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PubMed2001

Guidelines: In-office use of conscious sedation in periodontics.

In this time of heightened awareness of periodontal diseases and the potential consequences of untreated disease, a deterrent in the delivery of periodontal care continues to be patient anxiety concerning treatment and the fear of pain. These guidelines are intended for periodontists in the in-office use of enteral, inhalation, and/or parenteral conscious sedation in the delivery of care. The definitions, educational guidelines, and policies presented in these guidelines are consistent with the most current American Dental Association (ADA) documents Guidelines for the Use of Conscious Sedation, Deep Sedation and General Anesthesia for Dentists and the Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry available from the American Dental Association, 211 E. Chicago Avenue, Chicago, IL 60611 or http://www.ada.org, and for Revisions to Anesthesia Care Standards Comprehensive Accreditation Manual for Ambulatory Care, effective January 1, 2001, Joint Commission on Accreditation of Health Care Organizations, available through http://www.jcaho.org/standard/anesamb.html. This paper replaces the former position paper entitled "Guidelines for the Use of Conscious Sedation in Periodontics."

Analgesia↗
PubMed1986

Dissociation between changes in renal nerve activity and renal vascular resistance in conscious dogs.

The effects of acute volume expansion and hemorrhage on renal nerve activity and renal vascular resistance were examined in chronically instrumented conscious dogs. In six conscious dogs, when the blood volume was expanded by 18 ml/kg, the mean arterial pressure increased by 14 +/- 3 mmHg, mean left atrial pressure increased by 5.3 +/- 0.7 mmHg, and renal nerve activity decreased by 87 +/- 3%, while the renal blood flow was not altered significantly and renal vasoconstriction occurred, i.e., the calculated renal vascular resistance increased by 12 +/- 4% from 0.49 +/- 0.05 mmHg/ml/min. Volume depletion, induced by 20 ml/kg hemorrhage, did not alter the mean arterial pressure (-4 +/- 6 mmHg), while it decreased the mean left atrial pressure by 4.0 +/- 0.7 mmHg and increased the renal nerve activity by 200 +/- 67%. However, the renal blood flow was well maintained at the pre-hemorrhagic control level and renal vasoconstriction did not occur. Thus, in conscious dogs, acute volume changes altered the renal nerve activity dramatically, but these changes in renal nerve activity did not exert any significant effects on renal vascular resistance.

Animals↗
PubMed1986

Service consciousness and service knowledge among older Americans.

This article explores statistical relationships between socioeconomic characteristics of elderly persons in a large region of California and their consciousness and knowledge of services available to them. Regression and probit estimation are used to analyze survey data. Service knowledge is a prerequisite to utilization or informal referrals and general consciousness of services increases the probability that older persons will search for services to meet their needs. Education, age, sex, rurality, and minority status are found to be associated with service consciousness and knowledge, although a number of other characteristics have significant associations for at most a few services.

Aged↗
PubMed2005

MT+/V5 activation without conscious motion perception: a high-field fMRI study.

While activity of MT+/V5 neurons is believed to be necessary for the conscious perception of visual motion, whether neural activity in MT+/V5 is a sufficient condition for the conscious perception of motion in vision still remains unanswered. A high-field (3.0 Tesla) functional magnetic resonance imaging (fMRI) study was designed and performed to answer this specific question. Eleven healthy subjects viewed a checkerboard pattern stimulus reversed in contrast at 0.2, 12, 30, and 60 Hz while being probed for activation in MT+/V5. At 0.2 Hz, all viewers perceived pattern-reversal which was stationary in position. However, at 12, 30, and 60 Hz, many subjects perceived apparent motion (e.g., vertical and horizontal flows) in the square pattern. At 12 and 30 Hz reversals, MT+/V5 was activated in all subjects (11/11). Nevertheless, three out of eleven (3/11) subjects denied motion perception in these conditions. At 60 Hz reversal, as many as seven out of eleven (7/11) subjects failed to see motion but activation in MT+/V5 was found in the majority (5/7) of the subjects. The results demonstrated that significant MT+/V5 activation occurs without accompanying subjective awareness of seeing motion in an apparent-motion stimulus, indicating that neural activity in MT+/V5 does not represent a sufficient condition for conscious perception of motion in vision.

Adult↗
PubMed1991

Relationship between body-image and self-consciousness.

The purpose of this study was to assess whether there is a relation between body-image and self-consciousness and if there are any sex differences on measures of these two concepts. A total of 267 undergraduates, 56 men and 211 women whose ages ranged from 19 to 25 years, were tested. Analysis indicated a significant negative correlation between body-image and self-consciousness and between body-image and social anxiety. Private and public self-consciousness correlated positively with each other as well as with social anxiety. Men and women differed significantly on social anxiety only.

Adult↗
PubMed1998

Body consciousness in Dohsa-hou, a Japanese psychorehabilitative program.

To seven cerebral palsied children in a special elementary school, Dohsa-hou, a Japanese psychorehabilitative program, was introduced in a pre-post design. With the help of their mothers in writing they rated on a 5-point scale changes in their body consciousness by applying 8 1-hr. sessions of Dohsa-hou training to each child. Analysis suggests a significant positive change after training in body consciousness of these children especially for private as compared to public body consciousness.

Adolescent↗
PubMed1991

Private self-consciousness: does it influence convergent and discriminant validity of self-reported anxiety and depression?

A continuing problem in measurement of anxiety and depression with self-report is lack of discriminant validity. It is argued that private self-consciousness might be expected to be related to both convergent and discriminant validity of self-reported anxiety and depression. Several self-report measures of anxiety and depression were administered to 157 female undergraduates, ages 20 to 36 years, but no evidence was found for a moderating influence of private self-consciousness. The possibility of lack of correspondence between private self-consciousness and self-awareness with regard to attentiveness to internal states is discussed as a possible explanation.

Adult↗
PubMed1995

Inner speech as a cognitive process mediating self-consciousness and inhibiting self-deception.

The cognitive processes which mediate self-consciousness are unknown. although Morin and others have suggested that inner speech may mediate self-consciousness. We developed a questionnaire which measures the extent to which one talks to oneself about oneself. As expected, the correlation between inner speech and self-consciousness was significant. A German version of the 1979 self-deception questionnaire by Sackeim and Gur correlated negatively with the scores on inner speech, suggesting the validity of the questionnaire. We also replicated the negative association between depression and self-deception in a different culture.

Adult↗
PubMed1994

Dissociation of "conscious desire" (craving) from and relapse in alcohol and cocaine dependence.

Treatment of withdrawal and postabstinence craving has yielded mixed results in eliminating drug and alcohol use, improving outcomes, and reducing relapse in those patients addicted to alcohol and drugs. To assess the role of "conscious desire" (or craving) for drugs/alcohol during abstinence and withdrawal in continued addictive drug and alcohol use, we analyzed data from 1626 patients voluntarily admitted to a primary rehabilitation center in Minnesota. Eighty-one percent and 71% of all patients completed surveys at 6 and 12 months following discharge. Forty-two percent were diagnosed as alcohol dependent (AD) alone, 28% as alcohol and drug dependent (ADD) other than cocaine, and 25% as cocaine dependent (CD). At 6 months following discharge, the CD group had the lowest abstinence rate for drugs, at 83%, compared to the AD group, at 99%, and for alcohol, at 76%, compared to the AD group, at 75%. The AD group had the best outcomes and the least slippage from 6 to 12 months for drugs and alcohol. In all groups craving was not a major self-reported cause of relapse. For the CD subgroup, impulsive action with no known cause was the most common reason for relapse, while the AD group cited depression. These data agree with other reports in the literature suggesting that relapse is not commonly related to conscious craving. Our experience suggests that craving is rarely the first reason given for relapse. Drug seeking and use are such highly ritualized, automatic behaviors that the addict may appear not to require the intervention of conscious thoughts or distinct craving states to use.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Tachycardic and hypertensive effects of centrally administered clonidine in conscious rats.

The centrally mediated cardiovascular changes induced by clonidine were studied in conscious rats. Clonidine administered intracerebroventricularly (i.c.v.), and intravenously (i.v.) caused hypotension following an initial pressor response. I.v. clonidine caused significant greater hypotension than i.c.v. clonidine (30 micrograms/kg; p less than 0.05). With the 30 micrograms/kg i.c.v. dose, a tachycardia was observed in all rats following initial transient bradycardia. No tachycardia was observed when clonidine was administered i.v. Propranolol (3 mg/kg i.v.) did not modify the cardiovascular actions of i.c.v. clonidine except initial pressure response. While combined treatment with propranolol (3 mg/kg i.v.) and atropine (1 mg/kg i.v.) abolished both the bradycardic and tachycardic actions of i.c.v. clonidine (30 micrograms/kg), but did not modulate the hypotensive action. Yohimbine (30 micrograms/kg i.c.v.) converted the hypotension induced by i.c.v. clonidine (30 micrograms/kg) to hypertension, attenuated the bradycardia but did not modulate the tachycardia. The same dose of i.c.v. yohimbine attenuated the hypotensive effect of i.v. clonidine (30 micrograms/kg) but did not affect the initial pressor response. Prazosin (30 micrograms/kg i.c.v.) did not modulate either phase of the heart rate response to i.c.v. clonidine. These results provide evidence of centrally mediated pressor and tachycardic actions of clonidine in conscious rats. The tachycardia appears to be mediated through the inhibition of parasympathetic tone and is not dependent on alpha-adrenoceptor mechanism. In conscious rats the opposing influence of centrally mediated pressor and depressor actions may result in the apparently low hypotensive potency of i.c.v. clonidine.

Animals↗
PubMed1997

Cardiovascular effects of oxymetazoline and UK14,304 in conscious and pithed rats.

Relatively selective alpha 2-adrenoceptor agonists have proven useful in a variety of therapeutic situations including hypertension, glaucoma and withdrawal from opiate addiction. In particular, oxymetazoline (OXY) and UK14,304 (UK) have been used in subclassifying alpha 2-adrenoceptors and imidazoline receptors. We evaluated the cardiovascular effects of OXY and UK in conscious and pithed rats in the presence and absence of efaroxan (EFA), idazoxan (IDA) and rauwolscine (RAU). Both OXY or UK (1, 5 and 10 micrograms/kg, i.v.) increased blood pressure (BP) and reduced heart rate (HR) in conscious rats. In pithed rats, OXY and UK each increased BP to a greater extent than that observed in conscious rats, but HR was not affected. BP increases following sympathetic nerve stimulation in the pithed rats were not affected by OXY but were reduced by UK at 0.1 Hz and 0.3 Hz. HR responses to nerve stimulation in pithed rats were reduced after OXY at all frequencies, but only at 0.1 Hz following UK. EFA, IDA and RAU inhibited the pressor responses of UK, with EFA being most potent. OXY-induced pressor responses were inhibited by all three antagonists, RAU being the least potent. HR responses to either OXY or UK were not affected by the antagonists. Taken together, the data suggest that: 1) alpha 2-adrenoceptors contribute less to the vascular response to OXY than to UK based upon the antagonistic effect of RAU; 2) prejunctional I1 receptors maybe more prevalent in the heart than in vascular tissue based upon the response to OXY in pithed rats. Thus, the heterogeneity among receptors mediating cardiac and vascular responses are complex.

Adrenergic alpha-Agonists↗
PubMed2003

Comparison of conscious sedation and general anesthesia for motor mapping and resection of tumors located near motor cortex.

OBJECT: The surgical treatment of tumors located near eloquent cortex carries a high risk of inducing worsening neurological deficits. Intraoperative electrocorticography techniques have been developed to help identify these areas at the time of surgery in an effort to minimize such risks. The optimal anesthetic technique for conducting these procedures, however, has never been determined. METHODS: The authors conducted a retrospective study to compare patients who underwent intraoperative motor mapping between September 2000 and May 2002. Demographic and neurophysiological monitoring data were collected from the hospital records. Patients were divided into two groups based on the anesthetic technique used for surgery: in Group 1 general anesthesia was used, and in Group 2 conscious sedation. Group 1 comprised 24 patients (mean age 47 years) with 16 right- and eight left-sided lesions. Group 2 consisted of 21 patients (mean age 46 years) with 18 right- and three left-sided lesions. Pathological diagnoses were similar between the two groups. Motor stimulation was elicited in 12 patients (50%) in Group 1 and in 21 patients (100%) in Group 2 (p < 0.001). In addition, the mean stimulation amplitude required was significantly higher (13 mA) in patients in whom conscious sedation was used as opposed to general anesthesia (5 mA, p < 0.0001). Electrographic evidence of seizures was seen in 29% of Group 1 compared with 10% of Group 2 patients (p > 0.05). CONCLUSIONS: The use of conscious sedation as an anesthetic technique for motor mapping not only improves the chances of achieving successful stimulation and identification of motor cortex in relationship to the lesion, but it also allows for repetitive monitoring of the patient's motor function during resection of the lesion.

Adenocarcinoma↗
PubMed1984

Cardiovascular and renin responses to vanadate in the conscious dog: attenuation after calcium channel blockade.

The effects of vanadate on cardiovascular function and on the secretion of renin and vasopressin were investigated by infusing sodium orthovanadate (0.32 mu mole/kg X min) intravenously into five conscious dogs. Vanadate caused significant increases in mean arterial pressure, total peripheral resistance, pulmonary arterial pressure, and cardiac output. These data illustrate that the hemodynamic effects of vanadate in the conscious dog are similar to those of the anesthetized dog but that minor differences do exist. Vanadate significantly suppressed plasma renin activity, but plasma vasopressin was unchanged. The effects of vanadate also were investigated in the same dogs on another day after administration of the calcium channel blocker, verapamil (0.3 mg/kg bolus + 0.01 mg/kg X min). After calcium channel blockade, the increases in arterial pressure and pulmonary arterial pressure induced by vanadate were attenuated, and cardiac output did not increase. Calcium channel blockade also prevented the vanadate-induced decrease in plasma renin activity. These data suggest that the cardiovascular and humoral alterations produced by vanadate in the conscious dog are at least partially mediated by changes in intracellular calcium.

Animals↗
PubMed1993

Contribution of plasma vasopressin concentration and blood pressure to norepinephrine-induced diuresis in conscious dogs.

Infusion of norepinephrine (NE) into humans and experimental animals induces diuresis by mechanisms that are not completely understood. Two series of experiments were performed to determine whether changes in plasma levels of vasopressin or changes in mean arterial pressure (MAP) are important-factors in NE-induced diuresis in conscious dogs. First, plasma vasopressin (PAVP) levels were measured in normal and cardiac-denervated conscious dogs during a 30-min intravenous infusion of NE (0.5 micrograms.kg-1.min-1). When NE was administered to normal dogs, urine flow increased from 0.3 +/- 0.1 to 0.9 +/- 0.4 ml/min. PAVP did not decrease, in spite of increases in mean arterial pressure (from 103 +/- 4 to 123 +/- 6 mm Hg) and left atrial pressure (from 5.2 +/- 0.9 to 8.6 +/- 1.4 mm Hg). The same dose of NE infused into cardiac-denervated dogs significantly increased urine flow (from 0.2 +/- 0.1 to 0.8 +/- 0.3 ml/min) and MAP (from 107 +/- 5 to 147 +/- 10 mm Hg), and decreased PAVP (from 1.8 +/- 0.3 pg/ml to 1.2 +/- 0.3 pg/ml). In the second series of experiments, NE was infused into cardiac-denervated dogs for 40 min. During the final 20 min of NE infusion, nitroprusside was infused to offset the pressor effect of NE by returning MAP to the initial control level. Urine flow increased during the first 20 min in which NE alone was given; however, when MAP was returned to the control level by nitroprusside infusion, urine flow also returned to the control level. PAVP increased from a control value of 3.6 +/- 0.6 to 18.9 +/- 3.8 pg/ml 15 min after the NP infusion had begun. We conclude that a decrease in PAVP is not required to elicit diuresis during NE infusion in normal conscious dogs and that the pressor effect of NE appears to play a major role in NE-induced diuresis.

Animals↗
PubMed1987

[Experimental analysis of the conscious structure of the sex-role-acceptance in the female adolescents: among the girl students in their final period of moratorium in Hokkaido].

The purposes of this paper are, 1) to determine the dimensions representing the structure of conscious level "sex-role-acceptance" by the female adolescents in relation to the environments within which the subjects were brought up and educated, and 2) to investigate several factors under which the conscious structure of role-acceptance have been deeply influenced: i.e., parents, sibling, boy friends in intimate terms, and others (male or female). Our data were collected from more than 1800 female students, and were subjected to multivariate analyses. The results were: 1) The following three dimensions pertaining to their sex-role-related decision-making were obtained: Biological, Social-motivational, and Self-interest. 2) The difference in the conscious-structure between the role acceptance group and the non-acceptance group was statistically significant. 3) the father-daughter interaction was significantly important in creating an active contributional will in the girls' life-plan, while the mother-daughter interaction turned out to have a rather negative influence upon their will of contribution. 4) The lack of identification with parents was sometimes compensated by their identification with others. The social importance of positive, warm support for the youngsters was clearly demonstrated.

Adult↗
PubMed2002

[Development of the Conscious Defensiveness Questionnaire (CDQ)].

Conscious defensiveness has been found to mediate the relationship between hostility and coronary artery disease. In order to investigate the influence in Japan, the Conscious Defensiveness Questionnaire (CDQ) was developed and its validity and reliability were assessed in the present studies. The first study with college students (N = 419) was conducted to construct the CDQ as a 16-item questionnaire based on two preliminary researches. Factor analysis indicated that the 16 items in the CDQ conform to one factor structure, and the CDQ showed adequate factorial validity as well as high internal consistency. In the second study, the results of test-retest with college students (N = 225) revealed satisfactory stability of the CDQ over a 6- to 7-week period, and furthermore it showed construct validity in the relationships with peer ratings and nominations for college and graduate students (N = 191). Thus the present studies established the CDQ as a standardized questionnaire to measure conscious defensiveness.

Adult↗
PubMed1999

The performance of electroencephalogram bispectral index and auditory evoked potential index to predict loss of consciousness during propofol infusion.

UNLABELLED: The bispectral index (BIS) of the electroencephalogram and middle latency auditory evoked potentials are likely candidates to measure the level of unconsciousness and, thus, may improve the early recovery profile. We prospectively investigated the predictive performance of both measures to distinguish between the conscious and unconscious state. Twelve patients undergoing lower limb orthopedic surgery during regional anesthesia additionally received propofol by target-controlled infusion for sedation. The electroencephalogram BIS and the auditory evoked potential index (AEPi), a mathematical derivative of the morphology of the auditory evoked potential waveform, were recorded simultaneously in all patients during repeated transitions from consciousness to unconsciousness. Logistic regression procedures, receiver operating characteristic analysis, and sensitivity and specificity were used to compare predictive ability of both indices. In the logistic regression models, both the BIS and AEPi were significant predictors of unconsciousness (P < 0.0001). The area under the receiver operating characteristic curve for discrete descending index threshold values was apparently, but not significantly (P > 0.05), larger for the AEPi (0.968) than for the BIS (0.922), indicating a trend of better discriminatory performance. We conclude that both the BIS and AEPi are reliable means for monitoring the level of unconsciousness during propofol infusion. However, AEPi proved to offer more discriminatory power in the individual patient. IMPLICATIONS: Both the bispectral index of the electroencephalogram and the auditory evoked potentials index are good predictors of the level of sedation and unconsciousness during propofol infusion. However, the auditory evoked potentials index offers better discriminatory power in describing the transition from the conscious to the unconscious state in the individual patient.

Aged↗
PubMed1999

[The risk of an organic lesion in mild craniocerebral injuries with loss of consciousness].

Despite its high frequency, there is not a consensus for the management of a patient with mild head trauma. In this prospective study we analyzed wether the transient loss of consciousness was associated with a higher risk of cranioencephalic injury in function of patient's age. Fifty-two patients with a Glasgow score of 15 at the Emergency Department but who reported a transient loss of consciousness were included. Patients were divided into two groups, patients aged > or = 60 years (n = 21) and patients aged < 60 years (n = 31). In all patients a head CT scan was performed. Nine abnormal CT scans were found in the group of patients aged > or = 60 years (three head fractures, three brain contusion, two subarachnoid haemorrhages, and one subdural haematoma) and one abnormal CT scan in the group of patients aged < 60 years (cranial fracture). This difference was statistically significant (p < 0.001). In conclusion, an urgent head CT scan should be performed in patients aged over 60 years with mild head trauma and loss of consciousness. In younger patients this scan should be performed when the patient presents with headache and vomiting.

Adult↗