Improving Outcome for the Elderly Surgical Patients in a Singapore Teaching H...Crimsonpublisherssmoaj
Improving Outcome for the Elderly Surgical Patients in a Singapore Teaching Hospital by Si Ching Lim*, Peter Chow, Peter CL Chow, Fuyin Li, Swee Sim Hiew, Lau Soy Soy and Zhang Di in Crimson Publishers: Surgical Medicine Open Access Journal
The elderly patients admitted under surgery have longer lengths of stay and develop multiple complications during their hospital stay particularly with delirium, medical complications and functional decline. A Geriatrician’s input was helpful to identify incident and postop delirium early and put in measures to improve outcome, together with better nursing care and pharmacist’s input to reduce harm from medications.
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Improving Outcome for the Elderly Surgical Patients in a Singapore Teaching H...Crimsonpublisherssmoaj
Improving Outcome for the Elderly Surgical Patients in a Singapore Teaching Hospital by Si Ching Lim*, Peter Chow, Peter CL Chow, Fuyin Li, Swee Sim Hiew, Lau Soy Soy and Zhang Di in Crimson Publishers: Surgical Medicine Open Access Journal
The elderly patients admitted under surgery have longer lengths of stay and develop multiple complications during their hospital stay particularly with delirium, medical complications and functional decline. A Geriatrician’s input was helpful to identify incident and postop delirium early and put in measures to improve outcome, together with better nursing care and pharmacist’s input to reduce harm from medications.
https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000537.php
For more open access journals in Crimson Publishers
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For more articles on Surgical Medicine Open Access Journal
Please click on link: https://crimsonpublishers.com/smoaj/index.php
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Efficacy and safety of two doses of oral midazolam as premedication in paedia...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Slide 1 : Title: ROLE OF PHARMACIST IN INTENSIVE CARE UNIT
By: Falakaara Saiyed
Slide 2: Introduction
Medication management plays a crucial part in managing a critically ill patient.
When it comes to drug therapy, intensivist have plenty of decision making every day including drug selection, dosing, administration, and monitoring strategies to optimize effective pharmacotherapy.
Even though the patient receives appropriate drug, a suboptimal dose or overdosing may result in either therapeutic failure or drug toxicity.
The concept of having a clinical pharmacist in an intensivist-led multidisciplinary team evolved in the early 1980s in USA.
In Today’s World Intensive Care Unit (ICU), the skills of a Critical care pharmacist addresses adverse drug events caused due to drug-related problems and medication errors. It improves the appropriateness, quality of prescribing and increases patient safety.
Slide 5: Aims & Objective
This aims to evaluate the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety.
Even though the contribution of critical care pharmacist to improve the quality of patient care is accepted worldwide, many ICUs have not recognized this important reserve.
This presentation is used to educate other healthcare professionals and administrators on impact of clinical pharmacist in the care of critically ill patients.
Slide 14: Pharmaceutical Care Process
Assess the patient
Identify the problems and opportunities
Develop care plan
Implement Plan
Evaluate for Efficacy and Safety
Slide 24: Desirable activities of ICU pharmacist
Includes formulating guidelines for the critically ill patients, active participation in research, and educating the ICU team.
Guidelines which have been developed and implemented by the clinical pharmacist in our ICU includes protocols for pain, sedation, delirium, stress, drug compatibility chart , drug administration, dilution guidelines, and toxicological management protocols.
Once the protocols are formulated, all the members of the ICU team are educated on how to use the protocol.
Most of these clinical pharmacist enforced protocols are nurse oriented, and hence, it becomes easy for optimizing patient care.
The effectiveness of these guidelines is under the supervision of a critical care pharmacist, and it is well studied in Western countries.
Slide 25: conclusion
Clinical pharmacist as a part of multidisciplinary team in an ICU is associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.
Clinical pharmacists are essential to improve patient safety and outcome, reduce costs, and provide quality of care in critically ill patients.
Slide 26: References
Kane-Gill SL, Jacobi J, Rothschild JM. Adverse drug events in intensive care units: Risk factors, impact, and the role of team care. Crit Care Med. 2010
An Epidemiological Data of Oral Health Status and Treatment Needs in Pamulapa...DrHeena tiwari
An Epidemiological Data of Oral Health Status and Treatment Needs in Pamulapadu Village of Guntur District, Andhra Pradesh, India: An Original Research
An Evaluation of Short Term Success and Survival Rate of Implants Placed in F...DrHeena tiwari
An Evaluation of Short Term Success and Survival Rate of Implants Placed in Fresh Extraction Socket Post Prosthetic Rehabilitation- A Prospective Study
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
COMPARATIVE EVALUATION OF EFFICACY OF INTRAVENOUS SEDATION REGIMENS IN DENTISTRY: AN ORIGINAL RESEARCH
1. European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 09, 2020
3035
COMPARATIVE EVALUATION OF
EFFICACY OF INTRAVENOUS
SEDATION REGIMENS IN DENTISTRY:
AN ORIGINAL RESEARCH
Dr. A V Thomas Raja1
, Dr. Siva Kumar Pendyala2
, Dr. Rahul VC Tiwari3
, Dr. Sharnjot
Kaur4
, Dr. Fida Qadri5
, Dr. Mohammed Ibrahim6
, Dr. Heena Tiwari7
1. Assistant Professor, Dept of Dental and Oral Surgery, ASRAM Medical College, Eluru,
Andhra Pradesh;
2. Associate Professor, Department of Oral & Maxillofacial Surgery, Faculty of Dentistry,
AIMST UNIVERSITY, Semeling, Bedong, Kedah-08100, Malaysia;
3. OMFS, FOGS, PhD Scholar, Dept of OMFS, Narsinbhai Patel Dental College and
Hospital, Sankalchand Patel University, Visnagar, Gujarat;
4. BDS, Genesis Institute of dental Sciences and research, Ferozepur, Punjab , 152002,
India;
5. BDS, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, India;
6. Assistant Professor, Department of Oral and Maxillofacial Surgery, College of dentistry,
King Khalid University, Abha, Kingdom of Saudi Arabia;
7. BDS, PGDHHM, MPH Student, Parul Univeristy, Limda, Waghodia, Vadodara, Gujarat,
India.
Corresponding Author:
Dr. A V Thomas Raja, Assistant Professor, Dept of Dental and Oral Surgery, ASRAM
Medical College, Eluru, Andhra Pradesh
ABSTRACT
Aim Purpose of our research was to compare and analyze the efficacy of sedation regimens
frequently used in dentistry by intravenous approach.
Methodology A total of 50 patients were provided one of four treatments: placebo;
midazolam provided (mean dose, 8.6 milligrams); fentanyl (1.4 micrograms/kilogram) plus
midazolam to get similar amount of sedation (mean dose, 5.7 mg); or fentanyl (1.4 (μg/kg),
midazolam (mean dose, 5.8 mg) and methohexital (mean dose, 61.0 mg) used in the surgery.
Results Each drug regimen decreased anxiety during surgery when compared with placebo,
with the combination of midazolam, fentanyl and methohexital resulting in drastically less
anxiety in as compared to other treatment groups. Pain felt by patients during surgery
decreased significantly by the combination of fentanyl, midazolam and methohexital.
Conclusion It was observed that drugs and doses evaluated resulted in therapeutic benefit for
patients undergoing dental procedures, with less possibility of potentially serious adverse
effects.
2. European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 09, 2020
3036
Keywords intravenous sedation, conscious sedation, anxiety, therapeutic benefit.
INTRODUCTION
IV conscious sedation, also referred to as parenteral or moderate sedation, is defined as a
drug-induced depression of consciousness during which patients respond purposefully to
verbal commands, either alone or accompanied by light tactile stimulation. No interventions
are required to maintain a patent airway, and spontaneous ventilation is adequate, as well as
cardiovascular function.1
In addition, patients must retain their protective airway reflexes, and
be able to respond to and understand verbal communication. The drugs and techniques used
must therefore carry a margin of safety broad enough to make loss of consciousness and
airway control unlikely.2
Conscious sedation is intended to allow the patient to maintain
protective reflexes, but sedation represents a continuum and at times an individual patient
may experience a deeper sedation than was anticipated. It is extremely important that the
practitioner has the requisite knowledge, training, and skill to manage all levels of sedation
adequately, identify unintended outcomes, and manage an emergency until either assistance
arrives or the patient is successfully recovered to baseline status.3
Therefore, understanding
the levels of anaesthesia is helpful in guiding provider in selection of the proper sedation
technique and drugs. A study published by the Journal of the American Dental Association in
2001 comparing 4 IV sedation drug regimens in 997 patients concluded that the drugs and
doses evaluated were of therapeutic benefit in the outpatient setting and there was minimal
incidence of potentially serious adverse effects. This study helped to reinforce the safety of
the use of conscious sedation using different drug combinations with careful titration and
adequate provider training.4
In contrast, a more recent study published in the Journal of
Public Safety by Karamnov and colleagues,5
in a retrospective review conducted on 143,000
moderate sedation cases performed outside the operating room, showed that adverse events
were associated with patient characteristics and procedure types. Patient harm was associated
with age, body mass index (BMI), comorbidities, female sex, and gastroenterology
procedures.6
Guidelines established by the ASA in 2001 and updated in 2002 provided the
foundation for provision of sedation in most practice settings.1,6
Having a satisfactory
outcome from IV sedation and anaesthesia greatly depends on the experience of the provider,
patient selection, and the sedation plan (preoperative and postoperative). It is critical that the
approach to sedation involves a preoperative evaluation of the patient that includes a
comprehensive medical and dental history and physical examination. Additional information
should include an anaesthesia history and any record of adverse reactions to sedation or
anaesthesia.7
The drugs currently used most frequently for parenteral sedation in dental
outpatients are a benzodiazepine (diazepam or midazolam), either alone or in combination
with an opioid (fentanyl or meperidine), an ultra short-acting anesthetic (methohexital or
propofol) or both. Few reliable estimates of morbidity and mortality are available to support
the claims of safety of parenteral sedation administered by dentists.8
Clinician surveys lack
scientific rigor, and the results can, at best, be generalized only to the population of
practitioners from which the samples are drawn. Although a consensus panel of experts has
stated that the use of sedative and anesthetic drugs in the dental office “has a remarkable
record of safety,” there are no reliable data to document this assertion.9-11
Fear of the pain of
3. European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 09, 2020
3037
dentistry and of local anesthetic administration is magnified in young children, in emotionally
and physically disabled patients, in patients undergoing an extensive surgical procedure and
in patients who have become phobic because of previous unpleasant dental or medical
procedures. As a consequence, patients continue to seek dental care performed with
anxiolytic drugs, including parenterally administered sedation.8
AIM OF THE STUDY
Purpose of our research was to compare and analyze the efficacy of various sedation
regimens frequently used by parenteral administration in dental patients undergoing
disimpaction of molars.
METHODOLOGY
50 Dental clinic outpatients from the various sites who required the surgical removal of
impacted third molars with parenteral sedation were invited to participate. The nature of the
procedure and the research protocol were explained to patients, and they each signed an
institutionally approved consent form. Inclusion criteria included the need for removal of two
to four third molars, one of which was at least partially impacted in bone; anticipated surgical
duration of 30 minutes; ASA physical status of P1 or P2. Patients were excluded from
participation if they were pregnant or lactating; had any systemic illness that increased the
risks associated with outpatient oral surgery or parenteral sedation. The four treatment groups
consisted of three active treatments and a placebo control. Fentanyl (50 micrograms/
milliliter) was administered first in a fixed dose of 0.1 milligram per 70 kilograms body
weight (1.4 (μg/kg) via slow intravenous infusion over two minutes; a matching saline
placebo was administered to subjects in the treatment groups not receiving this opioid.
Midazolam (1 mg/mL formulation), or a matching saline placebo, then was administered at a
rate of 1 mL/minute until a clinical endpoint, characterized by slurred speech, patient self-
reports of relaxation or drooping eyelids, was noted, or a maximum dose of 15 mL
(equivalent to a maximum dose of 15 mg) was reached. In the group receiving methohexital
(10 mg/mL), a 1-mL bolus was administered after the midazolam titration and shortly before
the local anesthetic was administered intraorally (patients in the other four groups received a
1-mL bolus of saline) along with midazolam and fentanyl. The oral surgeon and observer also
independently rated patient cooperation in terms of movements during administration of the
local anesthetic and during the extractions, as follows:
0–no interfering movements;
1–minor movements, but patient’s position remained appropriate;
2–minor movements that required repositioning of the patient;
3–movements that grossly interfered with the procedure.
The surgeon and observer independently rated the efficacy of the sedation as poor (0), fair
(1), good (2) or excellent (3). Physiological variables and continuous patient self-report
measures, such as anxiety and pain, were analyzed via one-way analysis of variance, or
ANOVA. χ2 tests were used to evaluate the incidence of recalling clinical events as well as
the incidence of elevated carbon dioxide or lowered oxygen saturation.
4. European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 09, 2020
3038
RESULTS
The distribution of sex, age, weight, height, procedure duration, local anesthetic dose and
health status was similar across treatment groups. The mean duration of surgery and the type
of extractions performed also were similar across groups. Patients in all three of the active
treatment groups reported significantly less anxiety than did patients in the placebo group
during the procedure. (Table 1) The administration of additional midazolam during the
procedure did not seem to provide any further anxiety relief than that achieved when
midazolam was only administered before the procedure, when assessed at five minutes
intraoperatively or at the completion of surgery. The combination of midazolam, fentanyl and
methohexital resulted in significantly less anxiety at both evaluation times. (Table 2) The
incidence of side effects elicited from patients at the end of surgery was low among the
placebo group (6.7 percent); the frequency was elevated among the groups that received
drugs, but did not differ substantially among the midazolam group (19.7 percent). However,
the incidence of side effects was slightly higher for the group that received midazolam,
fentanyl and methohexital (24.9 percent). Adverse events reported were primarily those that
were consistent with the sedative property of these drugs (that is, drowsiness, incoordination,
disorientation) and the stress of a minor surgical procedure (that is, syncope, nausea,
vomiting). (Table 3)
Table 1- Surgical variable observed in the present study.
TREATMENT GROUPS Procedure
Duration
(Minutes)
[Mean±SD]
Local
Anesthetic
Lidocaine
(Milligrams)
[Mean±SD]
Dental
Anxiety
Trait
Score *
[Mean±SD]
Placebo group 25.2 ±9.5 204.2 ±74.4 8.1 ±2.7
Midazolam 24.9 ±9.0 196.1 ±62.8 8.0 ±2.7
Fentanyl, midazolam 24.4 ±9.0 193.8 ±71.0 8.6 ±3.0
Midazolam, Fentanyl and
Methohexital
25.2 ±8.8 189.5 ±66.2 8.0 ±2.6
* The scores range from 4 (relaxed) to 20 (frightened, physically sick). A mean score of 8 is
equivalent to “a little uneasy” at the prospect of dental therapy.
Table 2-Surgeon and observer ratings during the surgical procedure.
TREATMENT GROUPS Interfering
Movements
Verbalization of
Discomfort
Nonverbal Signs
of Discomfort
Placebo group 0.59 ± 0.78 1.35 ± 1.08 1.10 ± 1.01
Midazolam 1.01** ± 0.95 1.44 ± 1.05 1.22 ± 1.07
Fentanyl, midazolam 0.53 ± 0.73 1.06** ± 1.10 0.81** ± 0.98
Midazolam, Fentanyl and
Methohexital
0.51 ± 0.81 0.65** ± 0.92 0.53** ± 0.77
5. European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 09, 2020
3039
Interfering movements-On a scale from 0 (no interfering movements) to 3 (grossly
interfering movements). Verbalization of discomfort -On a scale from 0 (none) to 3 (frequent
complaints).
Non-verbal signs of discomfort- On a scale from 0 (none) to 3 (marked discomfort).** P <
.05 compared with placebo.
Table 3- Side effects noticed in different regimens of intravenous sedation.
TREATMENT GROUPS Nausea Vomiting Drowsiness
Placebo group 6.7 % 0% 0.3%
Midazolam 19.7 % 0.2% 1.03%
Fentanyl, midazolam 18.3% 0.6% 1.4%
Midazolam, Fentanyl and
Methohexital
24.9 % 1.1% 3.6%
DISCUSSION
It was noted that midazolam when administered intravenously in our study with the purpose
of evading anxiety as well as having less amnesic effects on patients during and after
treatment without any particular distressing side effects. However, sometimes physiological
monitoring catches serious sequalae but it happens very less, mostly in elderly patients.
The combination of midazolam, fentanyl and methohexital is characterized as deep
sedation,12
and can result in CNS depression which can be more sedative as compared to
conscious sedation. However in this study; it was observed that clear sedation was achieved
which also had an advantage therapeutically in terms of anxiety relief, intraoperative pain
control, amnesia and the global evaluation of efficacy. This intravenous drug regimen was
rated as the best by the oral surgeons participating in the study. Various therapeutic
advantages were linked with decreased respiratory rate, transient apnea in 38 percent of the
sample, slight drop in oxygen saturation and temporary carbon dioxide retention. Use of
intravenous sedation similar to dentistry is in cases of gastrointestinal endoscopy. A large-
scale study (more than 20,000 cases) yielded a predictable incidence of cardiovascular side
effects of 5.4 per thousand cases and a mortality rate of 0.3 per thousand cases.13
with this it
was concluded that the concomitant use of opioids with a benzodiazepine as a factor leading
to increased morbidity and mortality. The incidence of mortality was similar to estimates of
mortality associated with inpatient general anesthesia: one to three deaths per 10,000
procedures.14
Adverse outcomes were associated with all routes of drug administration and all
classes of medication, and dental specialists had the greatest frequency of negative outcomes
associated with the use of 3 or more sedating medications.15
As with adult moderate sedation,
sedation of children can also result in significant risk. The requirements for sedation for
pediatric patients mirror those outlined for adults. When planning moderate sedation for
pediatric patients it is important to understand that they may require meticulous scrutiny
above and beyond what is required for adult patients in the preoperative, operative, and
postoperative stages. However, in recent years, increasing liability insurance costs and risks
6. European Journal of Molecular & Clinical Medicine
ISSN 2515-8260 Volume 07, Issue 09, 2020
3040
associated with office-based moderate sedation have caused more pediatric dentists to favor
oral sedation.16,17
Prospective data from dental outpatients are needed to provide credible
evidence that these discrepancies are real, and can be attributed to such factors as a healthier
population of dental patients than patients in whom anesthesia and sedation are produced on
an inpatient basis, the decreased likelihood of anesthetic complications with shorter-duration
outpatient procedures, the effect of state regulations governing the use of sedative agents in
dentistry, and the safety of conscious sedation in comparison with that of general anesthesia.
In a study carried out by AL–Zahrain, it was recommended that a waiting period of at least 25
to 30 minutes. The time taken for the maximum sedation had an average of around 33
minutes18
which is in accordance with the study by Mohammad19
and Darlong20
who found
an easier parental separation after 19 minutes. A noteworthy limitation that we observed were
that the patients included in the present study were young healthy adults rather than all other
age groups. While such patient selection is appropriate for a controlled clinical trial,
prospective studies that include the young, the elderly, patients with preexisting disease and
patients being treated with other medications are needed to provide evidence regarding the
safety of parenteral sedation in these populations. Nevertheless, fear of dentistry remains an
important impediment to care for a large segment of the population,21-23
and trained dentists
will continue to be needed to provide safe and effective anesthesia and sedation for
emotionally and physically challenged patients.
CONCLUSION
The long-term need for anesthesia and sedation in dentistry may diminish as the decreased
incidence of dental caries and tooth loss lessens the occurrence of traumatic procedures
during childhood and adolescence that contribute to dental phobia in adulthood.
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