Comparison of Midazolam and Dexmedetomidine for sedation in Postoperative intubated patients of head and neck surgery on spontaneous ventilation in Intensive care unit

Introduction: Sedation is important in the care of the critically ill and postoperative patients. Amount of drug and duration for which it is given, is important in determining patient outcome. Aim: Study aimed to compare the safety and efficacy of injection midazolam and injection dexmedetomidine for sedation in postoperative patients of oromaxillofacial surgery with endotracheal tube in-situ, on spontaneous ventilation in ICU. Methodology: This prospective, randomized, comparative study was conducted on 60 patients undergoing oromaxillofacial surgery who were randomized in two groups of 30 patients each. Group D received injection demedetomidine loading dose of 1μg/kg over 15 minutes, followed by infusion at the rate of 0.2-0.7µg/kg/hr (microgram/kilogram/hour) and Group M received injection midazolam loading dose of 0.05mg/kg over 15 minutes followed by maintenance infusion at the rate of 0.02-0.06mg/kg/hr (milligram/kilogram/hour). The monitored indices included heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, SpO2 and Ramsay sedation score at the start of sedation when the Ramsay sedation score (RSS) was I and time to extubation after stopping sedation. Results: Target sedation range was achieved in a mean duration of 10.36 ± 3.05 minutes in dexmedetomidine group and that in midazolam group was 7.43±2.06 minutes. Highest value of RSS score in dexmedetomidine group was 2.43±0.50, which was observed at the 4th and 10th hour whereas in midazolam group it was 2.83±0.38 which was observed at 6th hour of the study period. Total dose of rescue analgesic required was more in midazolam group as compared to the dexmedetomidine group. The mean duration of extubation after cessation of sedation was 33.27±11.37 minutes in dexmedetomidine group and 49.43±5.58 minutes in midazolam group. Conclusion: Injection dexmedetomidine is better as compared to injection midazolam for postoperative sedation.

Accidental arterial catheterisation during a maxillary nerve block using a modified infraorbital approach in a dog

The maxillary nerve block (MNB) is a local anaesthetic technique used in dentistry and oromaxillofacial surgery, with recent popular use for minimising adverse reactions during rhinoscopy. A modified approach via the infraorbital foramen using an intravenous catheter has been recently described in the veterinary literature to minimise potential nerve block associated complications. This case report describes inadvertent arterial catheterisation using the aforementioned technique in a 5.4-kg, 9-year-old male neutered Maltese terrier cross that was presented for diagnostic workup of a chronic cough that had recently worsened. To the authors’ knowledge, this is the first case report of such a complication. It is recommended for veterinary practitioners to be aware of accidental arterial puncture and catheterisation whenever a modified infraorbital approach to the MNB is performed in order to facilitate rapid intervention and management.

Submandibular Approach for Tracheal Intubation in Oro-maxillofacial Surgery: An Initial Experience in a Dental College Hospital in Bangladesh

Background: Tracheal intubation in oro-maxillofacial surgery is an important issue during operation. Objective: The purpose of the present study was to demonstrate the feasibility and the reliability of submandibular tracheal intubation as an alternative method for airway management in oro-maxillofacial surgery. Methodology: This clinical trial was conducted in the Department of oromaxillofacial Surgery at Dhaka Dental College and Hospital, Dhaka from January 2010 to June 2011 for a period of one and half year. Patients suffering from painful fractures associated with displaced nasal fracture were selected as study population. Results: A total number of 9 patients were recruited for this study of which 1 was female and 8 were males and the age range was between 16 to 51 years. The technique was found easy and offers a secure airway to the anaesthetist, an optimal operating field and an opportunity to check the dental occlusion with limited morbidity for the patient. In all patients the submandibular tracheal tube was extubated after the operation without complications or difficulties. Accidental dislodgement of the tube to the right main bronchus occurred in one patient while carrying out the procedure. It was rapidly detectedand corrected. No other complications were encountered. Conclusion: Submandibular tracheal intubation is a safe, simple and effective technique for upper airway management when both oral and nasal tracheal intubations are not convenient in some oromaxillofacial surgery. Journal of National Institute of Neurosciences Bangladesh, 2015;1(2): 41-46

The impact of Scottish Government protocols on practice in Scotland

Objectives:To investigate rates of septorhinoplasty and rhinoplasty in Scotland between 2006 and 2010, and to establish the impact of government legislation.Methods:Data on the rates of rhinoplasty and septorhinoplasty were collected and analysed according to specialty, region and year.Results:In 2006, 754 septorhinoplasty and rhinoplasty cases were recorded (147 per million population), rising to 893 (171 per million population) in 2010. Mean annual rates per million population were 152 (87 per cent of procedures) in ENT, 13.9 (8 per cent) in plastic surgery and 8.7 (8 per cent) in oromaxillofacial surgery. After 2009, there was a 43 per cent reduction in the rhinoplasty rate (p < 0.0001), although the oromaxillofacial surgery rate increased by 68 per cent (p < 0.05). Over the same period, the septorhinoplasty rate increased in ENT (46 per cent, p < 0.0001), and declined in plastic surgery (24 per cent, p = 0.49) and oromaxillofacial surgery (45 per cent, p = 0.05). Overall, the rate for rhinoplasty plus septorhinoplasty only declined by 1 per cent. There was significant regional variation.Conclusion:Overall, septorhinoplasty rates have increased and rhinoplasty rates have decreased. There was only a 1 per cent decrease in the overall rate following the 2009 legislation. Practice differs between regions.