Evaluation of the Sedative Effect of Midazolam with and Without Ketamine,  by Subcutaneous Via in Pediatric Dental Patients

Children's fear and anxiety about dental treatment can lead to difficulties in the behavior management by the practitioner, which can be a barrier to successful dental treatment. Non cooperative children may need dental treatment under sedation, which is indicated when the non-pharmacological behavioral guidance is unsuccessful. There are randomized controlled trials comparing different sedative protocols for dental procedures; however, evidence of superiority from one form over another is weak. The aim of the present study was to evaluate the sedative effect of midazolam subcutaneously, with and without ketamine, on dental procedures performed in non-cooperative pediatric patients. A randomized, crossover clinical trial with single blinding was performed in 13 children (10 males and 3 females) from 19 to 48 months of age, ASA I and Frankl I behavior. The two methods were applied in the same patient, and the order of the same was assigned randomly, for the two treatment appointments. In each session were evaluated the patient's general behavior, body movements and crying through the modified Houpt scale. In addition, heart rate and oxygen saturation were monitored by means of a pulse oximeter.

Download Full-text

The Effect of Virtual Reality on Preoperative Anxiety: A Meta-Analysis of Randomized Controlled Trials

Journal of Clinical Medicine ◽

10.3390/jcm9103151 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3151

Author(s):

Chang-Hoon Koo ◽

Jin-Woo Park ◽

Jung-Hee Ryu ◽

Sung-Hee Han

Keyword(s):

Virtual Reality ◽

Randomized Controlled Trials ◽

Pediatric Patients ◽

Meta Analysis ◽

Random Effect Model ◽

Preoperative Anxiety ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

Significant Difference

Virtual reality (VR), a technology that provides a stimulated sensory experience, has recently been implemented in various fields of medicine. Several studies have investigated the efficacy of VR on preoperative anxiety. The purpose of this meta-analysis was to validate whether VR could relieve preoperative anxiety in patients undergoing surgery. Electronic databases were searched to identify all randomized controlled trials (RCTs) investigating the effect of VR on preoperative anxiety. The primary outcome was defined as the preoperative anxiety scores. We estimated the effect size using the standard mean difference (SMD) with a 95% confidence interval (CI) using a random effect model. Ultimately, 10 RCTs, with a total of 813 patients, were included in the final analysis. Preoperative anxiety was significantly lower in the VR group than in the control group (SMD −0.64, 95% CI −1.08 to −0.20, p = 0.004). In a subgroup analysis, the preoperative anxiety scores were lower in the VR group than in the control group in pediatric patients (SMD −0.71, 95% CI −1.14 to −0.27, p = 0.002), whereas a significant difference was not observed between the two groups in adult patients (p = 0.226). The results of this meta-analysis indicated that VR could decrease preoperative anxiety, especially in pediatric patients.

Download Full-text

Behavior Management of Pediatric Dental Patients

PEDIATRICS ◽

10.1542/peds.90.4.651b ◽

1992 ◽

Vol 90 (4) ◽

pp. 651-652

Author(s):

◽

Richard D. Krugman ◽

Jan Bays ◽

David L. Chadwick ◽

Carolyn J. Levitt ◽

...

Keyword(s):

Behavior Management ◽

Pediatric Patients ◽

Case Reports ◽

The Other ◽

Behavioral Management ◽

Dental Patients ◽

Bladder Control ◽

Abuse And Neglect ◽

Pediatric Dentists ◽

Special Circumstances

To the Editor.— It has been brought to the attention of The American Academy of Pediatric Committee on Child Abuse and Neglect that some dentists continue to use the hand-over-mouth technique with airway restriction (HOMAR) for behavioral management of pediatric patients. We have received two case reports of children who were adversely affected by this technique. One was left with bruises and petechiae and the other lost consciousness and bladder control. The original literature on the hand over mouth (HOM) technique is alarming as it indicates that "once in a great while a patient's nostrils can be closed until he really needs air, as indicated by his color" and that 19 of 35 pediatric dentists surveyed in 1969 "felt it is permissible to completely close off a child's airway in special circumstances."

Download Full-text

A New Concept for the Treatment and Rehabilitation of Patients with Pathologic Comorbidities Using Cutting-Edge Digital Technologies in Dental Orthopaedics

European Journal of Dentistry ◽

10.1055/s-0040-1713295 ◽

2020 ◽

Vol 14 (04) ◽

pp. 533-538

Author(s):

Alexey V. Yumashev ◽

Maria V. Mikhailova ◽

Igor V. Fomin ◽

Jiaqi Li ◽

Bowen Yang

Keyword(s):

Statistical Analysis ◽

Dental Treatment ◽

Management Strategies ◽

Digital Technologies ◽

Statistical Probability ◽

Dental Patients ◽

Dental Examination ◽

Dental Procedures ◽

Probability Criterion

Abstract Objectives This article investigates the specific aspects of overactive or exaggerated vomiting reflexes affecting the procedure of dental examination and impression in patients with complete secondary adentia, who need orthopaedic dental treatment. Materials and Methods The prevailing manifestation degree of exaggerated vomiting reflex was diagnosed among patients with complete secondary adentia and exaggerated vomiting reflex. Statistical Analysis Exaggerated vomiting reflexes occur when a patient suffers from dentophobia, the term, which is otherwise known as the fear of dentists. The study was performed using methods of mathematical statistics, including the Pearson χ2 criterion and the statistical probability criterion (p). Results The role of an exaggerated vomiting reflex was revealed in the development of patients’ dentophobic experiences, and the nature of such experiences was established. Variations in dentophobic reactions were distinguished and management strategies were studied for patients with complete secondary adentia and exaggerated vomiting reflex. Conclusions These studies were aimed at preventing the development of vomiting reflex during dental procedures and at identifying an optimal strategy for stopping exaggerated vomiting reflex. The role of the vomiting reflex in the orthopaedic treatment of dental patients was determined.

Download Full-text

Comparison of dexmedetomidine with propofol as sedatives for pediatric patients undergoing magnetic resonance imaging: A meta‑analysis of randomized controlled trials with trial sequential analysis

Experimental and Therapeutic Medicine ◽

10.3892/etm.2019.7751 ◽

2019 ◽

Author(s):

Yong Tang ◽

Juan Meng ◽

Xinxian Zhang ◽

Jiong Li ◽

Qiang Zhou

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Randomized Controlled Trials ◽

Sequential Analysis ◽

Pediatric Patients ◽

Meta Analysis ◽

Trial Sequential Analysis ◽

Controlled Trials ◽

Resonance Imaging ◽

Randomized Controlled

Download Full-text

Investigation of myocardial protection during pediatric CPB: Practical experience in 100 Chinese hospitals

Perfusion ◽

10.1177/0267659120983107 ◽

2020 ◽

pp. 026765912098310

Author(s):

Peiyao Zhang ◽

Jinping Liu ◽

Yuanyuan Tong ◽

Shengwen Guo ◽

Liting Bai ◽

...

Keyword(s):

Myocardial Protection ◽

Congenital Heart ◽

Pediatric Patients ◽

Practical Experience ◽

Controlled Trials ◽

Crystalloid Solution ◽

Randomized Controlled ◽

Protection Strategies ◽

Tangible Evidence ◽

Systemic Hypothermia

Many measures have been proposed for myocardial protection in pediatric congenital heart surgeries, but little data is available for China. This study investigates myocardial protection strategies in pediatric cardiopulmonary bypass (CPB) throughout China. Online questionnaires were delivered to 100 hospitals in 27 provinces. The number of yearly on-pump pediatric cardiovascular surgeries in these hospitals varied greatly. About 91.0% of respondents believe that each surgery should have at least two perfusionists, while only 64.0% of hospitals actually met this requirement. For pediatric patients, crystalloid cardioplegia was more prevalent than blood-based cardioplegia. Histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid solution were dominant among crystalloid cardioplegia. Del Nido cardioplegia and St. Thomas blood-based cardioplegia ranked the top two in the popularity of blood-based cardioplegia. Dosages varied among different kinds of cardioplegia. In the choice of different cardioplegia, perfusionists mainly focused on myocardial protective effect and cost. Hypothermia of cardioplegia solution was maintained by ice buckets in 3/4 of the hospitals in this survey. In conclusion, the essence of myocardial protection management during pediatric CPB was cardiac arrest induced by cardioplegia under systemic hypothermia. However, there is no uniform standard for the type of cardioplegia, or dosages. Therefore, well-designed multicenter randomized controlled trials are warranted to provide tangible evidence for myocardial protection of cardioplegia in pediatric CPB.

Download Full-text

Glycemic control, mortality, secondary infection, and hypoglycemia in critically ill pediatric patients: a systematic review and network meta-analysis of randomized controlled trials

Intensive Care Medicine ◽

10.1007/s00134-017-4801-5 ◽

2017 ◽

Vol 43 (9) ◽

pp. 1427-1429 ◽

Cited By ~ 3

Author(s):

Tomohide Yamada ◽

Nobuhiro Shojima ◽

Kazuo Hara ◽

Hisashi Noma ◽

Toshimasa Yamauchi ◽

...

Keyword(s):

Systematic Review ◽

Glycemic Control ◽

Randomized Controlled Trials ◽

Critically Ill ◽

Pediatric Patients ◽

Secondary Infection ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled

Download Full-text

Assessing the Need for Anesthesia and Sedation Services in Kuwaiti Dental Practice

Anesthesia Progress ◽

10.2344/0003-3006-57.3.91 ◽

2010 ◽

Vol 57 (3) ◽

pp. 91-95 ◽

Cited By ~ 2

Author(s):

Mohammad Abdulwahab ◽

Fatima Al-Sayegh ◽

Sean G. Boynes ◽

Hawra Abdulwahab ◽

Jayme Zovko ◽

...

Keyword(s):

Public Health ◽

Dental Care ◽

Dental Treatment ◽

Dental Fear ◽

Care Providers ◽

The Public ◽

Dental Patients ◽

Kuwaiti Population ◽

Fear And Anxiety ◽

To Receive

Abstract The objective of this study was to examine the public health relevance of the prevalence of dental fear in Kuwait and the resultant barrier that it creates regarding access to dental care. The study analysis demonstrated a high prevalence of dental fear and anxiety in the Kuwaiti population and a perceived need for anesthesia services by dental care providers. The telephone survey of the general population showed nearly 35% of respondents reported being somewhat nervous, very nervous, or terrified about going to the dentist. In addition, about 36% of the population postponed their dental treatment because of fear. Respondents showed a preference to receive sedation and anesthesia services as a means of anxiety relief, and they were willing to go to the dentist more often when such services were available. People with high fear and anxiety preferred to receive some type of medication to relieve their anxiety. In conclusion, the significance and importance of the need for anesthesia services to enhance the public health of dental patients in Kuwait has been demonstrated, and improvements are needed in anesthesia and sedation training of Kuwaiti dental care providers.

Download Full-text

Carbon Dioxide vs. Air Insufflation for Pediatric Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Frontiers in Pediatrics ◽

10.3389/fped.2021.610066 ◽

2021 ◽

Vol 9 ◽

Author(s):

Chunwang Ji ◽

Xue Liu ◽

Peng Huang

Keyword(s):

Carbon Dioxide ◽

Randomized Controlled Trials ◽

Pediatric Patients ◽

Significant Risk ◽

Pulmonary Complications ◽

Current Evidence ◽

Controlled Trials ◽

Endoscopic Procedures ◽

Randomized Controlled ◽

Air Insufflation

Background: Carbon dioxide (CO2) insufflation during gastrointestinal (GI) endoscopic procedures has gained popularity in adults. However, its utility in pediatric patients is not known. The current review aimed to compare the efficacy of CO2 vs. air insufflation for GI endoscopic procedures in pediatric patients.Methods: The electronic databases of PubMed, Embase, Scopus, and CENTRAL were searched from the inception of databases to 15th August 2020.Results: All randomized controlled trials (RCTs) comparing CO2 vs. air insufflation for GI endoscopic procedures in pediatric patients were eligible for inclusion. Five RCTs were identified. Pooled analysis of data from 226 patients in the CO2 group and 224 patients in the air group revealed that patients receiving CO2 insufflation were at a lower odds of experiencing postoperative pain as compared to those undergoing the procedure with air (OR: 0.40; 95% CI: 0.19, 0.87; I2 = 62%; p = 0.02). Descriptive analysis indicated no difference in the two groups for abdominal distention after the procedure. Two trials reported elevated CO2 in the study group but without any pulmonary complications. Bloating was reported by two studies and both reported significantly less bloating in the CO2 group.Conclusion: Our study indicates that the incidence of pain may be reduced with the use of CO2 insufflation in pediatric GI endoscopies without a significant risk of adverse events. However, current evidence is from a limited number of trials and not strong to recommend a routine of CO2 in pediatric gastroenterology practice. Further high-quality RCTs are required to supplement current evidence.

Download Full-text