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Diode laser (980 nm) in oral and maxillofacial surgical procedures: clinical observations based on clinical applications.

OBJECTIVE: The aim of this study was to examine the wound healing of soft tissue after the application of a diode laser (980 nm) in oral surgical procedures. SUMMARY BACKGROUND DATA: Like the CO2 laser, the diode laser can be used for soft tissue surgery without extensive experience in the field of oral surgical. METHODS: A diode laser was used to treat a variety of oral soft tissue lesions in 22 patients. The oral surgical procedures included removal of soft tissue tumors, frenectomies, excision of gingival hyperplasias, vestibuloplasties, hemangioma removal, and periimplant soft tissue surgery. The laser was used in both pulsed and continuous modes, with and without contact to the tissue. Intraoperative and postoperative clinical observations are reported. RESULTS: Our preliminary clinical findings include sufficient hemostasis and precise incision margin with all of the surgical procedures. The coagulation properties, associated with the use of a diode laser, were particularly beneficial during removal of vascular lesions. The postoperative advantages, i.e., lack of swelling, bleeding, pain or, scar tissue formation, and the good wound healing were observed in all of the clinical applications and were dependent only on the laser physical parameters used. CONCLUSIONS: The clinical application of the diode (980 nm) laser in oral and maxillofacial surgical procedures seems to be of beneficial effect for daily practice.

Adult↗

Use of entonox plus carbon dioxide in the dental surgery.

The introduction of Entonox has made it possible to guarantee full oxygenation of the inspired gas of outpatients having nitrous oxide anaesthesia. The addition of 1-2% halothane enables good conditions to be obtained for minor surgery such as dental extraction. The use of an Entonox mixture containing 7% carbon dioxide to stimulate ventilation in patients receiving anaesthesia with nitrous oxide, oxygen and halothane is described.

Adolescent↗

Changes in cerebral electrical activity measured by the Cerebral Function Analysing Monitor following bolus injections of thiopentone.

Seven premedicated patients were anaesthetized with thiopentone administered incrementally every 180 s while cerebral electrical activity was recorded with the Cerebral Function Analysing Monitor (CFAM). Arterial blood samples were collected at 40, 90 and 165 s after each bolus of thiopentone for the measurement of plasma total and bound thiopentone concentrations. The correlation between free thiopentone concentration and the CFAM representation of mean electroencephalogram (EEG) amplitude was -0.78 (P less than 0.001), excluding values following the first two boluses. Beta band percentage activity was inversely related (r = 0.70-0.90; P less than 0.05- less than 0.001) and delta directly related (r = 0.76-0.86; P less than 0.05- less than 0.001) to log of free thiopentone concentration, including all values. The closest correlations (beta, r = 0.88, P less than 0.001; delta r = 0.80, P less than 0.001) were found at 90 s after each bolus.

Adolescent↗

I.v. sedation for conservative dentistry. A comparison of midazolam and diazepam.

Midazolam and the emulsion formulation of diazepam were compared in a cross-over study in 50 patients undergoing out-patient conservative dentistry, with particular regard to sedation and the quality of recovery. Both agents proved effective, but sedation was achieved more rapidly with midazolam (P = 0.001) and was more effective (P less than 0.02). Significantly greater anterograde amnesia for the dental procedure (P less than 0.001) and a more rapid return to normal activities (P less than 0.02) were found with midazolam. Psychometric testing, however, failed to show any objective differences between the treatments. A mean dose of midazolam 0.14 mg kg-1 was required to achieve sedation equating to 0.29 mg kg-1 of diazepam, although there was considerable variation between individual patients.

Adolescent↗

Pharmacokinetics of propofol during conscious sedation using target-controlled infusion in anxious patients undergoing dental treatment.

Infusion of propofol by a target-controlled infusion (TCI) system is effective in achieving conscious sedation for anxious patients presenting for dental surgery. It is a common clinical observation that anxious patients require more anaesthetic drugs than non-anxious individuals. In study 1 we have defined blood propofol concentrations necessary for conscious sedation in both anxious (n = 23) and non-anxious (n = 18) patients. The pump performance of the TCI system, using Gepts' pharmacokinetic model, was evaluated in these two patient groups. Subsequently, clearance of propofol was compared in the two groups. Mean measured venous serum propofol concentrations obtained between 20 and 35 min after the optimal sedation level was reached were 1.6 (SD 0.2) micrograms ml-1 in the anxious patients compared with 1.7 (0.3) micrograms ml-1 in the control group (study 1) and 1.4 (0.27) micrograms ml-1 in study 2. The pump systematically overpredicted measured propofol concentrations in both groups (study 1). There was no significant difference in propofol clearance between the two groups. In study 2, an optimized set of microconstants was derived which should more accurately predict the pharmacokinetic profile of the anxious population and this set was tested prospectively in another group of 12 anxious dental patients. Bias and precision with the optimized kinetic set were significantly less than the values obtained in study 1. We conclude that there was no significant pharmacokinetic differences between anxious and non-anxious subjects receiving subanaesthetic doses of propofol for conscious sedation.

Adolescent↗

Intravenous sedation in dentistry and oral surgery.

IV administration is the most precise and effective means of sedating a patient. Its desired effect is a comfortable and cooperative patient whose pain is alleviated by regional local anesthesia. It requires a patient who understands the difference between being lightly sedated and unconscious. Its primary purpose is to diminish anxiety and apprehension rather than to obtund protective reflexes. At all times, the patient should remain conscious and appropriately responsive to questions or commands. This state can be readily achieved in most patients by carefully titrating a single drug such as diazepam or midazolam to effect. The use of multiple drugs is to be discouraged, since it generally increases the level of sedation and the number of complications. Dosing should be individualized rather than averaged or arbitrary. The end point of titration is the patient's verbal acknowledgement of feeling more relaxed and the physical evidence of such relaxation. The "Verrill sign" indicates a level of deep sedation--too deep for most cases of conscious sedation in the office setting. I strongly oppose the routine use of narcotics for office sedation. Monitoring of vital signs before, during, and after surgery ensures the safety of the consciously sedated patient. The use of a pulse oximeter is an evolving standard in general anesthesia and may eventually prove important for patients receiving conscious sedation in the office setting.

Ambulatory Care↗

Multiple testing to establish superiority/equivalence of a new treatment compared with k standard treatments for unbalanced designs.

In clinical studies, multiple superiority/equivalence testing procedures can be applied to classify a new treatment as superior, equivalent (same therapeutic effect), or inferior to each set of standard treatments. Previous stepwise approaches (Dunnett and Tamhane, 1997, Statistics in Medicine16, 2489-2506; Kwong, 2001, Journal of Statistical Planning and Inference 97, 359-366) are only appropriate for balanced designs. Unfortunately, the construction of similar tests for unbalanced designs is far more complex, with two major difficulties: (i) the ordering of test statistics for superiority may not be the same as the ordering of test statistics for equivalence; and (ii) the correlation structure of the test statistics is not equi-correlated but product-correlated. In this article, we seek to develop a two-stage testing procedure for unbalanced designs, which are very popular in clinical experiments. This procedure is a combination of step-up and single-step testing procedures, while the familywise error rate is proved to be controlled at a designated level. Furthermore, a simulation study is conducted to compare the average powers of the proposed procedure to those of the single-step procedure. In addition, a clinical example is provided to illustrate the application of the new procedure.

Analgesics↗

Local complications following intravenous benzodiazepines in the dorsum of the hand. A comparison between midazolam and Diazemuls in sedation for dentistry.

Two hundred patients requiring sedation for minor oral surgery were randomly allocated to receive either midazolam or diazepam as Diazemuls intravenously through a 23-gauge indwelling needle in the dorsum of the hand. The site of injection was inspected at 7 days and 14 days post injection and assessed for pain, tenderness, redness, induration, painless thrombosis, and thrombophlebitis. The mean dose administered was 0.119 mg/kg of midazolam and 0.298 mg/kg of Diazemuls. At 7 days there was no significant difference in venous complications. At the 14 day follow up, the midazolam group had a significantly greater incidence of tenderness and redness (p less than 0.001 and p less than 0.05 respectively using Chi squared test). The incidence of thrombophlebitis in the midazolam group was 2% at 7 days and 1% at 14 days, the corresponding figures in those given Diazemuls being none and 1% respectively. We conclude that the dorsum of the hand is a satisfactory site of injection for administration of these drugs. The higher incidence of minor complications at 14 days following midazolam was offset by its more reliable amnesic properties.

Adult↗

Hysteria. A cause of failure to recover after anaesthesia.

Hysteria as a cause of failure to recover consciousness following general anaesthesia is a rare event. This case report describes such an instance in a young, healthy 22-year-old female suffering severe dental phobia who was undergoing dental conservation. The literature is reviewed and a summary of the possible physiological mechanisms involved is given.

Adult↗