scholarly journals Independent Factors Affecting Recovery Time After Sedation in Patients with Intellectual Disabilities

2015 ◽  
Vol 9 (1) ◽  
pp. 146-149 ◽  
Author(s):  
Shigeru Maeda ◽  
Yumiko Tomayasu ◽  
Hitoshi Higuchi ◽  
Minako Ishii-Maruhama ◽  
Ayaka Yamane ◽  
...  
Keyword(s):  
Intellectual Disabilities ◽  
Psychotropic Drugs ◽  
Recovery Time ◽  
Dental Treatment ◽  
Outcome Variable ◽  
Intravenous Sedation ◽  
Factors Affecting ◽  
Oral Midazolam ◽  
Prolonged Recovery ◽  
Independent Determinant

Purpose:The purpose of this study was to identify independent factors associated with prolonged recovery time after intravenous sedation for dental treatment in patients with intellectual disabilities.Methods:This study was designed as a prospective cohort study. Participants were patients with intellectual disabilities, for whom sedation for dental treatment was planned in Okayama University Hospital. The outcome variable was recovery time. The predictor variables were patient background, antiepileptic and psychotropic drugs, and anesthesia-related variables. Factors affecting the outcome were examined with multiple regression analysis.Results:We enrolled 260 cases in this study. Oral midazolam was a strong independent determinant in prolonged recovery time. Teeth extraction, short treatment time and lower body mass index were significant independent predictors of prolonged recovery time.Conclusion:Oral midazolam is a clear independent determinant of prolonged recovery time after sedation, while psychotropic drugs and antiepileptic drugs were not independent determinants in this study.

scholarly journals Independent Predictors of Delay in Emergence From General Anesthesia

2015 ◽  
Vol 62 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Shigeru Maeda ◽  
Yumiko Tomoyasu ◽  
Hitoshi Higuchi ◽  
Minako Ishii-Maruhama ◽  
Masahiko Egusa ◽  
...  
Keyword(s):  
Intellectual Disabilities ◽  
General Anesthesia ◽  
Antiepileptic Drugs ◽  
Multivariate Regression ◽  
Dental Treatment ◽  
Multivariate Regression Analysis ◽  
Emergence Time ◽  
Factors Affecting ◽  
Dental Patients ◽  
Time Parameters

Abstract Some patients with intellectual disabilities spend longer than others in emergence from ambulatory general anesthesia for dental treatment. Although antiepileptic drugs and anesthetics might be involved, an independent predictor for delay of the emergence remains unclear. Thus, a purpose of this study is to identify independent factors affecting the delay of emergence from general anesthesia. This was a retrospective cohort study in dental patients with intellectual disabilities. Patients in need of sedative premedication were removed from participants. The outcome was time until emergence from general anesthesia. Stepwise multivariate regression analysis was used to extract independent factors affecting the outcome. Antiepileptic drugs and anesthetic parameters were included as predictor variables. The study included 102 cases. Clobazam, clonazepam, and phenobarbital were shown to be independent determinants of emergence time. Parameters relating to anesthetics, patients' backgrounds, and dental treatment were not independent factors. Delay in emergence time in ambulatory general anesthesia is likely to be related to the antiepileptic drugs of benzodiazepine or barbiturates in patients with intellectual disability.

Factors Affecting Self-Reported Pain in Children receiving Dental Treatment

2017 ◽  
Vol 19 (2) ◽  
pp. 2441-2452
Author(s):  
Fatma Abd El-Manem Hendawy ◽  
Sawsan Hafez Mahmoud
Keyword(s):  
Dental Treatment ◽  
Factors Affecting

Systemic Determinants in Surgery: Nonclinical Factors Affecting Time to Operation for Incarcerated Ventral Hernias

2021 ◽  
pp. 000313482110111
Author(s):  
David E. Wang ◽  
Paul J. Chung ◽  
Rafael Barrera ◽  
Gene F. Coppa ◽  
Antonio E. Alfonso ◽  
...  
Keyword(s):  
Operating Room ◽  
Negative Binomial ◽  
Private Insurance ◽  
Negative Binomial Regression ◽  
Outcome Variable ◽  
Hospital Size ◽  
Factors Affecting ◽  
Binomial Regression ◽  
Comorbidity Status ◽  
Ventral Hernias

Introduction We explore nonclinical factors affecting the amount of time from admission to the operating room for patients requiring nonelective repair of ventral hernias. Methods Using the 2005-2012 Nationwide Inpatient Sample, we identified adult patients with a primary diagnosis of ventral hernia without obstruction/gangrene, who underwent nonelective repair. The outcome variable of interest was time from admission to surgery. We performed univariate and multivariable analyses using negative binomial regression, adjusting for age, sex, race, income, insurance, admission day, comorbidity status (van Walraven score), diagnosis, procedure, hospital size, location/teaching status, and region. Results 7,253 patients met criteria, of which majority were women (n = 4,615) and white (n = 5,394). The majority of patients had private insurance (n = 3,015) followed by Medicare (n = 2,737). Median time to operation was 0 days. Univariate analysis comparing operation <1 day to ≥1 day identified significant differences in race, day of admission, insurance, length of stay, comorbidity status, hospital location, type, and size. Negative binomial regression showed that weekday admission (IRR 4.42, P < .0001), private insurance (IRR 1.53-2.66, P < .0001), rural location (IRR 1.39-1.76, P < .01), small hospital size (IRR 1.26-1.36, P < .05), white race (IRR 1.30-1.34, P < .01), healthier patients (van Walraven score IRR 1.05, P < .0001), and use of mesh (IRR 0.39-0.56, P < .02) were associated with shorter time until procedure. Conclusion Shorter time from admission to the operating room was associated with several nonclinical factors, which suggest disparities may exist. Further prospective studies are warranted to elucidate these disparities affecting patient care.

scholarly journals Effective Dosage of Midazolam to Erase the Memory of Vascular Pain During Propofol Administration

2016 ◽  
Vol 63 (3) ◽  
pp. 147-155 ◽  
Author(s):  
Aiji Boku ◽  
Mika Inoue ◽  
Hiroshi Hanamoto ◽  
Aiko Oyamaguchi ◽  
Chiho Kudo ◽  
...  
Keyword(s):  
Roc Analysis ◽  
Operating Characteristic ◽  
Dental Treatment ◽  
Common Adverse Effect ◽  
Effective Dosage ◽  
Injection Pain ◽  
Intravenous Sedation ◽  
Logistic Analysis ◽  
Ramsay Sedation Scale ◽  
Vascular Pain

Intravenous sedation with propofol is often administered to anxious patients in dental practice. Pain on injection of propofol is a common adverse effect. This study aimed to determine the age-adjusted doses of midazolam required to erase memory of vascular pain of propofol administration and assess whether the Ramsay Sedation Scale (RSS) after the pretreatment of midazolam was useful to predict amnesia of the vascular pain of propofol administration. A total of 246 patients with dental phobia requiring dental treatment under intravenous sedation were included. Patients were classified according to their age: 30s, 40s, 50s, and 60s. Three minutes after administration of a predetermined dose of midazolam, propofol was infused continuously. After completion of the dental procedure, patients were interviewed about the memory of any pain or discomfort in the injection site or forearm. The dosage of midazolam was determined using the Dixon up-down method. The first patient was administered 0.03 mg/kg, and if memory of vascular pain remained, the dosage was increased by 0.01 mg/kg for the next patient, and then if the memory was erased, the dosage was decreased by 0.01 mg/kg. The effective dosage of midazolam in 95% of each age group for erasing the memory of propofol vascular pain (ED95) was determined using logistic analysis. The accuracy of RSS to predict the amnesia of injection pain was assessed by receiver operating characteristic (ROC) analysis. The ED95 of midazolam to erase the memory of propofol vascular pain was 0.061 mg/kg in patients in their 30s, 0.049 mg/kg in patients in their 40s, 0.033 mg/kg in patients in their 50s, and 0.033 mg/kg in patients in their 60s. The area under the ROC curve was 0.31. The ED95 of midazolam required to erase the memory of propofol vascular pain demonstrated a downward trend with age. On the other hand, it was impossible to predict the amnesia of propofol vascular pain using the RSS.

scholarly journals A systematic review of convalescent plasma treatment for COVID19

2020 ◽  
Author(s):  
Ville N. Pimenoff ◽  
Miriam Elfström ◽  
Joakim Dillner
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Recovery Time ◽  
Clinical Trial Data ◽  
Poisson Model ◽  
Clinical Report ◽  
Prolonged Recovery ◽  
Report Data ◽  
Using Data ◽  
Clinical Trial Results

ABSTRACTBackgroundTransfusion of convalescent immune plasma (CP) is commonly used in epidemics. Several articles now describe clinical report data of CP for treatment of SARS-CoV-2-induced COVID-19 disease.MethodsA systematic literature review was conducted using the NCBI curated COVID-19 related open-resource literature database LitCovid to identify studies using CP as treatment for COVID-19 patients. We retrieved and curated all COVID-19 related patient and treatment characteristics from previously reported studies. A Poisson model was developed to evaluate the association between age of the patients, older age being the most common risk factor for COVID-19 mortality, and recovery time since CP treatment using data extracted from the literature.ResultsFrom 18,293 identified COVID-19 related articles, we included ten studies reporting results of CP treatment for COVID-19 from a total of 61 patients. Decreased symptoms of severe COVID-19 and clearance of SARS-CoV-2 RNA were the most direct observations. We found that patients over the age of sixty who received CP treatment for COVID-19 had a significantly prolonged recovery estimated by viral clearance (from 10 to 29 days since first dose of CP) compared to younger patients, who recovered from the infection in less than a week after receiving CP treatment.ConclusionsLimited published results on plasma transfusion treatment for COVID-19 disease with concomitant treatments suggest that CP therapy for COVID-19 is well tolerated and effective. First randomized clinical trial results, however, revealed no improvements in recovery time for elderly patients with severe COVID-19 between standard treatment alone and added with convalescent plasma. Accordingly, we argue that older patients may need a significantly longer time for recovery. Further randomized clinical trial data for COVID-19 with rigorous ethical standards is urgently needed.

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