Biomedical subjects
Publications and source records attributed to R Steelman.
Malignant hyperthermia is a skeletal muscle disorder thought to be genetically acquired. Inhalation anesthesia presents a dangerous risk to the patient predisposed to the condition.
Conscious sedation is commonly utilized in pediatric dentistry. Although opioid analgesics are often employed, patient safety would be enhanced if nonopioid drugs were used. The purpose of this study was to determine if rectal ketamine could produce plasma concentrations that would achieve both conscious sedation and analgesia to gingival needle puncture. Five 2-year-old male Macaca fuscata monkeys were given rectal ketamine at a dosage of 60 mg/kg and 90 mg/kg one week apart. Blood was drawn at selected times after administration, and vital signs, level of sedation, and consciousness were assessed. Plasma ketamine concentrations ranged from 240 to 820 ng/mL and from 390 to 3120 ng/mL after rectal administration at doses of 60 mg/kg and 90 mg/kg, respectively. Two monkeys after the high dose showed analgesia to a gingival needle puncture at plasma ketamine concentrations that ranged from 1390 to 3120 ng/mL. A good level of sedation was consistently observed in four monkeys (80%) following rectal ketamine at a dosage of 90 mg/kg, whereas one monkey showed a consistently good level at a dosage of 60 mg/kg. Sedation and dose were significantly (P less than 0.001) associated with plasma ketamine concentrations; physiologic parameters were not (P greater than 0.05). The results of this study suggest that rectal ketamine can produce plasma concentrations of the drug sufficient to achieve sedation in the monkey. The attainment of concomitant analgesia to a gingival needle puncture was not as predictable.
The Tell-Show-and-Do behavior management technique has been the most frequently utilized method to obtain cooperation from pediatric dental patients. The purpose of this study was to determine the age and sex predilection of unmanageable Hispanic pediatric patients. Five hundred sixteen normal Hispanic pediatric dental patients, ranging in age from three to fourteen years, were introduced to and received dental treatment using only the Tell-Show-and-Do, positive reinforcement, and voice-control behavior-management techniques. The majority of these patients (95.7 percent) were successfully managed. Cooperation was not obtained for twenty-two of these patients (4.3 percent) who ranged in age from three to six years. Uncooperative female patients, three to four years of age, outnumbered three-to-four-year-old uncooperative male patients, by approximately twofold. Explanations for the difference in the lack of cooperation between males and females included lack of parental presence in the operatory, sex of the patient, and maternal anxiety.
The right and left mandibular first permanent molars of 156 Hispanic children were studied radiographically to determine the incidence of an accessory distal root. The overall incidence was 6.4 percent for 73 boys and 83 girls combined, results that differ from reports of other ethnic groups.
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The nomenclature and nature of various dental anomalies are discussed in this case report to determine the etiology. The tooth in question appeared to be a normally developing eumorphic premolar, and a conservative treatment plan was presented.
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