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Hemodynamic differences between propofol-remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants.

BACKGROUND: Propofol-remifentanil anesthesia is widely used in adults but few studies are available in infants. We aimed at comparing the hemodynamic effects of propofol-remifentanil vs sevoflurane-fentanyl anesthesia. In addition, we sought to investigate recovery and whether remifentanil induced acute opioid tolerance. METHODS: In total, 39 infants 4-6 months old were prospectively enrolled and randomized to receive either a combination of remifentanil and propofol (n = 17) or a sevoflurane-fentanyl anesthesia (n = 22) for surgical repair of cleft lip and palate. In both groups, sevoflurane was used for induction of anesthesia and fentanyl was administered before tracheal extubation. Mean arterial blood pressure and heart rate were recorded every 5 min after induction. We also recorded time from termination of surgery to tracheal extubation, postoperative behavior and the need for analgesia for the first 24 h after surgery. Postoperative observations were blinded. RESULTS: In the remifentanil-propofol group, the mean arterial blood pressure was higher [58 (51-65) vs 51 (45-55), P = 0.02] and the mean heart rate was lower [111 (108-113) vs 128 (122-143), P < 0.0001]. There were no differences in recovery time or behavior after surgery. In the remifentanil group, a median fentanyl dose of 4 microg x kg(-1) was required to insure a smooth recovery, but there was no difference in morphine consumption during the first 24 h after surgery. CONCLUSIONS: A high-dose remifentanil-propofol infusion was associated with a higher blood pressure and lower heart rate than sevoflurane-fentanyl anesthesia in infants. Postoperative morphine consumption, recovery time and quality were similar.

Anesthesia Recovery Period↗

Congenital oral anomalies in argentinian children.

A total of 6,180 Argentinian school-age children were examined clinically for the presence of oral congenital anomalies. The following prevalence figures were found: commissured lip pits (0.7%), ankyloglossia (0.1%), geographic tongue (1.5%), localized enamel hypomaturation (2.8%), median rhomboid glossitis (0.10/00), torus palatinus (0.30/00) and dentinogenesis imperfecta (0.30/00). Data are presented for the first time on snowcap amelogenesis imperfecta with a prevalence value of 0.1%.

Adolescent↗

Oral anomalies in Nigerian children.

A total of 2203 Nigerian school-age children (10-19 yr) were examined clinically for the presence of oral anomalies. The following prevalence figures were found: commissural lip pits (2.9%), ankyloglossia (0.2%), geographic tongue (0.3%), fissured tongue (0.8%), torus palatinus (4.5%), torus mandibularis (1.9%), snowcap type amelogenesis imperfecta (0.2%), localized enamel hypomaturation (11.7%), missing lateral incisors (0.7%), and peg lateral incisors (1.5%). None of the following conditions was found: cleft chin, cleft lip, double lip, medium rhomboid glossitis, bifid tongue, macroglossia, cleft palate or cleft lip and palate.

Adolescent↗

Developmental oral anomalies among schoolchildren in Gizan region, Saudi Arabia.

The present report gives prevalence values for some developmental oral anomalies in 1932 schoolchildren aged 6-12 yr in Gizan region, Saudi Arabia. The developmental oral anomalies identified in this study were: torus palatinus (1.4%), fissured tongue (0.8%), geographic tongue (0.2%), and tongue tie (0.1%). None of the following developmental oral anomalies were observed: lip pits, cleft lip and/or palate, torus mandibularis, microglossia, macroglossia or median rhomboid glossitis.

Child↗

Objective evaluation of an airway management appliance in infants with craniofacial anomalies.

This study describes an intraoral appliance designed to reposition the tongue to facilitate a patent airway for infants experiencing respiratory distress. Transcutaneous pulse oximetry is used to objectively evaluate this method of airway management in 15 neonates with craniofacial anomalies. The appliance can significantly improve the blood oxygen saturation level in the infants in whom it is used (P less than .0001).

Airway Obstruction↗

Smith-Lemli-Opitz syndrome: a review, case report and dental implications.

Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive developmental disorder characterized by multiple congenital malformations, dysmorphic craniofacial features, and mental impairment. SLOS is caused by a deficiency of the enzyme 7-dehydrocholesterol delta7 reductase which converts 7-dehyrocholesterol to cholesterol. This error results in elevated serum levels of 7-dehydrocholesterol and decreased levels of serum cholesterol. This article describes the clinical features and medical treatment of SLOS. A case report is included, with recommended guidelines for providing safe and comprehensive dental care for individuals with SLOS.

Adult↗

Orofacial clefts and oesophageal atresia.

Of 114 children with oesophageal atresia, 6 had cleft palate and other craniofacial anomalies present included cleft lip, micrognathia, hypertelorism, microcephaly, and hydrocephalus. The difficulties encountered in the management of patients in whom these conditions present together are emphasised with special reference to swallowing problems and recurrent chest aspiration.

Cleft Palate↗