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At least 1,315 records · Page 73Linked to original sources
PubMed1992

Recovery characteristics using isoflurane or propofol for maintenance of anaesthesia: a double-blind controlled trial.

We studied 114 female patients (ASA 1 or 2) who were within 20% of ideal body weight and who were scheduled to undergo gynaecological laparoscopy which required supplementation with an opioid (groups IA and PA), or dental procedures which did not require opioid supplementation (groups IO and PO). A computerised package of psychomotor tests was performed before surgery. Anaesthesia was induced with propofol 2.5 mg.kg-1 and all patients received atracurium 0.3 mg.kg-1 and 67% nitrous oxide in oxygen. Patients in group IA received isoflurane 1% (inspired), and alfentanil 10 micrograms.kg-1 as a bolus and 10 micrograms.kg-1.h-1 as an infusion. Patients in group PA received propofol 9 mg.kg-1.h-1 as an infusion, decreasing to 6 mg.kg-1.h-1 after 15 min, together with alfentanil 10 micrograms.kg-1.h-1. Patients in groups IO and PO received isoflurane and propofol in the regimens described for groups IA and PA, but without alfentanil. Recovery was assessed by a blinded observer who recorded times to awakening (eye opening) and orientation (giving date of birth), and who repeated the psychomotor tests at 1, 3 and 5 h. Linear analogue scales of mood, nausea and pain were obtained and other side effects were noted in the succeeding 48 h. A matched control group of 25 females (who were not anaesthetised) underwent psychomotor testing on four occasions in order to assess the 'learning effect' of repeated recovery testing. The analysis of recovery tests did not assume a normal distribution.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Chair dental anaesthesia: a survey of current and intended practice in Mersey Region.

We performed a questionnaire survey to establish the current and intended practice of chair dental anaesthesia amongst recently appointed consultants, and senior registrars within the Mersey Region. Only 26% of the consultants surveyed practised chair dental anaesthesia, however, more consultants would have had their anaesthetic sessions allowed. Consultants performed 4.62 +/- 3.5 sessions per month and anaesthetised 8.0 +/- 2.27 patients per session. Cases were mostly performed in community dental centres. The most common reason for discontinuing the practice of chair dental anaesthesia was the Poswillo report and its implications. Sixty-eight per cent of senior registrars declared an interest in chair dental anaesthesia. This group had received significantly more training (p < 0.005) in dental anaesthesia than those with no interest. Most anaesthetists (52/71) felt that chair dental anaesthesia was acceptable in centres approved to Poswillo standards; 16 anaesthetists felt that it should be confined to a hospital environment and three felt that it should not be performed at all.

Ambulatory Surgical Procedures↗
PubMed1996

A novel device for patient-controlled sedation: laboratory and clinical evaluation of the Baxter Intermate LV250 infusor and patient-control module.

The Baxter Intermate LV250 infusor is a large capacity, high flow mechanical infusor, designed to deliver viscous solutions and suspensions. The objective of the laboratory study was to evaluate the LV250 infusor when used with either 0.9% sodium chloride solution or an emulsion, propofol 1%. Following this, the LV250 infusor with the patient-control module was assessed in the clinical setting as to its suitability for use in patient-controlled sedation with a propofol and lignocaine mixture. Between reservoir volumes of 250 and 55 ml, the LV250 infusor was found to infuse a propofol 1% and lignocaine mixture at a lower flow compared with the sodium chloride solution, 170 ml.h-1 and 260 ml.h-1 respectively. The lower flow with the propofol mixture may be a result of its higher viscosity. All patients using the LV250 infusor for patient-controlled sedation found it easy to use and stated that they were able to achieve their desired level of sedation. All patients maintained arterial oxygen saturations above 95%. The LV250 infusor performed reliably and with little inter-device variation, and with the patient-control module could be used as an alternative to electronic devices for providing patient-controlled sedation. Compared with electronic infusors, its advantages include compactness and simplicity of design.

Anesthetics, Intravenous↗
PubMed1976

The interdental brush and its place in operative and crown and bridge dentistry.

The effect of the interdental brush was evaluated on sixty-seven extracted teeth which were stained and examined under the stereomicroscope. Thirty-one of the teeth were totally covered with plaque when the interdental brush was used on them immediately before extraction. Thirty-six of the teeth were from patients who had used the interdental brush routinely for several years. The interdental brush was found to have an excellent effect both in the central part of the interdental space and on the embrasures. However, the most noteworthy finding was that it removes plaque as far as 2-2 1/2 mm below the gingival margin. This means that restorations can be kept free of plaque, even if they are extended into the pocket. In modern dentistry 'extension for prevention of dental caries' has become a controversial principle because subgingival restorations retain plaque which induces destructive periodontal disease. In many cases this problem can be solved by introducing the interdental brush.

Crowns↗
PubMed1996

Shortened dental arch therapy: views of consultants in restorative dentistry in the United Kingdom.

This paper reports the results of a study on the attitudes of the consultants in restorative dentistry (CRD) in the UK towards shortened dental arch therapy (SDAT). Data were collected by means of questionnaire, with a response of 67% achieved. The results indicate that 95% (n = 87) of the 91 participants in the study were of the opinion that SDA has a place in contemporary clinical practice. Eighty (88%) of the participants reported having prescribed SDA therapy during the last 5 years, the number of these patients requiring > 5 units of crown and bridgework being typically less than 25%. Forty-one (45%) of the participants reported patients being considered for SDAT expressing reservations about the outcome of their treatment, although around 75 (82%) of the participants indicated that SDAT was satisfactory in terms of oral function, comfort and well being. Experience of having to extend shortened dental arches following SDAT was limited to 34 (37%) of the participants. It is concluded that SDA is widely accepted but not widely practiced by CRDs in the UK and that, in patients satisfying existing criteria, the outcome of SDAT may be found to be acceptable in approximately 82% of cases.

Attitude of Health Personnel↗
PubMed1978

Non-polluting dental analgesia.

Three anaesthetic circuits for use in nose-piece application of inhalation analgesia are described. An ejector flowmeter is used for the scavenging of overspill gas.

Air Pollution↗
PubMed1992

Recovery and discharge of patients after long propofol infusion vs isoflurane anaesthesia for ambulatory surgery.

Fifty unpremedicated patients scheduled for outpatient restorative dentistry and/or oral surgery lasting 2 to 4 h were anaesthetized with either propofol infusion or isoflurane inhalation. Before induction of anaesthesia with propofol (2.5 mg.kg-1), all patients were given 75 mg of diclofenac and 0.01 mg.kg-1 vecuronium intravenously. Intubation was facilitated with suxamethonium (1.5 mg.kg-1) and anaesthesia was maintained in random order either with propofol infusion (12 mg.kg-1.h-1 for the first 20 min, 9 mg.kg-1.h-1 for the next 20 min, and 6 mg.kg-1.h-1 for the rest of the anaesthesia) or with isoflurane (inspired concentration 1-2.5%), both with nitrous oxide and oxygen (30%). The patients breathed spontaneously using a non-rebreathing circuit. Patients given propofol infusion became re-orientated faster (11.0 +/- 5.5 min vs. 16.5 +/- 7.5 min; P less than 0.01) and at 30 min walked along a straight line better (P less than 0.01). At 60 min, none of the propofol patients displayed an unsteady gait, whereas 11 of the 25 isoflurane patients did (P less than 0.001). None of the patients receiving propofol had emesis at the clinic, compared with 10 of the 25 patients receiving isoflurane (P less than 0.001). The overall incidence of emesis was 2 of 25 and 14 of 25 in the propofol and isoflurane groups, respectively (P less than 0.01). Patients receiving propofol were discharged home earlier than patients receiving isoflurane (80 +/- 14 min and 102 +/- 32 min, respectively; P less than 0.01). It is concluded that propofol allows early discharge of patients, even after long anaesthesias.

Adult↗
PubMed2005

Spontaneous ventilation with remifentanil in children.

BACKGROUND: Remifentanil is a short-acting drug that allows us to study the specific respiratory effects of potent opioid analgesics. The purpose of this study is to describe the effects of a remifentanil infusion during spontaneous ventilation in children. Pharmacokinetic studies provide useful information on the time course of opioid blood concentrations; however, they cannot be easily translated into infusion administration guidelines for pediatric clinical practice. METHODS: A total of 32 children, aged 2-7 years, undergoing restorative dentistry, spontaneously breathing under sevoflurane anesthesia were enrolled in the study. After an initial bolus dose of remifentanil, an infusion was administered in ascending logarithmic increments at 10 min intervals. Increments were discontinued when endtidal carbon dioxide exceeded 9 kPa (70 mmHg), desaturation occurred (SpO2 < 94%) or with the onset of apnea (>5 s). The maximum tolerated dose was determined for each subject. Endtidal carbon dioxide, minute ventilation and respiratory rate were continuously recorded. RESULTS: The median tolerated dose of remifentanil was 0.127 microg.kg(-1).min(-1) (range: 0.053-0.3 microg.kg(-1).min(-1)). When comparing the last four incremental increases in each subject, 35% change in respiratory rate occurred in the last 10 min period while changes in endtidal carbon dioxide and minute ventilation were gradual and of less magnitude. There was no correlation between age and respiratory rate. CONCLUSIONS: There is a large variation in the dose of remifentanil tolerated by children while breathing spontaneously under anesthesia. A respiratory rate of <10 b.min(-1) appears to be the best predictor of the maximum tolerated dose.

Analgesics, Opioid↗
PubMed2001

Sounded an alarm.

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Dentistry, Operative↗
PubMed2001

Sorry for your loss.

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Dentistry, Operative↗
PubMed2001

Struck a chord.

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Dentistry, Operative↗
PubMedDate not supplied

Bacterial isolates from plaque and from blood during and after routine dental procedures in dogs.

OBJECTIVE: This study evaluates the association between dental procedures and bacteremia in dogs, including a comparison of bacteria isolated from plaque and blood, severity of the bacteremia versus the severity of dental disease, and the longevity of bacteremia. STUDY DESIGN: Bacteria cultured from the blood over time were compared with those isolated from the plaque and crevicular fluid and in relation to severity of dental disease. ANIMALS OR SAMPLE POPULATION: Twenty adult greyhounds. METHODS: Blood samples were collected for culture before induction of general anesthesia, immediately after intubation, 20 minutes after initiation of the dental procedure, and at 10-minute intervals until 10 minutes after the dental procedure was completed. Samples of plaque were taken for microbiological culture. RESULTS: Sixty to ninety percent of the bacterial genera isolated from the plaque were present in the blood. Dogs classified according to severity of dental disease showed no difference in the total number of different species or number of different Gram-negative, Gram-positive, or anaerobic bacteria isolated from plaque or blood (P < .05). Bacteremia was present in all of the dogs studied, within 40 minutes from the initiation of the dental procedure, regardless of the severity of oral disease. CONCLUSIONS: Gram-negative, Gram-positive, and anaerobic bacteria are present in blood during dental procedures; the bacteremia can persist beyond the dental procedure, and is not associated with the severity of dental disease. CLINICAL RELEVANCE: The nature and extent of bacteremia occurring during routine dental procedures is important in understanding a potential risk to dogs.

Animals↗
PubMed1978

Evaluation of quandrant dentistry in provision of dental care.

The chairtime required for a single Class I or Class II amalgam restoration at 163 sittings was compared with the chairtime required for 99 cases in which two restorations in a quandrant were treated at the same sitting. The "Quadrant Dentistry Efficiency Rate" was calculated and it was found that quadrant dentistry resulted in a saving of between 30% and 50% of chairtime. The individual speed of the three dentists treating the children did not greatly influence the percentage of chairtime saved.

Child↗
PubMed1999

Painting the future for ART.

The objective of this paper is to review recent research and developments with respect to the atraumatic restorative treatment (ART) approach and to outline future areas of research and development. Areas identified as requiring further investigation include the evaluation of: ART restorations for longer than 3 years duration using recognised evaluation criteria, multi-surface ART restorations, ART restorations in primary teeth and ART sealants. In addition, the possibility and potential dangers of caries remaining after cavity cleaning with hand instruments must be investigated and the findings balanced against the known damage to sound tooth tissue caused by more routine cavity preparation techniques. New bioactive restorative materials which offer the possibility of healing dentinal caries lesions should be developed and evaluated. Finally, behavioural and educational aspects of the ART approach should be investigated.

Cariostatic Agents↗