Postoperative evaluation of special needs and healthy patients with endodontic treatment under general anesthesia: a retrospective research.

BACKGROUND: This retrospective clinical study was undertaken to comparatively evaluate the number of restorative treatments, endodontic treatments, and tooth extractions performed for patients under general anesthesia due to dental anxiety or special needs between 2015 and 2022 and to examine the pain, bleeding, nausea, and vomiting data of those patients. METHODS: In total, 1165 patients underwent dental treatment under general anesthesia in the faculty hospital. Those under the age of 15 and with no endodontic procedure planned (n = 918) were excluded, followed by those with incomplete data (n = 25) and those without endodontic treatment (n = 25). Patients who underwent at least one endodontic treatment were finally included in the study (n = 184). Patients were divided into two groups: healthy and with special needs. Dental treatments were recorded as endodontic, restorative, and teeth extractions. Endodontic treatments were classified according to the tooth type (premolar, molar, and incisors). The composite restorations were classified as anterior, occlusal (O), occluso-distal (OD) or occluso-mesial (OM), and mesio-occluso-distal (MOD) restorations and patients' post-treatment pain, nausea, vomiting, and bleeding were recorded. The data were analyzed statistically. RESULTS: Among the 184 patients included in the study, 70 (38%) were healthy, and 114 (62%) had special needs. Postoperative bleeding was observed more in patients with special needs (χ2 = 4.189, p < 0.05), whereas pain was observed more in healthy patients (U = 2922.00, p < 0.05). While the number of anterior, O, and MOD restorations was higher in patients with special needs, the number of OD or OM restorations was higher in healthy patients (χ2 = 74.877, p < 0.05). CONCLUSIONS: Patients with special needs undergo a greater number of restorative treatments compared to control patients, which may be associated with the inadequate oral hygiene care of such patients. However, restorative treatment is mostly indicated for such patients in our faculty hospital, which may indicate that a conservative approach is taken. Additionally, the finding that postoperative bleeding was more severe in this group of patients compared to the control group in this study may emphasize the need to consider more possible complications after general anesthesia in these patients.

Comparison of Dexmedetomidine and Ketamine for Managing Postoperative Symptoms After Third-Molar Surgery.

PURPOSE: Lower-impacted third-molar surgery is the most common oral-maxillofacial surgery procedure and involves a considerable degree of soft- and bony-tissue trauma. This study measured and compared postoperative sequalae between patients receiving dexmedetomidine or ketamine after third-molar surgery. PATIENTS AND METHODS: This study was a randomized double-blind prospective trial. The patients were divided into 2 groups: ketamine and dexmedetomidine. Pain, swelling, and trismus outcomes were evaluated before and 2 and 7 days after surgery. In addition, patients were asked to record the number and timing of oral analgesic tablets they required during the postoperative period. Data were analyzed using the Mann-Whitney U test and a repeated-measures general linear model. The significance level was set at P < .05. RESULTS: The study included 66 patients (38 women and 28 men) undergoing extraction of impacted mandibular third molars. Significant differences were found between the groups in visual analog scale pain scores at 1, 6, and 12 hours after surgery (P < .001, P = .010, and P = .030, respectively). Trismus and swelling did not differ significantly between the 2 groups (P > .05). CONCLUSIONS: Ketamine resulted in less postoperative pain than dexmedetomidine during the first 12 hours after third-molar surgery.

Assessment of Effect of Submucosal Injection of Dexmedetomidine on Postoperative Symptoms.

PURPOSE: Embedded third molar surgery is the most frequent oral-maxillofacial surgical procedure performed. The purpose of this study was to assess the clinical effect of submucosal dexmedetomidine (dex) on decreasing postoperative edema, trismus, and pain after surgical molar extraction. MATERIALS AND METHODS: We carried out a double-blind, randomized, prospective study including patients undergoing surgical bilateral embedded mandibular molar extraction. Patients were divided into 2 groups: those receiving saline solution and those receiving dex. The main outcome measures of pain, facial swelling, and trismus were assessed on days 2 and 7 after surgery. In addition, patients were requested to record the time rescue analgesics were taken, as well as the total number taken. The variables were analyzed using the Student t test and a repeated-measures general linear model. P < .05 was considered statistically significant. RESULTS: The study included 40 patients (9 women and 11 men per group; mean age, 23.40 years) undergoing surgical bilateral embedded mandibular molar extraction. On day 2, a statistically significant difference in edema was found between the groups (P = .004). On days 2 and 7, statistically significant differences in the severity of trismus were found between the groups (P = .001 and P < .001, respectively). In addition, statistically significant differences were found between the groups in visual analog scale pain scores at 1, 6, 12, 24, and 48 hours (P = .161, P = .038, P = .110, P = .136, and P = .007, respectively) and in the number of analgesic tablets taken (P < .001). CONCLUSIONS: Preoperative submucosal dex is an efficient, safe, and beneficial therapeutic strategy to decrease edema, trismus, and pain after surgical molar extraction.

The incidence of postoperative residual curarization following the use of intermediate-acting muscle relaxants and related factors.

PURPOSE: To evaluate the incidence of residual curarization (RC) and related risk factors in the early and late postoperative periods in patients receiving general anesthesia with intermediate-acting muscle relaxants. METHODS: Two-hundred and eight American Society of Anesthesiologists class I and II patients, aged 18-70 years, who underwent general anesthesia with intermediate-acting muscle relaxants, were included. Heart rate, blood pressure, oxygen saturation, tympanic temperature were recorded for each patient who was transported to the recovery room, every 10 minutes by a trained nurse. To define the efficacy of residual muscle relaxants, neuromuscular monitoring was performed, and Train of Four (TOF) ratios < 90% were regarded as RC whereas ratios ≥ 90% were considered as adequate neuromuscular recovery in early and late recovery periods. Age, duration of anesthesia, repeated doses, reversal and types of intermediate-acting neuromuscular blockers were evaluated as risk factors for RC. Logistic Regression Analysis was performed to define the risk factors for RC in early and late periods. RESULTS: The RC rate was 10.6% in the early recovery period, and short duration of anesthesia, repeated doses and lack of reversal use were the risk factors for RC. However, RC rate was 2.9% in the late recovery period, and the only risk factor was repeated doses. CONCLUSION: Reversal use was shown to reduce residual effects of intermediate-acting muscle relaxants in early recovery period, whereas risk of RC in 30 min in PACU was shown to increase with repeated doses of muscle relaxants.

Comparison of the HugeMed video laryngoscope with the Macintosh direct laryngoscope for nasotracheal tracheal intubation in children undergoing dental treatment: a randomized controlled clinical study.

OBJECTIVES: The aim of this study was to compare the performance of the HugeMed® videolaryngoscope with a direct Macintosh laryngoscope for nasotracheal intubation. METHODS: Eighty-eight children aged 4-10 years were randomly assigned to either the HugeMed® videolaryngoscope (HVL) or the Macintosh direct laryngoscope (MDL) group. Intubation difficulty, glottic view grade, time-to-intubation, number of tracheal intubation attempts, use of external laryngeal manipulation and Magill forceps, recovery time, pediatric-anesthesia-delirium-scale (PAEDS) scores, pain due to tracheal intubation, and laryngeal bleeding were evaluated. RESULTS: Easy tracheal intubation incidence was higher in the HVL group than that in the MDL group (p = 0.001). Glottic view was better in the HVL group as compared to the MDL group (p = 0.027). There was no difference between the groups in terms of time-to-tracheal intubation, number of tracheal intubation attempts, Magill forceps usage, pain, and bleeding due to tracheal intubation. The need for external laryngeal manipulation (p = 0.004) and PAEDS scores (p = 0.006) were higher in the MDL group than those in the HVL group. CONCLUSION: HugeMed® videolaryngoscope may provide easier tracheal intubation, create a better glottic view, and significantly reduce the need for additional manipulation compared to the Macintosh direct laryngoscope, for nasotracheal intubation. CLINICAL TRIAL REGISTRATION: www.clinicaltrial.gov identifier is NCT05121597.

The incidence of residual neuromuscular blockade associated with single dose of intermediate-acting neuromuscular blocking drugs.

BACKGROUND: The goal of this study is to investigate the incidence and risk factors of residual paralysis associated with single-dose intermediate-acting muscle relaxants (atracurium, vecuronium, rocuronium) during early postoperative period. METHODS: Adult patients (ASA I and II) who received a single dose of vecuronium, atracurium or rocuronium during general anesthesia for elective surgical procedure were included in the study. Train-of-four (TOF) ratios under 0.9 were recorded as "postoperative residual neuromuscular block (PRNB)". Age, weight, gender, reversal, anesthesia duration, time for transfer to the recovery room after extubation were studied regarding with PRNB. RESULTS: 84 patients were included in this study. 29 patients were received vecuronium, 28 patients were received atracurium and 27 patients were received rocuronium. Neostigmine was used for reversal in 49 patients (58.3%) at the end of the surgery. PRNB incidence (TOF < 0.9) was 13.1%. Based on the regression analysis, the only risk factor affecting PRNB was found as gender. PRNB risk was increased in women (OR: 7.250, 95%, CI: 1.019-51.593). CONCLUSION: In patients who have general anesthesia longer than one hour, "gender" may affect residual paralysis incidence associated with single-dose intermediate-acting muscle relaxants use.

Efficacy of Preemptive Analgesia on Postoperative Pain Control in Children Who Underwent Full-Mouth Dental Rehabilitation Under General Anesthesia: A Randomized Controlled Clinical Trial.

AIMS: To evaluate the efficacy of intravenous preemptive analgesia on postoperative pain in children undergoing dental rehabilitation under general anesthesia. METHODS: In this prospective randomized clinical trial, 70 children aged 3 to 7 years were scheduled for dental treatment and randomized into two groups: the control group or the preemptive group. Patients received 15 mg/kg of intravenous paracetamol either before the start of treatment (preemptive group, n = 35) or at the end of treatment (control group, n = 35). Postoperative pain scores were recorded at 1, 2, 4, 6, 8, 12, and 24 hours using the Wong-Baker FACES Pain Rating Scale (WBFS). Additionally, the need for rescue analgesic and the total opioid consumption of the patients were recorded during the first 24 hours postoperative. RESULTS: The pain scores in the preemptive group were significantly lower than those in the control group at the postanesthesia care unit and at 2, 4, and 8 hours postoperative (P < .05). However, there were no statistically significant differences in pain scores between groups at 12 and 24 hours postoperative. Need for rescue analgesics and total intravenous fentanyl consumption were significantly higher in the control group than in the preemptive group (P < .05). The percentage of children who received medication for pain relief at home was higher in the control group than in the preemptive group, but the difference was not statistically significant (P > .05). CONCLUSION: Preemptive use of intravenous paracetamol reduces postoperative pain scores and postoperative opioid consumption. However, there is a need to evaluate pain levels in children who receive comprehensive dental treatment under general anesthesia after hospital discharge for effective postoperative pain control.

Propofol based total intravenous anesthesia versus sevoflurane based inhalation anesthesia: The postoperative characteristics in oral and maxillofacial surgery.

OBJECTIVE: Total intravenous anesthesia and inhalation/volatile anesthesia are the main general anesthesia procedures used in all surgical applications. The aim of this study was to compare sevoflurane anesthesia and total intravenous anesthesia with propofol in terms of postoperative complications, especially after oral and maxillofacial surgeries. MATERIAL AND METHODS: Each patient was taken to the recovery room following extubation, and the pulse rate, non-invasive blood pressure (NIBP) and oxygen saturation were monitored. Presence of hypoxia, tachycardia, bradycardia, hypertension and hypotension were determined as vital sign complications. RESULTS: The risk of complications related to vital functions were low for both anesthesia methods, and no statistically significant difference between the groups. The incidence of nausea and vomiting was found to be significantly higher in the patients undergoing both major (p = 0.011) and minor (p = 0.021) surgeries in the IA-S group. The recovery time was found to be significantly longer in the TIVA-P group compared to the IA-S group in the patients undergoing both major (p = 0.026) and minor surgery (p = 0.018). CONCLUSION: TIVA and IA methods, which are considered safe in terms of vital signs, should be preferred according to patient characteristics. Despite the fact that inhaled anesthetics require PONV premedication for long term interventions, we believe that they could be preferred due to shorter recovery time compared to intravenous anesthetics.

Comparison of oral dexmedetomidine and midazolam for premedication and emergence delirium in children after dental procedures under general anesthesia: a retrospective study.

BACKGROUND: Premedication is the most common way to minimize distress in children entering the operating room and to facilitate the smooth induction of anesthesia and is accomplished using various sedative drugs before the children are being transferred to the operating room. The aim of this study was to compare the effect of oral dexmedetomidine (DEX) and oral midazolam (MID) on preoperative cooperation and emergence delirium (ED) among children who underwent dental procedures at our hospital between 2016 and 2017. PATIENTS AND METHODS: The medical records of 52 children, who were American Society of Anesthesiologists I, aged between 3 and 7 years, and who underwent full-mouth dental rehabilitation under general anesthesia (GA), were evaluated. Twenty-six patients were given 2 µg/kg of DEX, while another 26 patients were given 0.5 mg/kg of MID in apple juice as premedication agents. The patients' scores on the Ramsay Sedation Scale (RSS), Parental Separation Anxiety Scale (PSAS), Mask Acceptance Scale, Pediatric Anesthesia Emergence Delirium Scale (PAEDS), and hemodynamic parameters were recorded from patients' files. The level of sedation of children had been observed just before premedication and at 15, 30, and 45 min after premedication. The data were analyzed using a chi-square test, Fisher's exact test, Student's t-test, and analysis of variance in SPSS. RESULTS: The Mask Acceptance Scale and PSAS scores and RSS scores at 15, 30, and 45 min after premedication were not statistically different (p>0.05) in both groups, whereas the PAEDS scores were significantly lower in the DEX group (p<0.05). CONCLUSION: Oral DEX provided satisfactory sedation levels, ease of parental separation, and mask acceptance in children in a manner similar to MID. Moreover, children premedicated with DEX experienced lesser ED than those premedicated with MID.

Recovery characteristics of total intravenous anesthesia with propofol versus sevoflurane anesthesia: a prospective randomized clinical trial.

BACKGROUND: Pediatric dental procedures are performed under anesthesia because children may be uncooperative in the dental clinic due to their young age. Emergence delirium (ED), which involves a variety of behavioral disturbances that are frequently observed in children following emergence from general anesthesia, remains an unclear phenomenon. The aim of this randomized controlled trial is to compare the incidence of ED in children who underwent full mouth dental rehabilitation under either sevoflurane (SEVO) anesthesia or propofol-based total intravenous anesthesia (TIVA). PATIENTS AND METHODS: One hundred and twenty children with American Society of Anesthesiologists status I-II, aged ≥3 and ≤6 years, undergoing dental rehabilitation were assigned to receive either TIVA or SEVO. ED and postoperative pain were evaluated by a blinded investigator using the Pediatric Anesthesia Emergence Delirium scale and the Face, Legs, Activity, Cry, Consolability scale every 5 min. The recovery time, satisfaction levels of parents or guardians, extubation time, duration of the operation, and type of dental procedure were also recorded. RESULTS: Data of 116 subjects were analyzed. The incidence of ED was higher after SEVO than after TIVA (65.5 vs 3.4%, P=0.00). Greater postoperative pain was observed in the SEVO group (median 3 vs 1, P=0.000). A statistically significant, moderate correlation (rs=0.46, P<0.0001) was found between the Face, Legs, Activity, Cry, Consolability and Pediatric Anesthesia Emergence Delirium scores. A higher parental satisfaction level was observed in the TIVA group. CONCLUSION: A lower incidence of ED and a higher parental satisfaction level were observed after TIVA. Moreover, TIVA resulted in a more comfortable postoperative period due to reduced postoperative pain, and the extubation time and recovery time were not increased.

Postoperative discomfort and emergence delirium in children undergoing dental rehabilitation under general anesthesia: comparison of nasal tracheal intubation and laryngeal mask airway.

BACKGROUND: Several studies have identified side effects of general anesthesia with endotracheal intubation, such as laryngeal pain, dysphonia, and postoperative nausea and vomiting (PONV). The laryngeal mask airway (LMAw) is believed to decrease these side effects. The aim of this trial was to compare postoperative discomfort, emergence delirium, and recovery time of patients who received either an LMAw or nasotracheal intubation (NTI). PATIENTS AND METHODS: A total of 70 children were randomly assigned to the LMAw group (n=35) or the NTI group (n=35). Both groups underwent mask induction with 8% sevoflurane. The NTI group received muscle relaxant, whereas the LMAw group did not. Postoperative laryngeal pain, dental pain, dysphonia, and PONV were assessed immediately and at 1 hour and 6 hours postoperatively. The Wong-Baker Faces Scale was used to evaluate the patients' self-reported pain. In addition, decayed, missing, and filled teeth (dft/DMFT) values, dental procedure type, number of dental procedures, duration of the dental operation, duration of anesthesia, recovery time, emergence delirium, pediatric dentist's access to the mouth, and parents' satisfaction levels were recorded. Data were analyzed using descriptive statistics, chi-square tests, and two-sample t-tests. RESULTS: The incidence of postoperative laryngeal pain was significantly higher in the NTI group immediately (97.2% vs. 8.5%, P=0.00), 1 hour (94.2% vs. 0%, P=0.00), and 6 hours postoperatively (25.7% vs. 0%, P=0.00). There were no statistically significant differences between the two groups in dental pain scores, dft/DMFT values, duration of anesthesia, duration of the dental operation, number of dental procedures, the incidence of PONV, or pediatric dentist's access to the mouth (P>0.05). Emergence delirium and recovery time were significantly higher in the NTI group (P<0.05). CONCLUSION: The LMAw provided a more comfortable postoperative period than NTI for children who underwent full-mouth dental rehabilitation under general anesthesia.

The Effect of Oral Dexmedetomidine Premedication on Preoperative Cooperation and Emergence Delirium in Children Undergoing Dental Procedures.

INTRODUCTION: The aim of this study was to detect the effect of 1 µg/kg of oral dexmedetomidine (DEX) as premedication among children undergoing dental procedures. MATERIALS AND METHODS: The study involved 100 children between 2 and 6 years of age, ASA I, who underwent full-mouth dental rehabilitation. The DEX group (n = 50) received 1 µg/kg DEX in apple juice, and the control group (n = 50) received only apple juice. The patients' scores on the Ramsay Sedation Scale (RSS), parental separation anxiety scale, mask acceptance scale, and pediatric anesthesia emergence delirium scale (PAEDS) and hemodynamic parameters were recorded. The data were analyzed using chi-square test, Fisher's exact test, Student's t-test, and analysis of variance in SPSS. RESULTS: RSS scores were significantly higher in the DEX group than group C at 15, 30, and 45 min (p < 0.05). More children (68% easy separation, 74% satisfactory mask acceptance) in the DEX group showed satisfactory ease of parental separation and mask acceptance behavior (p < 0.05). There was no significant difference in the PAEDS scores and mean hemodynamic parameters of both groups. CONCLUSIONS: Oral DEX administered at 1 µg/kg provided satisfactory sedation levels, ease of parental separation, and mask acceptance in children but was not effective in preventing emergence delirium. The trial was registered (Protocol Registration Receipt NCT03174678) at clinicaltrials.gov.

Immediate Postoperative Pain and Recovery Time after Pulpotomy Performed under General Anaesthesia in Young Children.

BACKGROUND: The aim of this retrospective study was to compare immediate postoperative pain scores and need for rescue analgesia in children who underwent pulpotomies and restorative treatment and those who underwent restorative treatment only, all under general anaesthesia. METHODS: Ninety patients aged between 3 and 7 years who underwent full mouth dental rehabilitation under general anaesthesia were enrolled in the study and reviewed. The experimental group included patients who were treated with at least one pulpotomy, and the control group was treated with dental fillings only. The Wong-Baker FACES scale was used to evaluate self-reported pain and need for rescue analgesia. The data were analysed using the Kruskal-Wallis test, two sample t-tests, chi-square tests, and Pearson's correlation analysis. RESULTS: Ninety percent of the children experienced postoperative pain in varying degrees of severity. Immediate postoperative pain scores in experimental group were found to be significantly higher than in control group (x2 = 24.82, p < 0.01). In the experimental group, 48% of the children needed rescue analgesia, compared with only 13% of the children in the control group (x2 = 13.27, p < 0.05). CONCLUSION: Children who underwent pulpotomy treatment had higher postoperative pain scores and greater need for rescue analgesia than control group who underwent only dental fillings.