Gastone Zanette

Traditional acupuncture in migraine: A controlled, randomized study

Objective.— To check the effectiveness of a true acupuncture treatment according to traditional Chinese medicine (TCM) in migraine without aura, comparing it to a standard mock acupuncture protocol, an accurate mock acupuncture healing ritual, and untreated controls.

Toward the Validation of Visual Analogue Scale for Anxiety

Anxiety is a relevant problem in dental practice. The Visual Analogue Scale for Anxiety (VAS-A), introduced in dentistry in 1988, has not yet been validated in large series. The aim of this study is to check VAS-A effectiveness in more than 1000 patients submitted to implantology. The VAS-A and the Dental Anxiety Scale (DAS) were administered preoperatively to 1114 patients (459 males and 655 females, age 54.7 ± 13.1 years). Statistical analysis was conducted with Pearson correlation coefficient, the receiver operating characteristic (ROC) curve, and McNemar tests. A close correlation between DAS and VAS-A was found (r  =  0.57, P < .0001); the VAS-A thresholds of dental anxiety and phobia were 5.1 and 7.0 cm, respectively. Despite a significant concordance of tests in 800 cases (72%), disagreement was found in the remaining 314 cases (28%), and low DAS was associated with high VAS-A (230 cases) or vice versa (84 cases). Our study confirms that VAS-A is a simple, sensitive, fast, and reliable tool in dental anxiety assessment. The rate of disagreement between VAS-A and DAS is probably due to different test sensitivities to different components of dental anxiety. VAS-A can be used effectively in the assessment of dental patients, using the values of 5.1 cm and 7.0 cm as cutoff values for anxiety and phobia, respectively.

The usefulness of routine preoperative laboratory tests for one-day surgery in healthy children.

Since 1984, laboratory tests have not been routinely required for healthy paediatric patients scheduled for one‐day surgery in our Paediatric Surgery Department. We reviewed the medical charts of all children ASA physical status 1 and 2 who underwent a minor surgical procedure in the last 15 years. We excluded all former preterm infants of less than 60 weeks postconceptual age. The series under examination includes two groups of patients: group A includes 1884 children who underwent routine preoperative laboratory tests; group B includes 8772 children who had preoperative, selected laboratory tests performed only when the childs history and/or clinical examination revealed some abnormalities. The following data were collected: demographic data, ASA physical status classification, surgical procedure, anaesthetic technique, major and minor complications, length of hospital stay, the difference between the expected length of hospitalization and the actual length, number and reasons for cancellations of surgery. On the basis of our experience we believe that a thorough clinical assessment of the patient is more important than routine preoperative laboratory screening, which should be required only when justified by real clinical indications. Moreover, this practice eliminates unnecessary costs without compromising the safety and the quality of care.

Effects of Hypnotic Focused Analgesia on Dental Pain Threshold

Abstract The rate, intensity, and selectivity of hypnotic focused analgesia (HFA) were tested with dental pulp stimulation. Thirty-one healthy subjects were hypnotized, and hypnotic suggestions were given for anesthesia of the right mandibular arch. A posthypnotic suggestion of persisting analgesia was also given. The pain threshold of the first premolar was bilaterally measured before, during, and after hypnosis using a pulp tester. During hypnosis, the pain threshold increased significantly (p < .0001) for both sides. The posthypnotic right pain threshold was also significantly (p < .0015) higher than in the basal condition.

Respiratory depression following administration of low dose buprenorphine as postoperative analgesic after fentanyl balanced anaesthesia

Opioids are among the most ancient and widely used drugs in anaesthesiology. The pharmacology of opioid analgesics and their receptors is a complex and not fully understood matter; even more complex are the interactions between different classes of opioids at both molecular and clinical levels. We want to report here a clinical observation to emphasize the importance of the theoretical basis of anaesthesiology. This paper contains a clinical observation of respiratory depression following the administration of buprenorphine as postoperative analgesic after balanced anaesthesia with fentanyl. The observed case is interpreted in the light of the pharmacokinetics and pharmacodynamics of the different classes of opioid drugs (agonists, agonists–antagonists, antagonists) and of the interactions with their respective receptors.

Hypnosis as sole anaesthesia for skin tumour removal in a patient with multiple chemical sensitivity

A female patient with multiple chemical sensitivity and previous anaphylactoid reactions to local anaesthetics was admitted for removal of a thigh skin tumour under hypnosis as sole anaesthesia. The hypnotic protocol included hypnotic focused analgesia and a pre‐operative pain threshold test. After inducing hypnosis, a wide excision was performed, preserving the deep fascia, and the tumour was removed; the patients heart rate and blood pressure did not increase during the procedure. When the patient was de‐hypnotised, she reported no pain and was discharged immediately. Our case confirms the efficacy of hypnosis and demonstrates that it may be valuable as a sole anaesthetic method in selected cases. Hypnosis can prevent pain perception and surgical stress as a whole, comparing well with anaesthetic drugs.

Isolated atrial fibrillation (IAF) after local anaesthesia with epinephrine in an anxious dental patient

Cardiac arrhythmias are not uncommon in dental practice, depending on many factors, including patient features, dental treatment and drugs administered. We describe a case of isolated atrial fibrillation (IAF) developed, in a young patient, soon after a supraperiosteal injection. The patient was admitted to hospital and recovered spontaneously. Since stress is a possible cause of IAF, this may has been triggered by endogenous and/or exogenous epinephrine. We highlight the need for careful preoperative evaluation, including anxiety assessment and treatment in all dental patients.

Sedation in dentistry: current sedation practice in Italy.

EDITOR: The power of patient sedation to blunt the stress response to surgery is important in dentistry [1,2]. The advantages of the available sedation techniques should be evident to teachers of Dental Schools, to dental students, to dentists, to all involved dental practitioners and, obviously, to dental patients [3–5]. Unfortunately, this knowledge is not so widely shared in Italy, so that the use of patient sedation is still a limited practice among Italian dentists [4,6]. We report information about the current sedation practice in Italy within both academic and private practice. An E-mail or telephone survey was performed in January 2005 to collect data about current sedation practice in Italy. The survey covered all the 33 Dental Schools of Italy and 110 private dental offices of the Veneto region in the northeast of Italy. Data from a previous study [6] of private dental practice in the Friuli Venezia Giulia region were added. The two Italian regions, Friuli Venezia Giulia and Veneto, have 5 730 000 inhabitants, about 10% of the whole Italian population. In Italy there are 18 921 dentists and 34 625 physicians working as dentists. Results from the survey on the education of undergraduate dental students and of private dental practice in Italy are reported in Table 1. Sedation in Italian Dental Schools is provided mainly by anaesthesiologists (94%) with the remainder by dentists (6%). In private dental practice the situation is different with the anaesthesiologists performing the sedation in about 20% of cases, the remainder being performed by dentists and physicians. Since the foundation of Dental Schools in Italy, in 1981, the teaching of Anaesthesia in Dentistry presented many problems defining a didactic model according to the goal of this specialty. This situation had not improved 20 yr later, after the introduction of the new European Standards (2001) in the academic didactic organization that included teaching of patient evaluation and information, anxiety and pain control, emergency prevention and treatment. This is due to a lack of clinical facilities in Dental Schools and theoretical but not practical adjustment to European Standards together with lack of information among dentists. In Italian Dental Schools all the sedation masters are anaesthesiologists with a clear preference toward topics for anaesthetists and not for dentists: many anaesthesiologists had little knowledge of the training presently available to dentists wishing to practise conscious sedation. It is of great concern that a considerable number of these anaesthesiologists do not feel that is appropriate for dentists to be administering even the simplest method of sedation including the use of nitrous oxide/oxygen inhalation. The sedation techniques taught and performed in the Dental Schools depend on the knowledge and wisdom of the teachers, skill of clinical staff and available resources of the Institution. Oral sedation is widely employed because it is simple to teach, to learn and to perform. Intravenous (i.v.) sedation needs special skill but is suitable for titration. Inhalation of nitrous oxide and oxygen is a relatively frequent technique, but intranasal and sublingual routes of drug administration are less used. The drugs studied in most of the Italian Dental Schools are benzodiazepines and nitrous oxide but general i.v. anaesthetics (ketamine, propofol, barbiturates, opioids, etc.) and halogenated anaesthetics (sevoflurane, desflurane) are, erroneously, also taught. We believe erroneously because these are topics for anaesthesiologists and not for dentists. Special sedation techniques, for children and/or disabled patients are carried out only in a minority of cases because these are considered, mostly, as patients for anaesthesiologists requiring general anaesthesia in the majority of the Institutions. Education is carried out on a theoretical basis, while practice on the patient is lacking in the majority of the Dental Schools. The nearly total absence of academic continuing education about this topic is evident as only two Universities perform such education: Bologna University, where Correspondence to: Gastone Zanette, Department of Medico-Surgical Specialties, Chair of General and Special Anaesthesiology in Dentistry, University of Padua, Via Giustiniani 2, 35100 Padova, Italy. E-mail: gastone.zanette@unipd.it; Tel: 39 49 8212041; Fax: 39 49 8218229

Porcine Bone Scaffolds Adsorb Growth Factors Secreted by MSCs and Improve Bone Tissue Repair

An ideal tissue-engineered bone graft should have both excellent pro-osteogenesis and pro-angiogenesis properties to rapidly realize the bone regeneration in vivo. To meet this goal, in this work a porcine bone scaffold was successfully used as a Trojan horse to store growth factors produced by mesenchymal stem cells (MSCs). This new scaffold showed a time-dependent release of bioactive growth factors, such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), in vitro. The biological effect of the growth factors-adsorbed scaffold on the in vitro commitment of MSCs into osteogenic and endothelial cell phenotypes has been evaluated. In addition, we have investigated the activity of growth factor-impregnated granules in the repair of critical-size defects in rat calvaria by means of histological, immunohistochemical, and molecular biology analyses. Based on the results of our work bone tissue formation and markers for bone and vascularization were significantly increased by the growth factor-enriched bone granules after implantation. This suggests that the controlled release of active growth factors from porcine bone granules can enhance and promote bone regeneration.

Psychological Features of Hypnotizability: A First Step Towards Its Empirical Definition

Abstract This study examined the relationship between the Hypnotic Induction Profile (HIP) and several psychological tests: Tellegen Absorption Scale (TAS), Spontaneity Assessment Inventory-Revised (SAI-R), Dissociative Experiences Scale (DES), Short-Form Boundary Questionnaire (SFBQ), Mini Locus of Control (MLOC), Testoni Death Representation Scale (TDRS), and the Interpersonal Reactivity Index (IRI). Two hundred and forty volunteers were administered the above tests; 78 of them were also administered the HIP, and its scores were compared to those on the other tests. A significant correlation was found among the TAS, DES, SFBQ, and IRI. The HIP was significantly correlated to the DES (r = .19 p1tail = .045), and the IRI-ec subscale (r = .19 p1tail = .044); 14 test items from DES, IRI, TAS, SAIR, and SFBQ were also significantly related to the HIP. The findings suggest that hypnotizability may relate to stronger perception of the inner world, decreased aptitude for managing memory processing, and increased sensitivity and empathy.