Estudio comparativo lesional en judocas de élite / Lessional Comparative Study in Elite Judocas

El Judo es un deporte estático alto y dinánimo bajo, con alto riesgo de colisión corporal y lesional. El objetivo de este trabajo es determinar la incidencia lesional y comparar los distintos factores de riesgo que pudieran estar implicados. Se estudió a un total de 86 judocas del Equipo Nacional de Judo español (ENJE) durante dos períodos olímpicos: Beijing-Río. Se produjeron 2028 lesiones con mayor frecuencia en miembro inferior, sin diferencias significativas por sexo. Se objetivó mayor incidencia lesional cuando el judoca era tori y durante el momento del entrenamiento. No existen trabajos previos que comparen estos parámetros, por lo que este estudio aporta datos que pueden ser utilizados para prevenir los riesgos de lesión en el judo de alta competición. (AU)

Judo is a high static and low dynamic sport, with a high risk of bodily and injury collision. The objective of this work is to determine the incidence of injury and to compare the different risk factors that may be involved. A total of 86 judokas from the Spanish National Judo Team (ENJE) were studied during two Olympic periods: Beijing-Rio. 2028 injuries occurred more frequently in the lower limb, without significant differences by sex. A higher incidence was observed in tori judoka and during training. No existing work has examined these parameters. The present study provides data that can be used to reduce the risk of injury in elite judokas. (AU)

Oral midazolam sedation in third molar surgery.

A double-blind randomised study was designed to assess the value of oral midazolam in patients undergoing minor oral surgery. 30 young healthy Hong Kong Chinese with bilateral symmetrical impaction of lower third molars to be surgically removed in 2 visits, were included in the study. Randomly selected, a powdered midazolam tablet or placebo was given on the 1st visit and the alternative on the 2nd visit. 45 min were given for the drug to act. Surgical removal of the teeth was carried out by a single operator, randomly, one side being done at one visit. The majority who had midazolam were relaxed during the operation. Nearly 75% had partial to complete amnesia. Midazolam sedation lasted about 45 min, produced good operating conditions and stable vital signs with adequate verbal response. The main adverse effects were drowsiness and dizziness on the same day. The majority had never heard of oral sedation being available to supplement local anaesthesia. The majority preferred midazolam to placebo and preferred to have local anaesthesia supplemented with oral sedation for minor oral surgery in the future.

Paracetamol and diflunisal for pain relief following third molar surgery in Hong Kong Chinese.

In a double blind study in Hong Kong Chinese, 250 mg of diflunisal, 500 mg of paracetamol or placebo were given for post-operative pain relief following 77 third molar surgical procedures. The intensity of pain was recorded on a visual analogue scale. The first and second doses of paracetamol reduced pain significantly more than placebo, while this was true only for the second dose of diflunisal. There was no significant difference in pain reduction with the first and second dose of paracetamol, when compared with the first and the second dose of diflunisal. In this study in Hong Kong Chinese, neither the dose nor the interval between ingestion of the analgesic tablets in patients, who needed analgesics for postoperative pain, were significantly different to that reported before in non-Chinese, in contrast to the popular belief that Chinese patients have higher pain thresholds. However, a higher proportion of Chinese than that reported in non-Chinese did not need any analgesics for relief of postoperative pain.

Use of inhalational and intravenous sedation in dentistry.

Having gained knowledge of the advantages of inhalational and intravenous sedation many dental practitioners use these techniques to supplement local anaesthesia for dental procedures. Inhalational sedation is commonly carried out with nitrous oxide and oxygen while isoflurane in oxygen has also been tried out. Intravenous sedation is commonly carried out with midazolam or diazepam given as a single titrated dose to an end point which does not result in anaesthesia. When sedation with benzodiazepines is carried out, the specific antagonist, flumazenil should always be available for use in emergencies such as accidental oversedation, iatrogenic overdose or paradoxical reactions. Patient controlled sedation with midazolam, the modern technique of intravenous sedation, is comparable to anaesthetist controlled sedation and patients may be administered increments of one milligram at one minute intervals. Computer controlled sedation has been carried out with propofol. Mortality following sedation is low in the United Kingdom, partly due to the strict guidelines of the General Dental Council in the United Kingdom.

Patient maintained propofol sedation for dental surgery.

AIM: This study evaluated a system for patients to operate a target-controlled infusion (TCI) of propofol for sedation. PARTICIPANTS: 50 healthy adults, undergoing minor oral surgical procedures under local anaesthesia. METHODS: Following instructions, patients were allowed to control their own sedation to comfortably undergo surgery. OUTCOME MEASURES: Operating conditions, degree of sedation, vital signs and patients' assessment of the technique. RESULTS: Operating conditions were described as good in 47 patients and fair in 3. Optimal sedation was provided at a median target blood concentration of 2 mcg/ml (range1-3mcg/ml). 30 were sedated moderately, 16 deeply and 4 mildly. None were oversedated. The vital signs were stable in all patients. 30% of patients had injection pain and 28% became talkative. Patient satisfaction was high with 86% feeling adequately relaxed and 92% willing to use it again. 14 patients had complete and 22 had partial amnesia for the procedure. CONCLUSIONS: This technique combines the benefits of target-controlled infusion with patient-controlled feedback and produces safe dental sedation.

Conscious sedation with propofol.

The study was designed to assess the suitability of propofol for conscious sedation. Thirty-one patients undergoing bilateral third molar surgery were randomly given either propofol or midazolam for sedation as an adjunct to local anaesthesia at the first visit, and the alternative at the second visit. Propofol, like midazolam, produced reliable sedation, good operating conditions, stable vital signs and profound amnesia, with minimum intra-operative and post-operative adverse effects. Furthermore, most patients were willing to undergo either sedation procedure again. The advantages of propofol over midazolam were the ease with which the degree of sedation could be altered and the quick recovery. Its disadvantages were pain during injection, increased talkativeness, the extra equipment needed, and cost.

A study of inhalational sedation with nitrous oxide/oxygen for oral surgery in Hong Kong Chinese.

Thirty healthy Chinese between 17-36 years undergoing extraction of bilaterally similarly impacted third molars in two visits were randomly given nitrous oxide/oxygen inhalational sedation to supplement local anaesthesia or unsupplemented local anaesthesia for operation on one side and the alternative for the other. The majority in the study had never heard of inhalational sedation being available to supplement local anaesthesia, and when given a chance to experience this method, the majority preferred it to local anaesthesia alone. Supplementation of local anaesthesia with inhalational sedation produced patients who were more relaxed. With both methods, the operating conditions were assessed to be good, with good patient co-operation. Inhalational sedation with nitrous oxide/oxygen had no significant effect on vital signs, intraoperative or post operative adverse effects and patients were street fit within ten minutes of ending sedation.

Does midazolam sedation in oral surgery affect the potency or duration of diflunisal analgesia?

A randomized cross-over study was carried out to determine whether midazolam in doses used for conscious sedation had any effect on the potency or duration of diflunisal, a non-narcotic analgesic used for postoperative pain in oral surgery. Thirty-two Hong Kong Chinese patients of either sex, aged between 16 and 28 years, were given either midazolam to supplement local anaesthesia or local anaesthesia alone at one visit and the alternative at the other visit, for surgical removal of bilateral symmetrically impacted third molars. Surgery was carried out on one side only at each visit. Diflunisal was given for postoperative pain relief. Midazolam had no effect on the potency or duration of action of diflunisal. Independent of the method, more patients had better pain relief following the second procedure than following the first, probably due to a degree of adaptation to the pain, at the second visit.

Pre-operative diflunisal for pain relief following third molar surgery under general anaesthesia.

In order to find out whether long-acting non-narcotic analgesics given pre-operatively reduce the post-operative pain and decrease the narcotic analgesic requirements following third molar surgery under general anaesthesia, thirty Hong Kong Chinese patients undergoing this procedure were randomly given either diflunisal or placebo one hour prior to anaesthesia. Pain reduction was monitored for ten hours from the end of surgery using visual analogue scales. Except in the first hour, pain reduction at each hour was significantly better in the diflunisal group than in the placebo group. Furthermore, only one patient required narcotic analgesics in the diflunisal group compared with five in the placebo group. In patients who had multiple tooth sectioning or very difficult surgery of one or both lower third molars, the requirement for post-operative analgesics was high in the placebo group.

Comparison of two techniques of patient-controlled sedation with midazolam.

OBJECTIVE: To compare patient-controlled sedation with 1-mg increments of midazolam at 1-min intervals with 0.1-mg increments of midazolam without a lock-out interval. DESIGN: Randomized cross over study. SUBJECTS: 32 patients aged 17-35 years having third molars removed. RESULTS: Doses of midazolam obtained, degree of sedation and operating conditions were similar in the two groups. The demands far exceeded the increments actually received by patients obtaining 0.1-mg increments. Some were extremely sedated with both techniques. CONCLUSIONS: In this age group, there were no significant advantages or disadvantages of one technique over the other. Patients obtained the degree of sedation they required to undergo the operation by pressing the button independently of the dose or incremental interval. So-called 'true' patient-controlled sedation is a misnomer. The cut-off interval proved to be an extremely important safety feature.

Effect of conscious sedation with midazolam on oxygen saturation.

A randomized cross-over study was done to determine if significant oxygen desaturation occurs during third molar surgery under conscious sedation with midazolam to warrant supplementary oxygen. Thirty-two healthy patients of either sex, between the ages of 18 and 40 years, had bilateral symmetrically impacted lower third molar surgery under local anesthesia in two visits. Randomly at one visit the local anesthesia was supplemented with midazolam sedation. Continuous monitoring of oxygen saturation, blood pressure, and pulse were carried out. At the rate of injection with the dose of midazolam used, no significant desaturation attributable to midazolam sedation was observed. However, short periods of significant desaturation occurred with both procedures. These episodes, though of no consequence to healthy people, may produce problems in compromised patients, and indicate the importance of monitoring of oxygen saturation in all patients during minor oral surgery procedures.

Isoflurane for conscious sedation.

Isoflurane 0.5% in oxygen for conscious sedation was compared with placebo (oxygen) and with an equipotent concentration of nitrous oxide in oxygen, in patients scheduled for surgical removal of bilateral, similarly impacted lower third molars. The majority of patients were sedated with 0.5% isoflurane in oxygen and preferred it to both placebo and nitrous oxide in oxygen. It produced good operating conditions with cooperative patients and had no significant effect on vital signs. There were no significant intra- or postoperative adverse effects. Patients were street fit within 10 minutes after the end of the operation.

A study of intravenous sedation with diazepam and midazolam for dentistry in Hong Kong Chinese.

Fifty Hong Kong Chinese patients between 20-40 years, of ASA Gd I, undergoing third molar extraction were randomly allocated into two groups. For conscious sedation, to supplement local anaesthesia, one group received intravenous diazepam and the other intravenous midazolam. The majority in the study had never heard of intravenous sedation being available to supplement local anaesthesia during dental surgery and when given the chance to experience this method the majority found it highly acceptable. None preferred general anaesthesia for dental surgery. In this study midazolam had more advantages to the patient than diazepam; quicker onset of sedation, less pain during injection, profound anterograde amnesia and fewer postoperative complications being the main features. However, both drugs produced good operating conditions. Incidence of thrombophlebitis was low with both drugs, and may be so in Chinese compared with non-Chinese.

A comparative study of intravenous diazepam and midazolam for oral surgery.

Intravenous diazepam was compared with intravenous midazolam for conscious sedation in a single-blind study of 50 Hong Kong Chinese patients acting as their own controls. Verrill's sign was used as the end-point of sedation, and bilateral, similarly impacted lower third molars served as the surgical model. The drugs produced comparable levels of sedation, stable vital signs, and good operating conditions in all patients. Midazolam had numerous advantages over diazepam: more rapid onset of sedation, less pain during injection, profound anterograde amnesia, and fewer postoperative complications. The incidence of thrombophlebitis was low with both drugs and appears to be so in Chinese in general. A significant majority of the patients preferred sedation to other techniques and midazolam to diazepam.

The effect of Ro15-1788 (Anexate) on conscious sedation produced with midazolam.

A double-blind cross-over randomised study was performed to investigate whether Ro15-1788 (Anexate) adequately reversed the conscious sedation with midazolam so that patients were clinically recovered and fit for discharge quicker than when midazolam was used alone. Twenty-eight healthy patients between 18 and 34 years sedated with midazolam for bilateral 3rd molar surgery, one side being operated on at each visit. Ro15-1788 or normal saline (placebo) was given at the end of the surgical procedure at the first visit and the alternative at the second visit. Recovery with Ro15-1788 was significantly quicker than with the placebo, both by subjective (86%) and objective (93%) evaluation. Patients' evaluation indicated that only 61% were more alert at home with Ro15-1788. Postoperative adverse effects were similar in both groups.

A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery.

Thirty healthy Hong Kong Chinese patients between the ages of 15 and 31 years with bilaterally impacted lower third molar teeth, scheduled for surgical removal were studied. All the patients presented twice (for the right and left sides) and received, on separate occasions, patient or anaesthetist-controlled midazolam sedation allocated using a randomised, crossover design. Both techniques provided reliable sedation with verbal contact maintained, minimal changes in respiratory and cardiovascular function, good operating conditions and a high degree of patient satisfaction. The majority of patients (67%) thought they could sedate themselves better on a subsequent visit and were confident that they could do this more satisfactorily than the anaesthetist. An almost equal number preferred patient (n = 12) or anaesthetist (n = 13) controlled sedation, with the remainder having no preference. The total dose of midazolam was very similar in the two groups, 5.3 (SD 2.4) mg and 5.0 (SD 1.1) mg for patient and anaesthetist controlled sedation respectively.

A comparison of the incidence and nature of cardiac dysrhythmias occurring during enflurane and isoflurane anaesthesia for dental surgery.

The incidence and nature of dysrhythmias with equipotent concentrations of enflurane and isoflurane during dental surgery were compared. Seventy-six Chinese patients between 17-30 years, of ASA Grade I, randomly received either enflurane or isoflurane with N2O and O2 for spontaneous ventilation during third molar extractions. The cardiac rhythm and the blood pressure were continuously monitored during the procedure. The incidence of dysrhythmias with both enflurane and isoflurane was low and the difference not statistically significant. During surgery one patient exhibited unifocal ventricular ectopics with isoflurane. Sinus tachycardia was common with both agents. No life-threatening dysrhythmias were seen with either agent and no clinically significant lowering of blood pressure occurred in association with the exhibited dysrhythmias. In this Chinese population, as in other studies, the incidence of dysrhythmias with both agents was low thus showing no difference between the races.

Flumazenil reversal of conscious sedation for minor oral surgery.

In order to find out whether resedation occurred following antagonism with flumazenil of sedation for minor oral surgery, in a double-blind randomised cross-over study thirty healthy Hong Kong Chinese patients undergoing bilateral third molar surgery at two visits were sedated with midazolam. Following surgery they received either flumazenil or placebo at one visit and the alternative at the other visit. Recovery was monitored by observation and objective tests. Following recovery they were monitored for resedation for a total period of two hours from the injection of the reversal agent. Resedation, sufficient to prevent a patient from being discharged to be accompanied home with an escort, did not occur provided the patient responded to verbal command following sedation.

Comparison of the incidence and nature of cardiac arrhythmias occurring during isoflurane or halothane anaesthesia. Studies during dental surgery.

Seventy-six Chinese patients aged between 15 and 30 yr, undergoing 3rd molar extraction, were randomly allocated to two groups. One group received halothane and the other isoflurane. The incidence of arrhythmia during surgery under anaesthesia with isoflurane was significantly less than with halothane. Sinus tachycardia was a significant feature under anaesthesia with isoflurane. Under anaesthesia with halothane, the arrhythmias occurring most frequently during surgery were ventricular ectopics, the commonest being ventricular bigeminy. The frequency and nature of arrhythmias during surgery on right and left sides were similar. In three patients a slight decrease in arterial pressure was recorded in association with the arrhythmia, but on stopping the stimulus, both rhythm and arterial pressure returned to normal. The incidence of arrhythmia with halothane in the Chinese population in this study was significantly higher than that reported previously in non-Chinese patients.

A randomised crossover comparison of patient-controlled sedation and patient-maintained sedation using propofol.

This randomised, crossover study compared patient-controlled sedation using boluses of propofol and patient-maintained sedation using a target-controlled infusion of propofol. Twenty-three patients aged 18-35 years having surgical removal of bilateral third molar teeth under local anaesthesia during two separate visits were studied. In the majority of patients, both techniques provided moderate sedation, good operating conditions, stable physiological parameters and a high degree of patient satisfaction. Two patients became over-sedated during patient-controlled sedation. The time taken for titration to adequate sedation was longer with patient-maintained sedation than with patient-controlled sedation [mean (SD) = 8.6 (3.7) min vs. 5.7 (3.1) min, p < 0.005]. The mean overall propofol consumption was similar with both techniques. The majority of patients preferred patient-maintained sedation to patient-controlled sedation, p < 0.05.