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INTRODUCTION: Increasedlife expectancy in populations has brought along specific new scenarios in the fields of medicine for the elderly; prevalence of physical complications such as edentulism and patients with dentures is growing. Management of anesthesia and ventilation in this group of patients has turned into a great challenge. Some researchers suggest dentures to be left in place during bag-mask ventilation; yet, no unanimous agreement exists in this regard. METHODS: In a single blind randomized clinical trial, we studied 300 patients with ASA class I, II (American Society of Anesthesiologists), Mallampati class (I, II) and aged over 55 years in three groups. After induction of anesthesia, in group G dentures were removed and in each buccal space an eight-layer 10 × 10 cm gauze and an oral airway were placed. In group D, the dentures and an oral airway were left in place. In group C (control), after removing dentures just an appropriate oral airway was placed. Then, each three group underwent bag-mask ventilation. Success of bag-mask ventilation (BMV) was considered as increase in end-tidal carbon dioxide to more than 20 mmHg and back to baseline with fresh gas flow of 3 L/min and adjustable pressure limiting valve pressure of 20 cm H2O. Success rates were evaluated between groups. RESULTS: Effective BMV was possible in 91 (91%), 64 (64%) and 41 (41%) patients in groups G, D and C respectively. The differences were statistically significant. Successful BMV rate was significantly higher in female patients in group G compared to group C; 43/44 versus 25/46 individuals, P = 0.0001, odds ratio = 0.03, 95% confidence interval (0.00, 0.22). CONCLUSIONS: Leaving dentures in place in edentulous patients after inducing anesthesia improves bag-mask ventilation. However, placing folded compressed gauze in buccal space leads to more significant improvement in BMV compared to leaving dentures in place.
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BACKGROUND: Rapid Response Teams (RRTs) assess patients during early phases of deterioration to reduce patient morbidity and mortality. OBJECTIVES: This study aimed to evaluate the ability of earlier medical intervention by a RRT prompted by clinical instability in patients to reduce the incidence of and mortality from unexpected cardiac arrest at our hospital. PATIENTS AND METHODS: A nonrandomized, population-based study before 2008 and after 2010 introduction of the Rapid Response Teams in a 300 bed private hospital. All patients were admitted to the hospital in 2008 (n = 25348) and 2010 (n = 28024). RRT (One doctor, one senior intensive care nurse and one staff nurse) attended to clinically unstable patients immediately with resuscitation drugs, fluid, and equipment. Response was activated by the bedside nurse or doctor according to predefined criteria. Main outcome measures were incidence and outcome of unexpected cardiac arrest. RESULTS: The incidence of unexpected cardiac arrest was 17 per 1000 hospital admissions (431 cases) in 2008 (before RRT intervention) and 12.45 per 1000 admissions (349 cases) in 2010 (after intervention), with mortality being 73.23% (274 patients) and 66.15% (231 patients) respectively. After adjustment for case mix the intervention was associated with a 19% reduction in the incidence of unexpected cardiac arrest (odds ratio 0.81, 95% confidence interval 0.65-0.98). CONCLUSIONS: The RRT was able to detect preventable adverse events and reduce the mortality and incidence of unexpected cardiac arrests.