[Oral sedation in pediatric outpatient dentistry]. / Primenenie peroral'noi sedatsii pri ambulatornom stomatologicheskom vmeshatel'stve u detei.

THE AIM OF THE STUDY: Was to improve the quality of treatment in pediatric outpatient dentistry with the effective use of oral sedation. MATERIALS AND METHODS: The study comprised 60 children aged 3-12 years who were undergoing therapeutic/surgical dental treatment. All children's somatic state was assessed as ASAI-II. All children met a number of psychological, anamnestic and procedural criteria. Midazolam and chloropyramine in a dose calculated for the patient's body weight were used as components of oral sedation. The estimated sedation depth was Ramsay II-III. The study included an analysis of objective (the time of comfortable treatment, the amount of treated or removed teeth per visit, the possibility of treatment without anesthesia during further visits) and subjective (the possibility of contact with the child during treatment, behavioral reactions at home and on further visits) criteria. Negative behavioral reactions and dental effects were also assessed. RESULTS: The treatment features correlated with the age category and gender of the patient. In the older age group of 7-12 years, the amount of comfortable treatment time was higher, the possibility of contact with the child reached 100% (which is twice as much as in the younger one), and also a larger number of patients were treated during further visits without an anesthetic aid. At the same time, in the younger age group of 3-6 years, the volume of treatment per visit was higher, since it takes less time to treat a primary tooth than for a permanent one. Side effects (visual hallucinations, diplopia, hyperactivity, tearfulness and aggressiveness) were more often recorded in the younger age group, but emotional instability was equally manifested in both groups. CONCLUSION: In order to maximize the effectiveness of using oral sedation as a method, it is necessary to take into account the duration and traumatism of the proposed procedure, the peculiarities of age psychology and the peculiarities of the psychological development of boys and girls.

[Practical potentials of using dexmedetomidine in oral and maxillofacial surgery]. / Prakticheskie vozmozhnosti primeneniia sovremennogo sedativnogo preparata pri anesteziologicheskom posobii v stomatologii i cheliustno-litsevoi khirurgii.

Dexmedetomidine is a selective α2 adrenoreceptor agonist. The drug has a set of useful properties due to wide prevalence of the receptors in a body. The article presents review of the literature of using dexmedetomidine in anesthetic practice of various surgery fields which positive results may be extrapolated to dentistry and maxillofacial surgery to solve important anesthesiologic problems. Inclusion of the drug in routine oral and maxillofacial surgery anesthesia can bring a significant amount of benefits: safe sedation for dental interventions, sedation for compromised airways without respiratory depression, improvement of intraoperative and postoperative analgesia, reduction of postoperative nausea, vomiting and postoperative shivering incidence, nephroprotection and stability of hypotensive hemodynamics, decrease of intraoperative blood loss. Thus, the dexmedetomidine may be a useful agent for anesthesia in oral and maxillofacial surgery that increases anesthesia safety and quality of medical care.

[Effect of dexmedetomidine on perfusion of free flaps transferred to head and neck]. / Vliianie deksmedetomidina na perfuziiu revaskuliarizirovannykh autotransplantatov, perenesennykh v oblast' golovy i shei.

The paper presents the impact of perioperative care on feasibility of free fibula flap transfer for facial reconstruction. Flaps vitality was measured by means of somatic oximetry in 85 patients aged 20-74 years receiving reconstruction procedures in midfacial and lower facial areas. The patients were divided in three groups according to sedation agent used postoperatively. It has been demonstrated that dexmedetomidine postoperative sedation significantly improved free fibula flaps perfusion compared to propofol sedation.

[The improvement of safe sedation and dental treatment in patients with metabolic syndrome].

The paper concerns the anesthetic aspects of safe conscious sedation and dental treatment of patients with metabolic syndrome. BIS monitoring in combination with routine pulse oximetry and blood pressure measurement is getting dental sedation safer. Independently of the bolus or continuous intravenous midazolam infusion the investigators approved high efficacy of bispectral index in benzodiazepine dose titration. Successful dental treatment under conscious sedation and no evident associated with analgesia complications show the importance of BIS-monitoring in the improvement of safe sedation and dental treatment in patients with metabolic syndrome.

[Surgery for hyperostotic cranial orbital meningiomas]. / Khirurgiia giperostoticheskikh kanioorbital'nykh meningiom.

The paper analyzes surgical techniques for removal of hyperostotic cranial orbital meningiomas in 36 patients operated on in 1998 to 2000. In 19 cases hyperostosis extends to the upper and lower lid slits without involving the optic canal. It also spreads to the ethmoidal sinus in 6 cases to the frontal sinus in 3, and to the maxillary one in 2 patients. In 3 patients, hyperostosis was beyond the wing of the basic bone, by involving the temporal and frontal squamous. In 19 cases, hyperostosis was resected and the tumor was removed without creating any additional bone flaps. To make an additional basal bone flap can provide a much wider access by reducing the traction of both orbital and cerebral tissues. An orbitozygomatic flap was formed in 16 cases. To create a lateral orbital flap was sufficient to effectively eliminate hyperostosis in 3 patients. Impaired postoperative visual acuity was observed in 5 patients undergone resection for the hyperostotic optic canal, in 2 patients of them there was a decrease in visual acuity from 1.0 to 0.1 and in 1 patient it reduced from 1.0 to 0.2. A year later, visual acuity in these patients increased up to 0.5-0.8. After resection of the hyperostotic optic canal, blindness occurred in 2 patients, in one of them, photoperception appeared on day 5 after surgery and 3 months later visual acuity restored up to 0.6. Thus, the use of high-speed drill and the creation of an orbital or orbitozygomatic flap can increase the efficiency of removal of hyperostotic cranial orbital meningiomas.

[Multiple-organ pathology in septic shock in patients with hemoblastoses]. / Poliorgannaia patologiia pri septicheskom shoke u bol'nykh s gemoblastozami.

A prospective study of 20 patients with hemoblastosis and septic shock (SS) was carried out by invasive monitoring of the central hemodynamics and oxygen transport, evaluation of biochemical and coagulological parameters, and assessment of the severity of clinical condition by the APACHE II and SOFA scores. Septic shock was effectively treated in 12 patients, 5 of them were discharged from the department (group 1) and 7 died in intensive care wards from various complications (group 2). Eight patients died during the first 2 days from SS resistant to therapy (group 3). Group 2 patients were in need of a longer inotropic support than group 1 patients (5.8 +/- 1.6 vs. 2.7 +/- 0.8 days, p < 0.01). The deficit of bases was more expressed in groups 2 and 3 in comparison with group 1 (-11.3 +/- 3 and -2.7 +/- 9.1 mmol/liter vs. 1.4 +/- 4.4 mmol/liter) and left ventricular stroke index (LVSI) and oxygen delivery were lower. LVSI and base deficit were in linear correlation (rho = 0.4, p < 0.05). XIIa-dependent fibrinolysis was suppressed in all patients, which was more pronounced in group 3 in comparison with groups 1 and 2 (135 +/- 47.4 vs. 103 +/- 27 and 88.3 +/- 42.3). According to SOFA score, the severity of cardiovascular disorders during day 1 of SS was the same in all groups, while starting from day 2 it decreased in patients who survived. Acute respiratory failure was lower in group 1 only on day 1 according to SOFA. More pronounced (according to SOFA) hepatorenal failure was observed in group 2 in comparison with other patients. Organ involvement in hemoblastosis was detected at autopsy in 8 out of 13 cases. Hence, the need in prolonged cardiovascular support of SS patients is associated with development of polyorgan involvement. Fibrinolysis suppression is a frequent early manifestation of hemostasis disorders. Specific neoplastic organ involvement was observed in 61.5% patients with hemoblastosis who died from SS and its complications.