RESUMO
BACKGROUND: Sedation regimes during oral procedures frequently associated with airway obstruction. The aim of this study was to define the association of Bispectral Index (BIS) to the depth of sedation and airway obstruction events. METHODS: Forty-seven patients between 14-21 years old, who were candidates for 3rd molar teeth extraction, were enrolled in this study. Patients received a total of 4 mg midazolam, 100 microgram fentanyl followed by titrated incremental propofol in 10 mg. The Richmond Agitation Sedation Score (RASS) was used to assess the depth of sedation. Each patient was attached to BIS monitor, while clinicians were not involved in the data collection process. Apnea, airway obstruction, O2 saturation, timing and interventions for controlling the situation were recorded. All data was synchronized with BIS data monitoring. RESULTS: The results show that 97.5% of cases were ASA 1 and 2, with average age of 17.3 years (±1.4) and a median BMI of 26.1. By using linear regression, for every unit decrease of median RASS (less than zero), there was 1.78 decrease in mean BIS Score (P=0.045, 95% CI: 0.08-3.47). The mean BIS Index (over 1 minute) with airway obstruction was 64 (±10.2), which was significantly lower than the BIS during non-airway obstruction (77±11.6), (P<0.001). By using logistic regression analysis, for every on unit increase in BIS Index, there is 24% decrease in odds in having airway obstruction (P=0.0009, 95% CI: 0.65-8.94). CONCLUSIONS: This study demonstrates that the BIS could potentially be a valid continuous monitoring method to avoid airway obstruction during sedation for patients undergoing dental surgery.
Assuntos
Obstrução das Vias Respiratórias/fisiopatologia , Monitores de Consciência , Sedação Profunda , Complicações Intraoperatórias/fisiopatologia , Dente Serotino/cirurgia , Monitorização Intraoperatória/métodos , Extração Dentária , Adolescente , Estudos de Coortes , Sedação Profunda/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Adulto JovemAssuntos
Doenças Maxilares/patologia , Melanoma Amelanótico/patologia , Mucosa Bucal/patologia , Neoplasias Bucais/patologia , Neoplasias Cutâneas/patologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica , Terapia Combinada , Diagnóstico Diferencial , Evolução Fatal , Humanos , Linfoma/diagnóstico por imagem , Linfoma/patologia , Masculino , Maxila/diagnóstico por imagem , Maxila/cirurgia , Doenças Maxilares/diagnóstico por imagem , Doenças Maxilares/terapia , Melanoma Amelanótico/diagnóstico por imagem , Melanoma Amelanótico/terapia , Mucosa Bucal/cirurgia , Neoplasias Bucais/diagnóstico por imagem , Neoplasias Bucais/terapia , Terapia Neoadjuvante , Radiografia , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/terapiaRESUMO
Neuroectodermal tumors may arise in many places throughout the body including the diverse tissues of the head and neck. The primitive neuroectodermal tumor is a predominately neural, nonepithelial neoplasm similar to Ewing sarcoma. This article describes an 18-year-old female patient with a highly malignant peripheral primitive neuroectodermal tumor located in the soft tissue anterior to the mandibular symphysis. The clinical and radiographic presentation as well as the histopathology and immunohistochemistry of this rare entity is discussed. A review of the literature with respect to this tumor, as well as the current management of this tumor, is presented.
Assuntos
Neoplasias Mandibulares/patologia , Tumores Neuroectodérmicos Primitivos Periféricos/patologia , Antígeno 12E7 , Adolescente , Antígenos CD/análise , Moléculas de Adesão Celular/análise , Cromossomos Humanos Par 11 , Cromossomos Humanos Par 22 , Feminino , Humanos , Imuno-Histoquímica , Neoplasias Mandibulares/química , Neoplasias Mandibulares/genética , Invasividade Neoplásica/patologia , Tumores Neuroectodérmicos Primitivos Periféricos/química , Tumores Neuroectodérmicos Primitivos Periféricos/genética , Translocação GenéticaRESUMO
Patients with salivary gland complaints are seen with a large array of signs and symptoms. Usually these patients have an underlying pathophysiological process that can account for their symptoms. However, in a significant number of patients, no known biological process can be found that would account for the patient's complaint. In such cases, somatization is a possible cause. Somatization is a frequently cited feature of patients with various forms of mental illness. In this paper, we will attempt to illustrate the classic signs of a somatoform disorder in three different patients whose diverse salivary complaints fulfill the criteria for a diagnosis of somatoform disease.