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Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery

Background:  The purpose of the present study was to determine whether prophylactic use of 1 μg·kg−1 dexmedetomidine affected the incidence of emergence agitation (EA) after sevoflurane based anesthesia without surgery in children.

Premedication with melatonin vs midazolam in anxious children.

Aim:  Failure of dental treatment caused by anxiety is a common problem in children. Oral midazolam has been the most commonly used premedication for pediatric patient but the use of midazolam may be associated with paradoxical reactions in children. Melatonin may induce a natural sleepiness and improve sedation. We have investigated premedication with melatonin compared with midazolam in children under nitrous oxide/oxygen (N2O/O2) sedation for dental treatment.

Effectiveness of premedication agents administered prior to nitrous oxide/oxygen.

Background and objective In paediatric dentistry, when anxiety, fear of dental procedures or behavioural impairment precludes the conduct of dental treatments, sedation procedures are required. However, sedation at the desired level might not be achieved despite administration of various agents. The present study aimed to evaluate the effectiveness of oral premedication with different agents on children scheduled for dental treatment under nitrous oxide/oxygen (N2O/O2) sedation. Methods The present research was approved by the Ethics Committee of Gazi University Faculty of Medicine. Sixty children aged between 5 and 8 years, ASA I or II, having no mental or motor retardation, requiring at least two-visit dental treatment, having no sedation or general anaesthesia experience, and incompliant with dental treatment (Frankl Behaviour Scale≥3), were enrolled into the study after obtaining informed parental consent. The children were then randomly assigned to one of four groups. The treatment regimen according to the study groups was as follows: oral administration of 1 mg kg−1 hydroxyzine hydrochloride suspension (Atarax) 1 h preoperatively (group I, n = 15), oral administration of 0.7 mg kg−1 midazolam (Dormicum) 15 min preoperatively (group II, n = 15), oral administration of 3 mg kg−1 ketamine (Ketalar) with 0.25 mg kg−1 midazolam (Dormicum) 15 min preoperatively (group III, n = 15), and no oral premedication administration [group IV (controls), n = 15]. Peripheral oxygen saturation (SpO2) and heart rate were monitored with a pulse oximeter during treatment. The sedation level was monitored with the bispectral index. Following premedication, 40% N2O and 60% O2 was administered to all groups by means of a nasal mask. Sedation depth was evaluated using the Ramsay Sedation Scale and data were recorded at 5 min intervals. Sedation success and other sedation-related events were recorded. Results The evaluation of the findings of this study revealed that treatment procedures were completed without any serious complications. Achievement of sedation in terms of satisfactory/mid-level satisfactory/unsatisfactory was as follows: 13.3/53.3/33.3% in group I; 54/20/26% in group II; 33.3/33.3/33.3% in group III, and 6.7/60/33.3% in group IV, respectively. Ramsay Sedation Scale results revealed that the most effective medication was 0.7 mg kg−1 midazolam. Conclusion It is concluded that 0.7 mg kg−1 midazolam is more effective than 0.25 mg kg−1 midazolam with 3 mg kg−1 ketamine and 1 mg kg−1 hydroxyzine hydrochloride in terms of oral premedication prior to N2O/O2 sedation in children scheduled for dental treatments.

Effect of drinks that are added as flavoring in oral midazolam premedication on sedation success

Background:  Midazolam is one of the most frequently used agents for sedation in pediatric dentistry. The injectable form of midazolam can also be given orally. However, its bad taste has negative effects on ingestion of the drug. In this study, we aimed to evaluate the effect of drinks which were added to mask the bitter taste of midazolam for drug acceptance and sedation.

Antibacterial effect of a new haemostatic agent on oral microorganisms.

Objective: The purpose of this study was to determine the antibacterial effect of a newly developed haemostatic agent Ankaferd Blood Stopper® (ABS) and Ferric Sulphate (FS) on various oral microorganisms. Study design: Bacterial strains were freshly incubated in their specific broth media. For each of the strains, 3 wells per each agent, with a 5 mm diameter were made under aseptic conditions in the specific agar media. Then they were filled with a test agents or 0.2% chlorhexidine digluconate (CHX) (control group). After 24h and 48h incubation periods, inhibition zones were measured. Results: ABS showed antibacterial effect on all test microorganisms except Lactobacillus acidophilus and Lactobacillus salivarius. Ferric sulphate and CHX have antibacterial effect on all microorganisms. When the test agents compared, the inhibition zones of the ABS were found smaller than the ferric sulphate and CHX. Conclusions: Although ferric sulphate and ABS have antibacterial effect, ferric sulphate had better antibacterial activity than ABS on oral microorganisms under in vitro condition. FS and ABS not only exhibit the haemostatic activity but also antimicrobial activity. Key words:Ankaferd blood stopper, ferric sulphate, haemostatic agent, haemostasia, bleeding, bactericide.

Comparison of pre-emptive ibuprofen, paracetamol, and placebo administration in reducing post-operative pain in primary tooth extraction

BACKGROUND This study investigates preliminary investigations that a pre-emptive analgesia administration may reduce post-extraction pain. AIM This prospective, placebo-controlled, randomized, double-blind trial was planned to compare the efficacy of the pre-emptive administration of ibuprofen, paracetamol, and placebo in reducing post-extraction pain in children. DESIGN Forty-five children, ages 6-12, who needed primary mandibular molar tooth extraction were treated in paediatric dental clinics, with treatment preceded by local anaesthesia and analgesic drugs during the preoperative period. A five-face scale was used to evaluate pain reaction during the injection, extraction, and post-operative period. Self-report scores were recorded when the local anaesthesia had been administered in soft tissues and both before and after the extraction was completed. The Kruskal-Wallis and Mann-Whitney U tests (with Bonferroni correction paired t-test as the post hoc test) were used at a confidence level of 95%. RESULTS The use of pre-emptive analgesics showed lower scores compared to the placebo, irrespective of the age, weight, gender of the child, and the number of teeth extracted during the study period. Additionally, ibuprofen exhibited lower pain scores (P < 0.05) compared to paracetamol at the 15-min (P < 0.001) and 4-h (P < 0.009) periods. CONCLUSIONS Preoperative use of ibuprofen and paracetamol may provide a pre-emptive analgesic effect in paediatric patients who receive adequate analgesia during mandibular primary tooth extraction.

Effect of dexmedetomidine on erythrocyte deformability during ischemia-reperfusion injury of liver in diabetic rats.

UNLABELLED The aim of this study is to evaluate the effect of dexmedetomidine on erythrocyte deformability during IR heart injury in diabetic rats. METHODS Eighteen Wistar Albino rats were included in the study after streptozocin (55 mg/kg) treatment for four weeks. In the Group C and DC (sham-control group), the coronary artery was not occluded or reperfused in the control rats. In the Group DIR, a branch of the left coronary artery was occluded for 30 minutes followed by two hours of reperfusion to produce IR. In the Group DIRD, a branch of the left coronary artery was occluded for 30 minutes followed by two hours of reperfusion to produce IR, and dexmedetomidine was administrated via 100 µg/kg IP route 30 minutes before ligating the left coronary artery. Deformability measurements were performed in erythrocyte suspensions containing Htc 5 % in a PBS buffer. RESULTS The deformability index was significantly increased in diabetic rats; however, it was similar in the Group DC and DIRD. It was significantly increased in the Group DIR when compared to the Group C, DIRD and DC. The relative resistance was increased in IR models. CONCLUSION Erythrocyte deformability was decreased in rats having diabetes and IR injury. This injury might lead to further problems in microcirculation. It was shown that dexmedetomidine might be useful in enhancing the adverse effects of this type of injury (Fig. 1, Ref. 39).

Efficacy of preemptive lornoxicam on postoperative analgesia after surgical removal of mandibular third molars.

OBJECTIVE Pain is the most encountered complication following third molar surgery. Although nonsteroidal anti-inflammatory drugs are often used for pain control, the effect of preemptive lornoxicam has not been detailed. We compare the analgesic efficacy of preemptive lornoxicam versus postoperative lornoxicam. STUDY DESIGN Forty-three participants aged 18 to 33 years who had bilateral, symmetrical third molars were included in this double-blind, randomized, placebo-controlled study. All participants took part in each of the 2 groups for a 1-month interval (crossover design). Group Pre received lornoxicam 8 mg intravenously 25 minutes before surgery and 2 mL serum saline postoperatively. Group Post was given the opposite protocol. Pain was evaluated by visual analog scale in the first 12 hours. RESULTS We observed statistically significant differences in the reduction of the pain level in group Pre (P < .05). These participants felt less pain in the first 5 postoperative hours and needed fewer analgesics in the first 12 postoperative hours. CONCLUSIONS Preemptive lornoxicam is effective for postoperative pain control.

The Effects of α2-Adrenergic Receptor Agonist Dexmedetomidine on Hemodynamic Response in Direct Laryngoscopy

Background: In anesthesia practices, the prevention of sympathetic discharge is important. Dexmedetomidine is a sedative with anxiolytic and analgesic effects. However, its effects on hemodynamic response in direct laryngoscopy are not clear. Objectives: This study aimed to compare the effects of dexmedetomidine with well-known premedication agent midazo- lam. Methods: Intramuscular 0.05mgkg -1 midazolam (GroupM) or intravenous 1� gkg -1 dexmedetomidine (GroupD) was ap- plied to cases who were scheduled for direct laryngoscopy under general anesthesia. Heart Rate and mean arterial pressure (MAP) were measured before premedication and noted down as control values. Preoperative hemodynamic parameters, recovery times and sedation levels of both groups were compared. Results: In the comparison of MAP of the groups at the postintubation 1 st and 5 th min, the values of Group M were signifi- cantly higher (p=0.04, p=0.002). Mean postintubation MAP values at the 1 st , 5 th , and 10 th min and mean postextubation MAP values, at the 1 st min of GroupM were significantly higher than the mean control MAP (p=0.001, p=0.003, p=0.008, p=0.002, p=0.008 respectively). Conclusion: Dexmedetomidine premedication is a more effective alternative to midazolam premedication for hemody- namic stabilization and early recovery in direct laryngoscopy operation.

Analgesic Efficacy of Prophylactic Gabapentin and Lornoxicam in Preventing Postendodontic Pain

OBJECTIVE In dental applications, as in all other medical applications, pain needs to be prevented or at least controlled. The use of the tooth as a model for studying pain mechanisms is well established. In the current study, we aimed to evaluate and compare the analgesic effects of gabapentin and lornoxicam, respectively, vs a placebo for postendodontic treatment pain. DESIGN AND METHODS Clinical research was planned as prospective, randomized, and placebo controlled. Each subject was given 600 mg gabapentin (group G: N = 30), 8 mg lornoxicam (group L: N = 30), or a placebo (group C: N = 30) 30 min prior to endodontic treatment. OUTCOME MEASURES At 4 (T(3)), 8 (T(4)), 12 (T(5)), and 24 (T(6)) h after preoperative (T(0)) time points, the analgesic efficacies of the agents were evaluated by using the visual analog scale (VAS). RESULTS In group G, VAS values were significantly greater at T(0) time point than at T(5) or T(6). T(0) time point VAS value in group L was lower than at T4 time point and greater than at T(6). In group C, T(0) time point VAS values were significantly lower at T(3) and T(5) time points and greater than at T(6) time point. VAS values in group G at T(5) time point were significantly lower than in group C or group L (P < 0.05). CONCLUSIONS Based on the obtained data, prophylactic lornoxicam controlled postendodontic treatment pain more effectively than did the placebo drugs, and gabapentin was more effective in controlling the pain than either lornoxicam or the placebo.