[Evaluation of therapeutic effect of children's dental treatment under general anesthesia: 111 cases report].

OBJECTIVE: To retrospectively evaluate the efficiency of dental treatment under general anesthesia (GA) in child patients, and analyze the related factors. METHODS: The records of patients treated under GA in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, between Aug 2008 and Jun 2012 were collected and analyzed. Two hundred and twenty eight records were found, of which 111 patients under 18 years old who were recalled more than 3 months after GA were selected randomly. The unplanned treatments including caries, failed restoration, root canal treatment and space maintenance fall-off etc. were recorded and analyzed. The survival rate and median survival time of the teeth were calculated, and a multivariate analysis was performed by Cox proportional hazard model. RESULTS: Totally, there were 1 415 teeth treated under GA. The median survival time was 825 days, 77.0% of the teeth were present during their recall period. The median time of the first unplanned treatment was 215 days, and the failed restoration was the main reason for the unplanned treatment. Other factors such as the age at treatment, gender, total number of decayed teeth, reason for GA, and living place were found unassociated with the survival rate. CONCLUSION: The effect of dental treatment under GA is satisfied. Regular dental visit after GA is very important for children's dental health.

[A retrospective study of 693 children's dental treatment under general anesthesia].

OBJECTIVE: To retrospectively analyze the clinical features of children who received dental treatment under general anesthesia (GA) and the characteristics of dental treatment. METHODS: The records of 693 patients treated under GA in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, between Jan. 2001 and Dec. 2012 were collected and analyzed. RESULTS: The numbers of patients treated under GA increased year-to-year. Most of them were under 4-year-old. The main reasons of dental treatment under GA were uncooperative and disabled. The average number of teeth treated was 12±4 for each child, and the average time for treating one tooth was 12 min. The 3 months follow-up rate was 60.31%, and the older, the fewer treated tooth number and out-of-town associated with the less follow-up rate. CONCLUSION: The main reasons of dental treatment under GA are uncooperative and disabled. GA is an effective and safe method for dental rehabilitation in children.

[Effects of different concentrations of glucose infusion during the cleft lip and palate repair in infant patients].

OBJECTIVE: To analyze the feasibility of regular infusion with different concentrations of dextrose and blood glucose monitor in infant from 2 to 12 months during operation. METHODS: Ninety ASA(American Society of Anesthesiologists) I-II infants (age 2-12 months) who undertook cleft lip and palate repair (excluding patients with congenital diabetes) were divided into three groups (30 cases per group). Group I patients were infused with normal saline, Group II with 2.5% (mass fraction) dextrose in normal saline and Group III with 5% (mass fraction) dextrose, all by a rate of 6-8 mL/ (kg x h). Once the patient was sent into the operation room, Electrocardiogram(ECG) and Pulse Oxygen Saturation[SpO(2)] monitor were applied regularly; and anesthesia was inducted and maintained with sevoflurane in oxygen. The infants' age, gender, weight, fasting time, operation time and duration of anesthesia were recorded and the blood glucose concentrations before infusion, 10 minutes and 30 minutes after induction as well as at the end of operation were recorded. RESULTS: There were no differences in age, gender, weight, fasting time, operation time and duration of anesthesia among the three groups. The differences of blood glucose concentrations before induction had no statistical significance among the three groups. The blood glucose concentration after induction was higher than that before induction in each group. The occurrence of lower level of blood glucose in Group I was 13.3% (4/30, 2.8-4.3 mmol/L), with the lowest value being 3.1 mmol/L. None was detected hyperglycemia. In Group II, blood glucose value after induction was lower than Group III and higher than Group I at every time point and incidence rate of hyperglycemia was 10% (3/30, >11.1 mmol/L), with the highest value being 12.7 mmol/L. Blood glucose in Group III was higher than both Group I and Group II after infusion. Incidence rate of hyperglycemia in Group III was 70% (21/30, >11.1 mmol/L), with the highest value being 22.1 mmol/L. After induciton 5, 10 min and the end of operation, blood glucose values with group I were (5.8 + or - 1.3) mmol/L, (8.4 + or - 1.7) mmol/L and (10.6 + or - 2.8) mmol/L; group II were (6.3 + or - 1.4) mmol/L, (8.5 + or - 2.5) mmol/L and (11.3 + or - 2.9) mmol/L; group III were (6.6 + or - 1.5) mmol/L, (8.2 + or - 2.1) mmol/L and (12.2 + or - 3.5) mmol/L. CONCLUSION: 2.5% dextrose (at a rate of 6-8 mL/ (kg x h) is appropriate for infants during cleft lip and palate repair, while regular blood glucose monitor should be applied during operation.

[Clinical evaluation of oral midazolam sedation for dental treatment in children].

OBJECTIVE: To assess the safety, effectiveness and acceptability of oral midazolam sedation for dental treatment in children. METHODS: Twenty-three health children aged 4 to 14 (ASA I), who were classified as 4 or 5 by modified Venham's clinic anxiety and cooperative behavior rating scale, referred for dental treatment were included in the study. Each child was treated under sedation with oral midazolam (0.15-0.70 mg/kg), and totally 45 sedations were conducted. At each visit, heart rate, arterial oxygen saturation, respiration rate, sedation and behavioral scores were recorded. The level of acceptance and satisfaction of the patients and their guardians were recorded after the treatment. RESULTS: Among the 23 children, 19 were boys and 4 were girls with mean age of 6.2 years old. In all the 45 treatments, the heart rate, respiratory rate and arterial oxygen saturation levels were within acceptable clinical limits. Forty planned treatments were completed satisfactorily. Oral sedation was ineffective in 3 children, and they were treated under general anesthesia. Only 2 guardians refused to have oral midazolam sedation again. Six of seven children who had regular dental check-up could be treated under normal condition. CONCLUSION: Oral midazolam (0.15-0.70 mg/kg) could be a safe and acceptable approach of sedation for pediatric dental patients.

[Comparison of antalgic effects of patient-controlled intravenous lornoxicam and sufentanil in patients after oral maxillofacial surgery].

OBJECTIVE: To compare the analgesic efficiency and adverse effects of postoperative patient-controlled intravenous analgesia (PCIA) with lornoxicam and sufentanil in patients undergoing oral maxillofacial surgery. METHODS: 200 ASA (American Society of Anesthesiologists) I-II patients who undertook oral maxillofacial operation were divided into two groups: lornoxicam group (group L) and sufentanil group (group S), with 100 patients in each group. The effectiveness was assessed with visual analogue scale (VAS), Prince-Henry score (PHS) and Ramsay sedation Score (RSS) at different time points: 4, 8, 12, 24 and 48 h after the beginning of analgesia. The analgesic efficacy of analgesia and the adverse effects during analgesia period were observed. RESULTS: Statistical analysis revealed no significant difference in VAS, PHS and RSS at 4, 8, 12, 24, 48 h and the overall satisfaction on analgesia therapy. The percentage of nausea, vomiting and dizziness was significantly lower in group L than that in group S (1% vs 9%, 0 vs 4%, 0 vs 3%, P<0.05). CONCLUSION: Lornoxicam could provide an identical efficacy as sufentanil in the postoperative PCIA in patients undergoing oral maxillofacial surgery. In addition, lornoxicam caused less adverse effects.

[Efficacy and safety of low-energy QS Nd:YAG and QS alexandrite laser for melasma].

OBJECTIVE: To assess the efficacy and safety of low-energy QS Nd : YAG and QS alexandrite laser for melsasma. METHODS: We treated 32 patients with melasma using the low-energy QS Nd : YAG and QS alexandrite laser. Pigment subsided by > or = 90% was regarded as "cured", by 60% -89% as "remarkably improved", by 30% -59% as "effective", and by < 30% as "ineffective" . RESULTS: Among the 32 patients, 21 patients (65.6%) were cured after (10.2 +/- 3.5) times (range: 4-15 times) of treatments, 11 patients (34.4%) were remarkably improved after (11.4 +/- 2.5) times (range: 10-14 times) of treatment. The rates of "cured" and "remarkably improved" were 81.3% and 18.7% among patients with light brown melasma and 50.0% and 50.0% among patients with dark brown melasma (P < 0.05). In patients with a disease history of less than 2 years, the rates of " cured" and "remarkably improved" were 87.5% and 12.5%, which was significantly better than the treatment results of patients with a disease history of more than 2 years (the rates of "cured" and "remarkably improved" were 58.3% and 41.7%) (P < 0.05). No hyperpigment and scarring was observed and only one patient experienced a transient pigment loss. CONCLUSIONS: Lower-energy QS Nd : YAG and QS Alexandrite Laser can be used to treat patients with melasma safely and effectively. The color and disease course of melasma were factors that may affect the treatment results.

[Perioperative risk factors evaluation of cleft palate repair in Pierre Robin sequence at early age].

OBJECTIVE: To evaluate the perioperative risk factors of the cleft palate repair in Pierre Robin sequence patients at early age and to investigate how to control the risk factors. METHODS: Six consecutive patients with Pierre Robin sequence underwent primary repair of cleft palate in Department of Oral Maxillofacial Surgery, Peking University School of Stomatology from June 2001 to February 2004. The patients underwent von Longenbeck operation by the same perioperative observation of serum oxygen saturation were obtained for these patients. patients included 4 males and 2 females with age of 9 months to 5 surgeon. Pre- and post-operative polysomnographic studies and years. RESULTS: All the patients suffered various degree of hypoxaemia during the period of intubation. There was only one patient who had hypoxaemia within the first 2 hours during postanaesthetic recovery period. No obvious difference was found in apnea and hypopnea index (AHI) among the patients before and after operation. CONCLUSIONS: Severe hypoxaemia may happen in perioperative period when the patients with PRS underwent cleft palate repair. Most patients with PRS could undergo cleft palate repair safely performed by experienced surgeon at early age under comprehensive consideration and careful control of the risk factors.