jueves, 13 de junio de 2013

Más sobre anestesia dental/More on dental anesthesia



La demanda en la odontología pediátrica para la sedación y la anestesia general por los anestesiólogos dentistas: una encuesta de directores de anestesia dental y residencias de odontología pediátrica.


Demand in pediatric dentistry for sedation and general anesthesia by dentist anesthesiologists: a survey of directors of dentist anesthesiologist and pediatric dentistry residencies.
Hicks CG, Jones JE, Saxen MA, Maupome G, Sanders BJ, Walker LA, Weddell JA, Tomlin A.
James Whitcomb Riley Hospital for Children, Indiana University School of Dentistry, IN, USA.
Anesth Prog. 2012 Spring;59(1):3-11. doi: 10.2344/11-17.1.
Abstract
This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 10 anesthesiology training program directors was 9 of 10 or 90%. The response rate for the 79 pediatric dentistry training program directors was 46 of 79 or 58%. Thirty-seven percent of pediatric dentistry programs use clinic-based deep sedation/general anesthesia for dental treatment in addition to hospital-based deep sedation/general anesthesia. Eighty-eight percent of those programs use dentist anesthesiologists for administration of deep sedation/general anesthesia in a clinic-based setting. Pediatric dentistry residency directors perceive a future change in the need for deep sedation/general anesthesia services provided by dentist anesthesiologists to pediatric dentists: 64% anticipate an increase in need for dentist anesthesiologist services, while 36% anticipate no change. Dental anesthesiology directors compared to 2, 5, and 10 years ago have seen an increase in the requests for dentist anesthesiologist services by pediatric dentists reported by 56% of respondents (past 2 years), 63% of respondents (past 5 years), and 88% of respondents (past 10 years), respectively. Predicting the future need of dentist anesthesiologists is an uncertain task, but these results show pediatric dentistry directors and dental anesthesiology directors are considering the need, and they recognize a trend of increased need for dentist anesthesiologist services over the past decade.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309300/pdf/i0003-3006-59-1-3.pdf



Comparación entre midazolam-ketamina y midazolam-prometazina como sedantes en odontología pediátrica
Comparison of oral Midazolam-Ketamine and Midazolam-Promethazine as sedative agents in pediatric dentistry.
Golpayegani MV, Dehghan F, Ansari G, Shayeghi S.
Department of Pediatric Dentistry, Dental School, Shahid Beheshti Medical University, Tehran, Iran.
Dent Res J (Isfahan). 2012 Jan;9(1):36-40. doi: 10.4103/1735-3327.92925.
Abstract
BACKGROUND: Investigation was designed to evaluate the behavioral changes in children receiving dental treatment while they have been administered combination of Midazolam/Ketamine or Midazolam/Promethazine. MATERIALS AND METHODS: This was a randomized double blind clinical trial with cases being selected from those uncooperative children aged 2 to 6 years from those referred for treatment under general anesthesia. Anxiety score of all cases were recorded before any attempt using Frankel's anxiety scoring system with those in negative category being included. Cases with at least a pair of similar size cavities on similar teeth were selected with each tooth being randomly allocated for one sedative regimen group. To avoid sequence effect, half of the patients received one regimen at the first visit while the other half received the other regimen as the first. Each case served as control for him or herself to reduce influencing factors. Child's reaction was recorded before, during, and at the end of dental procedure. SO2 as well as Pulse rate were recorded as the most critical vital signs. Collected data were then analyzed using analysis of variance (ANOVA) and paired t-test. RESULTS: Patients' mean age was 3.5 years with 43% being male. Only 10% of the Ketamine/Midazolam group showed considerable amount of change in their behavior with a statistical significant difference being presented (P=0.029). CONCLUSION: Under the current circumstances, Ketamine/Midazolam combination provided sufficient sedative effect in lower doses. However, Midazolam/Promethazine combination did not produce similar results.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283976/



BIS como guía para intubación sin relajantes neuromusculares en anestesia general en el consultorio dental: evaluación retrospectiva

Bispectral index monitoring (BIS) as a guide for intubation without neuromuscular blockade in office-based pediatric general anesthesia: a retrospective evaluation.
Messieha ZS, Guirguis S, Hanna S.
Associate Professor of Clinical Anesthesiology, University of Illinois Medical Center at Chicago, Department of Anesthesiology, Chicago, Illinois 60612, USA. messieha@uic.edu
Anesth Prog. 2011 Spring;58(1):3-7. doi: 10.2344/0003-3006-58.1.3.
Abstract
The Bispectral Index System is a useful guide for timing of adequate intubation conditions in office-based pediatric general anesthesia without neuromuscular blockade. As the number of cases in the office-based setting increase, many clinicians opt to intubate patients without neuromuscular blockade to avoid airway complications associated with skeletal muscle relaxation. Conventionally, this technique is conducted using the traditional monitoring criteria of vital signs, end-tidal inhalation agents, as well as anesthesiologist timing and knowledge of the pharmacodynamics of the anesthetic agent to help determine the proper depth of anesthesia for adequate intubating conditions. This study retrospectively assesses the use of the Bispectral Index System (BIS) as a guide for timing of nonparalytic tracheal intubation in pediatric office-based general anesthesia. Anesthetic records for 168 children, American Society of Anesthesiology physical status I and II, and ranging in age from 18 months to 17 years were retrospectively analyzed. Intubation outcomes were based on 6 preset criteria to reflect the adequacy of the technique. The mean BIS value during the time of intubation was 34.7. There were no complications encountered. A BIS mean value of 34.7 provided adequate intubation conditions without muscle relaxation in office-based pediatric anesthesia without complications.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265266/pdf/i0003-3006-58-1-3.pdf




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

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