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Background: The fracture of the coronoid process of mandible is one of the rarest fractures seen and the paucity of literature on the topic reflects the same. Despite the low incidence rate, the complications maybe grave which is why proper management is important. The treatment is controversial also because of the absence of standardized treatment protocol. This systematic review aims to compare the outcome of various treatment modalities available. Methods: Registered under PROSPERO: CRD42020200700. Systematic research was conducted across databases like PubMed, Google Scholar, Pro Quest, Wiley Online. All clinical studies done till January 2021 which included participants above 14 years of age were included. Case reports, case series and studies not mentioning the treatment plan were excluded. The studies were shortlisted by the authors based on the eligibility criteria. Risk of bias was assessed using the MINORS tool and JBI checklist. Results: A total of five studies were included. Four were retrospective studies and one was a retrospective case-controlled study. Two studies reported high, two moderate and one low risk of bias. Various treatment modalities were reported for the management of coronoid process fractures including conservative management, ORIF and coronoidectomy. Most authors preferred conservative management in asymptomatic cases and surgical management in symptomatic cases. Discussion: No randomized control trials were found on the topic. Majority of the articles were case reports. Conservative management was preferred in minimally displaced fractures of coronoid process. However, in presence of displaced coronoid process fractures causing impediment of mandibular function surgical management is preferred.
RESUMEN
INTRODUCTION: The concerns for induction of anaesthesia in patients undergoing cardiac surgery include hemodynamic stability, attenuation of stress response and maintenance of balance between myocardial oxygen demand and supply. Various Intravenous anaesthetic agents like Thiopentone, Etomidate, Propofol, Midazolam, and Ketamine have been used for anesthetizing patients for cardiac surgeries. However, many authors have expressed concerns regarding induction with thiopentone, midazolam and ketamine. Hence, Propofol and Etomidate are preferred for induction in these patients. However, these two drugs have different characteristics. Etomidate is preferred for patients with poor left ventricular (LV) function as it provides stable cardiovascular profile. But there are concerns about reduction in adrenal suppression and serum cortisol levels. Propofol, on the other hand may cause a reduction in systemic vascular resistance and subsequent hypotension. Thus, this study was conducted to compare induction with these two agents in cardiac surgeries. METHODS: Baseline categorical and continuous variables were compared using Fisher's exact test and student's t test respectively. Hemodynamic variables were compared using student's t test for independent samples. The primary outcome (serum cortisol and blood sugar) of the study was compared using Wilcoxon Rank Sum test. The P value less than 0.05 was considered significant. RESULTS: Etomidate provides more stable hemodynamic parameters as compared to Propofol. Propofol causes vasodilation and may result in drop of systematic BP. Etomidate can therefore be safely used for induction in patients with good LV function for CABG/MVR/AVR on CPB without serious cortisol suppression lasting more than twenty-four hours.