiology and mood. Clinicians need to be aware of these effects.

Adult↗
PubMed2000

A survey of the teaching of conscious sedation in dental schools of the United Kingdom and Ireland.

AIM: To assess and compare, for the first time, the quantity and quality of dental undergraduate teaching in conscious sedation in the dental schools of the UK and Ireland. This was achieved using a prospective, questionnaire-based survey. METHODS: Questionnaires were designed to collect information about undergraduate sedation education from teaching staff and final year dental undergraduates at the 16 dental schools in the UK and Ireland. Staff questionnaires were distributed to a nominated sedation teacher at each dental school and sought details of didactic and clinical sedation teaching methods, plus the quantity and perceived quality of sedation teaching. Student questionnaires were distributed to 5th year dental students and enquired about the quantity and quality of clinical sedation teaching received. The survey was undertaken during May-June 1998. RESULTS: Thirteen dental schools returned staff questionnaires (81%). Seven also provided a student response (44%). The proportion of final year students within the 7 schools who returned completed questionnaires was 38%. Sedation teaching was undertaken primarily by oral surgery and paediatric dental departments. Three schools also utilised anaesthetic departments and 2 schools had dedicated dental sedation departments. All but 2 schools provided didactic teaching on sedation (mean: 4.2 lectures, 1.8 seminars). Of the 7 schools which returned staff and student questionnaires, all provided some clinical training using inhalational and intravenous demonstration cases (mean 5.1 and 4.4 cases, per student, respectively). All but one school provided hands-on inhalational sedation experience (mean 2.6 cases per student) but only two schools provided any hands-on intravenous sedation experience. The quantity of hands-on experience was greater at the two dental schools with dedicated dental sedation departments. Across the schools students rated the overall quality of sedation teaching at average or above, but most staff graded the overall quality of teaching at below average. CONCLUSION: Dental undergraduate sedation teaching shows considerable variation across the dental schools surveyed. At most schools students gained little or no hands-on experience in sedation, especially in intravenous techniques. The undergraduate foundation for sedation education must improve if conscious sedation is to become the principal alternative to general anaesthesia in dental practice.

Anesthesia, Dental↗
PubMed2000

A prospective randomised controlled study of patient-controlled propofol sedation in phobic dental patients.

The safety and effectiveness of patient-controlled propofol sedation was prospectively assessed in 18 healthy, phobic dental patients. Using a randomised, crossover design each patient received two sessions of equivalent dental treatment under patient-controlled or clinician-controlled propofol sedation. The patient-controlled technique used 29.8% less drug (time-weighted dose) than the clinician-controlled method (p = 0.011). There was a high correlation between number of demands and number of doses actually infused during the patient-controlled technique (r = 0.99, p < 0. 001). Clinically, the level of sedation was lighter and the degree of operator satisfaction was higher with patient-controlled sedation. Blood pressure and arterial oxygen saturation showed minimal changes and remained within normal ranges during both techniques. Patient-controlled sedation produced a greater reduction in dental and general anxiety compared with clinician-controlled sedation, but the difference did not reach statistical significance. Three times the number of patients expressed a preference for the patient-controlled, compared with the clinician-controlled, technique. Patient-controlled sedation provides safe and acceptable intra-operative anxiolysis for phobic dental patients, but with reduced propofol dosage.

Adult↗
PubMed1999

Cognitive properties of sedation agents: comparison of the effects of nitrous oxide and midazolam on memory and mood.

OBJECTIVES: To compare the effects of nitrous oxide and midazolam on cognition and mood. DESIGN: A three-way, counterbalanced, cross-over study, using patients receiving conscious sedation for routine dental treatment. METHODS: On each of three separate visits, patients performed a computerised test battery to determine baseline cognitive performance. Then, following administration of either midazolam, nitrous oxide, or no drug, patients re-performed the test battery. Finally, patients completed visual analogue scales assessing their subjective mood state. RESULTS: Relative to baseline performance, midazolam administration produced significantly slower reaction times compared with nitrous oxide and no-drug conditions. Furthermore, patients receiving midazolam were impaired in accuracy relative to the other conditions on many of the cognitive tasks, particularly those assessing the recall of information. Patient performance in nitrous oxide and control conditions did not significantly differ. These results could not be explained by differences in mood between the conditions, as subjective mood ratings during midazolam or nitrous oxide administration were very similar. CONCLUSIONS: It is important for clinicians to be aware that peri-operative recall of information is reduced in patients who have undergone midazolam sedation. This is an advantage for patients who are anxious, and do not wish to be aware of the operative treatment being performed. However, as the cognitive impairment is enduring, an adult escort and written post-operative instructions should be mandatory for midazolam sedation patients. In contrast, the use of nitrous oxide sedation does not significantly impair higher cognitive tasks and thus patients receiving nitrous oxide sedation can resume normal activities in the post-operative period.

Adolescent↗
PubMed1999

The emergency drugs box--time for action?

Many GDPs are confused about which emergency drugs they should stock. There is a lack of uniform advice on this topic. Most recommended lists of emergency drugs contain superfluous medications which GDPs would never be expected to use. This paper rationalises the content of the emergency drugs box and provides clear, standardised guidance. A list of ten essential emergency drugs is presented, all of which can be administered by simple routes. Every GDP should be trained and competent to use these essential emergency drugs.

Emergency Medical Services↗
PubMed1999

Sedation safety.

Explore the source record for details and available documents.

Adult↗
PubMed1999

Safe sedation.

Explore the source record for details and available documents.

Adult↗
PubMed1999

Prevalence of emergency events in British dental practice and emergency management skills of British dentists.

Medical emergencies in dental practice are generally perceived as being rare but when an emergency does occur it can be life-threatening. The ability of the dentist to initiate primary management is the key to minimising morbidity and mortality. Accurate data on the prevalence of emergency events, required so that dentists can adequately prepare to deal with emergency situations, is sparse and obsolete. This study aimed to determine the current prevalence of medical emergencies and the perceived emergency management skills of dentists. A questionnaire, distributed to 887 dentists working in general dental practice across five counties of Northern England, produced a response rate of 34%. The most frequently reported emergency was vasovagal syncope (1.9 cases, per dentist per year), followed by hypoglycaemia (0.17), angina (0.17), epileptic fit (0.13), choking (0.09), asthma (0.06), hypertensive crisis (0.023) and anaphylaxis (0.013). Myocardial infarction and cardiac arrest were extremely rare with an incidence of 0.003 and 0.002 cases per dentist per year, respectively. The total prevalence of all emergency events (excluding syncope) was 0.7 cases per dentist per year. Only 20.8% of dentists felt competent to diagnose the cause of a collapse in the dental surgery. However the majority believed that they would be able to undertake initial treatment of most common emergencies. Despite this more than 50% felt unable to manage a myocardial infarction or anaphylaxis, and 49.7% did not know how to insert an oral airway or undertake an intravenous injection. Future postgraduate training in emergency care for dentists needs to be more accurately targeted to the known prevalence of emergencies and deficiencies in dentists' emergency skills.

Adult↗
PubMed1999

An investigation into the need for supplementary steroids in organ transplant patients undergoing gingival surgery. A double-blind, split-mouth, cross-over study.

Organ transplant patients are frequently medicated with triple immunosuppressive therapy that includes both cyclosporin and the corticosteroid, prednisolone. Many of these patients experience gingival overgrowth that necessitates surgical intervention. Chronic dosing with corticosteroids can lead to suppression of the hypothalamic-pituitary axis, and subsequent adrenocortical suppression. To circumvent possible suppression, supplementary steroids are administered to such patients prior to so-called "stressful events". We have examined the need for supplementary steroids in 20 organ transplant patients undergoing gingival surgery under local anaesthesia to correct their drug-induced gingival overgrowth. All patients were operated upon in the first half of the morning. Prior to gingival surgery, resting blood pressure (BP) and serum ACTH concentrations were determined. Immediately before surgery patients received either intravenous hydrocortisone 100 mg or placebo in random, double-blind order. Each patient required 2 gingivectomies and thus acted as their own placebo control. BP was measured at various time points throughout surgery and upto 2 h postoperatively. On completion of surgery, a further blood sample was taken to determine ACTH concentration. There was no significant difference (p>0.05) between placebo and hydrocortisone treatments for BP and ACTH measurements. No patient experienced any symptoms that were suggestive of adrenocortical suppression. One patient did experience postural hypotension prior to gingival surgery, but this is attributed to his antidepressant medication. We can conclude from this study that immunosuppressed organ transplant patients taking the maintenance dose of prednisolone (5-10 mg/day) do not require corticosteroid cover prior to gingival surgery under local anaesthesia. We would however, advocate monitoring of their blood pressure throughout the procedure.

Adrenocorticotropic Hormone↗