Myocardial ischemia and delayed recovery after anesthesia in a patient with Cockayne syndrome: a case report.
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Anesthesia Recovery Period↗
Biomedical subjects
M R Rodrigo
Publications and source records attributed to M R Rodrigo.
Comparison of two techniques of patient-controlled sedation with midazolam.
OBJECTIVE: To compare patient-controlled sedation with 1-mg increments of midazolam at 1-min intervals with 0.1-mg increments of midazolam without a lock-out interval. DESIGN: Randomized cross over study. SUBJECTS: 32 patients aged 17-35 years having third molars removed. RESULTS: Doses of midazolam obtained, degree of sedation and operating conditions were similar in the two groups. The demands far exceeded the increments actually received by patients obtaining 0.1-mg increments. Some were extremely sedated with both techniques. CONCLUSIONS: In this age group, there were no significant advantages or disadvantages of one technique over the other. Patients obtained the degree of sedation they required to undergo the operation by pressing the button independently of the dose or incremental interval. So-called 'true' patient-controlled sedation is a misnomer. The cut-off interval proved to be an extremely important safety feature.
Adolescent↗
Use of inhalational and intravenous sedation in dentistry.
Having gained knowledge of the advantages of inhalational and intravenous sedation many dental practitioners use these techniques to supplement local anaesthesia for dental procedures. Inhalational sedation is commonly carried out with nitrous oxide and oxygen while isoflurane in oxygen has also been tried out. Intravenous sedation is commonly carried out with midazolam or diazepam given as a single titrated dose to an end point which does not result in anaesthesia. When sedation with benzodiazepines is carried out, the specific antagonist, flumazenil should always be available for use in emergencies such as accidental oversedation, iatrogenic overdose or paradoxical reactions. Patient controlled sedation with midazolam, the modern technique of intravenous sedation, is comparable to anaesthetist controlled sedation and patients may be administered increments of one milligram at one minute intervals. Computer controlled sedation has been carried out with propofol. Mortality following sedation is low in the United Kingdom, partly due to the strict guidelines of the General Dental Council in the United Kingdom.
Accidents↗
Ondansetron and minor oral surgery.
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Antiemetics↗
A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery.
Thirty healthy Hong Kong Chinese patients between the ages of 15 and 31 years with bilaterally impacted lower third molar teeth, scheduled for surgical removal were studied. All the patients presented twice (for the right and left sides) and received, on separate occasions, patient or anaesthetist-controlled midazolam sedation allocated using a randomised, crossover design. Both techniques provided reliable sedation with verbal contact maintained, minimal changes in respiratory and cardiovascular function, good operating conditions and a high degree of patient satisfaction. The majority of patients (67%) thought they could sedate themselves better on a subsequent visit and were confident that they could do this more satisfactorily than the anaesthetist. An almost equal number preferred patient (n = 12) or anaesthetist (n = 13) controlled sedation, with the remainder having no preference. The total dose of midazolam was very similar in the two groups, 5.3 (SD 2.4) mg and 5.0 (SD 1.1) mg for patient and anaesthetist controlled sedation respectively.
Adolescent↗
Ondansetron for prevention of postoperative nausea and vomiting following minor oral surgery: a double-blind randomized study.
The efficacy and safety of ondansetron in preventing postoperative nausea and vomiting following minor oral surgery was evaluated in a prospective randomized double-blind study. Of a total of seventy-seven patients, randomly 38 had 4 mg of ondansetron and 39 had normal saline as placebo intravenously immediately prior to induction of anaesthesia. A standard general anaesthetic with thiopentone, suxamethonium, fentanyl, nitrous oxide and isoflurane was employed. Postoperatively nausea was assessed verbally and on a visual analog scale at 1, 4 and 24 hours from the time of awakening. Episodes of vomiting were recorded. Eight patients (21.1%) in the ondansetron group compared to 19 (48.7%) in the placebo group had nausea (P < 0.05) and 1 (2.6%) in the ondansetron group compared with 9 (23.1%) in the placebo group vomited (P < 0.05). Patients who vomited twice or more and the number who required a rescue antiemetic were significantly fewer in the ondansetron group (P < 0.05). Cardiovascular parameters were stable and showed no significant difference in the two groups. There were no significant adverse effects that could be directly attributable to ondansetron.
Adolescent↗
Pre-operative diflunisal for pain relief following third molar surgery under general anaesthesia.
In order to find out whether long-acting non-narcotic analgesics given pre-operatively reduce the post-operative pain and decrease the narcotic analgesic requirements following third molar surgery under general anaesthesia, thirty Hong Kong Chinese patients undergoing this procedure were randomly given either diflunisal or placebo one hour prior to anaesthesia. Pain reduction was monitored for ten hours from the end of surgery using visual analogue scales. Except in the first hour, pain reduction at each hour was significantly better in the diflunisal group than in the placebo group. Furthermore, only one patient required narcotic analgesics in the diflunisal group compared with five in the placebo group. In patients who had multiple tooth sectioning or very difficult surgery of one or both lower third molars, the requirement for post-operative analgesics was high in the placebo group.
Adolescent↗
Flumazenil reversal of conscious sedation for minor oral surgery.
In order to find out whether resedation occurred following antagonism with flumazenil of sedation for minor oral surgery, in a double-blind randomised cross-over study thirty healthy Hong Kong Chinese patients undergoing bilateral third molar surgery at two visits were sedated with midazolam. Following surgery they received either flumazenil or placebo at one visit and the alternative at the other visit. Recovery was monitored by observation and objective tests. Following recovery they were monitored for resedation for a total period of two hours from the injection of the reversal agent. Resedation, sufficient to prevent a patient from being discharged to be accompanied home with an escort, did not occur provided the patient responded to verbal command following sedation.
Adolescent↗
'Leopard' syndrome.
'Leopard' syndrome is a rare inherited disorder associated with a high prevalence of cardiac abnormalities. General anaesthesia for dental treatment in a patient who had cardiomyopathy and bizarre electrocardiographic abnormalities associated with this syndrome is described. A thorough cardiac assessment is advised in a patient with multiple lentigines, although no clinical symptoms or signs may be found. Even if no cardiac abnormality is found before it is better to re-assess the patient, since abnormalities may develop later. The assessment should be repeated if any abnormality was detected before but without clinical significance, since the disease is progressive and may progress more rapidly in some patients than in others.
Adolescent↗
Does midazolam sedation in oral surgery affect the potency or duration of diflunisal analgesia?
A randomized cross-over study was carried out to determine whether midazolam in doses used for conscious sedation had any effect on the potency or duration of diflunisal, a non-narcotic analgesic used for postoperative pain in oral surgery. Thirty-two Hong Kong Chinese patients of either sex, aged between 16 and 28 years, were given either midazolam to supplement local anaesthesia or local anaesthesia alone at one visit and the alternative at the other visit, for surgical removal of bilateral symmetrically impacted third molars. Surgery was carried out on one side only at each visit. Diflunisal was given for postoperative pain relief. Midazolam had no effect on the potency or duration of action of diflunisal. Independent of the method, more patients had better pain relief following the second procedure than following the first, probably due to a degree of adaptation to the pain, at the second visit.
Adolescent↗
Conscious sedation with propofol.
The study was designed to assess the suitability of propofol for conscious sedation. Thirty-one patients undergoing bilateral third molar surgery were randomly given either propofol or midazolam for sedation as an adjunct to local anaesthesia at the first visit, and the alternative at the second visit. Propofol, like midazolam, produced reliable sedation, good operating conditions, stable vital signs and profound amnesia, with minimum intra-operative and post-operative adverse effects. Furthermore, most patients were willing to undergo either sedation procedure again. The advantages of propofol over midazolam were the ease with which the degree of sedation could be altered and the quick recovery. Its disadvantages were pain during injection, increased talkativeness, the extra equipment needed, and cost.
Adolescent↗
Effect of conscious sedation with midazolam on oxygen saturation.
A randomized cross-over study was done to determine if significant oxygen desaturation occurs during third molar surgery under conscious sedation with midazolam to warrant supplementary oxygen. Thirty-two healthy patients of either sex, between the ages of 18 and 40 years, had bilateral symmetrically impacted lower third molar surgery under local anesthesia in two visits. Randomly at one visit the local anesthesia was supplemented with midazolam sedation. Continuous monitoring of oxygen saturation, blood pressure, and pulse were carried out. At the rate of injection with the dose of midazolam used, no significant desaturation attributable to midazolam sedation was observed. However, short periods of significant desaturation occurred with both procedures. These episodes, though of no consequence to healthy people, may produce problems in compromised patients, and indicate the importance of monitoring of oxygen saturation in all patients during minor oral surgery procedures.
Adolescent↗
Isoflurane for conscious sedation.
Isoflurane 0.5% in oxygen for conscious sedation was compared with placebo (oxygen) and with an equipotent concentration of nitrous oxide in oxygen, in patients scheduled for surgical removal of bilateral, similarly impacted lower third molars. The majority of patients were sedated with 0.5% isoflurane in oxygen and preferred it to both placebo and nitrous oxide in oxygen. It produced good operating conditions with cooperative patients and had no significant effect on vital signs. There were no significant intra- or postoperative adverse effects. Patients were street fit within 10 minutes after the end of the operation.
Adolescent↗
Paracetamol and diflunisal for pain relief following third molar surgery in Hong Kong Chinese.
In a double blind study in Hong Kong Chinese, 250 mg of diflunisal, 500 mg of paracetamol or placebo were given for post-operative pain relief following 77 third molar surgical procedures. The intensity of pain was recorded on a visual analogue scale. The first and second doses of paracetamol reduced pain significantly more than placebo, while this was true only for the second dose of diflunisal. There was no significant difference in pain reduction with the first and second dose of paracetamol, when compared with the first and the second dose of diflunisal. In this study in Hong Kong Chinese, neither the dose nor the interval between ingestion of the analgesic tablets in patients, who needed analgesics for postoperative pain, were significantly different to that reported before in non-Chinese, in contrast to the popular belief that Chinese patients have higher pain thresholds. However, a higher proportion of Chinese than that reported in non-Chinese did not need any analgesics for relief of postoperative pain.
Acetaminophen↗
Oral midazolam sedation in third molar surgery.
A double-blind randomised study was designed to assess the value of oral midazolam in patients undergoing minor oral surgery. 30 young healthy Hong Kong Chinese with bilateral symmetrical impaction of lower third molars to be surgically removed in 2 visits, were included in the study. Randomly selected, a powdered midazolam tablet or placebo was given on the 1st visit and the alternative on the 2nd visit. 45 min were given for the drug to act. Surgical removal of the teeth was carried out by a single operator, randomly, one side being done at one visit. The majority who had midazolam were relaxed during the operation. Nearly 75% had partial to complete amnesia. Midazolam sedation lasted about 45 min, produced good operating conditions and stable vital signs with adequate verbal response. The main adverse effects were drowsiness and dizziness on the same day. The majority had never heard of oral sedation being available to supplement local anaesthesia. The majority preferred midazolam to placebo and preferred to have local anaesthesia supplemented with oral sedation for minor oral surgery in the future.
Administration, Oral↗
Huntington's chorea: midazolam, a suitable induction agent?
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Anesthesia, Dental↗
A comparison of the incidence and nature of cardiac dysrhythmias occurring during enflurane and isoflurane anaesthesia for dental surgery.
The incidence and nature of dysrhythmias with equipotent concentrations of enflurane and isoflurane during dental surgery were compared. Seventy-six Chinese patients between 17-30 years, of ASA Grade I, randomly received either enflurane or isoflurane with N2O and O2 for spontaneous ventilation during third molar extractions. The cardiac rhythm and the blood pressure were continuously monitored during the procedure. The incidence of dysrhythmias with both enflurane and isoflurane was low and the difference not statistically significant. During surgery one patient exhibited unifocal ventricular ectopics with isoflurane. Sinus tachycardia was common with both agents. No life-threatening dysrhythmias were seen with either agent and no clinically significant lowering of blood pressure occurred in association with the exhibited dysrhythmias. In this Chinese population, as in other studies, the incidence of dysrhythmias with both agents was low thus showing no difference between the races.
Adolescent↗
The effect of Ro15-1788 (Anexate) on conscious sedation produced with midazolam.
A double-blind cross-over randomised study was performed to investigate whether Ro15-1788 (Anexate) adequately reversed the conscious sedation with midazolam so that patients were clinically recovered and fit for discharge quicker than when midazolam was used alone. Twenty-eight healthy patients between 18 and 34 years sedated with midazolam for bilateral 3rd molar surgery, one side being operated on at each visit. Ro15-1788 or normal saline (placebo) was given at the end of the surgical procedure at the first visit and the alternative at the second visit. Recovery with Ro15-1788 was significantly quicker than with the placebo, both by subjective (86%) and objective (93%) evaluation. Patients' evaluation indicated that only 61% were more alert at home with Ro15-1788. Postoperative adverse effects were similar in both groups.
Adolescent↗