Detection of Respiratory Adverse Events in Pediatric Dental Patients Sedated With 0.75mg/Kg of Midazolam and Oxygen by Continuous Pretracheal Auscultation: A Prospective Randomized Controlled Trial.

PURPOSE: Sedation is becoming more commonplace for pediatric patients undergoing minor procedures. Fortunately, electronic monitors have contributed to a reduction in the associated respiratory adverse events (RAEs). To test the hypothesis that adding the pretracheal stethoscope (PTS) to standard monitoring methods (SMMs) may improve RAE detection in sedated pediatric dental patients, the frequency of RAEs detected by SMMs (i.e. visual observation, capnography, and pulse oximetry) was compared to that detected by SMMs alongside continuous PTS auscultation. STUDY DESIGN: A prospective, randomised, controlled trial was performed with 100 pediatric patient participants of ASA≤2, who were scheduled to receive dental treatment under 0.75 mg/kg and oxygen. Patients were randomised into Groups A (n=50; SMMs) and B (n=50; SMMs+PTS). Inclusion criteria were behavioral management problems and intolerance to dental treatment despite behavioral management techniques or nitrous oxide administration. Exclusion criteria were high-risk conditions for RAEs, altered mental status, gastrointestinal disorders, parental refusal of conscious sedation and failure of previous conscious sedation. An anesthesist was present throughout the dental treatments. RESULTS: RAEs were detected in 10 (20%) and 22(44%) Group A and B patients respectively (p=0.01). The majority of RAEs within Group B were detected by PTS auscultation (n=19). Capnography produced 13 and 15 false-positive results in Groups A and B respectively, whereas the PTS produced 4(8%) false-positive results in Group B (p=0.009). CONCLUSIONS: PTS was found to be useful for detecting RAEs during pediatric dental sedation with 0.75mg/kg midazolam and oxygen, in the presence of an anesthesist.

Measures to Limit COVID-19 Outbreak Effects Among Military Personnel: Preliminary Data.

INTRODUCTION: The COVID-19 outbreak posed a threat to the readiness of military forces as well as their ability to fulfill missions. Seeing that military forces have been encountering similar challenges, we found it eminent to share the Israeli Defense Force (IDF) Northern Command's (NC) preliminary experience. MATERIALS AND METHODS: We retrospectively summarized the actions that were taken by our team, focusing on 18 battalions at the Israeli NC. These actions included promoting a series of organizational changes in terms of social distancing and medical regulations as well as working to strengthen medical leadership through designated video meetings with medical commanders across our organization. Meetings included relevant clinical education, updates, and leadership building. These actions and others were aimed to increase our influence on the decision-making processes. While we conducted real-time reverse transcriptase polymerase chain reaction SARS-CoV-2 laboratory tests for soldiers who were suspected to have COVID-19 (those presenting with compatible signs and symptoms after having been exposed to a confirmed COVID-19 patient), we were not able to screen healthy populations, nor did we have serum antibody serologic tests available during the study period. We reviewed the COVID-19 outbreak national data, obtained from Ministry of Health publishings and the IDF databases. Data were included from February 26th, 2020 (day 0, first COVID-19 patient in Israel) to April 19th, 2020 (day 53, about 1 month after most of the COVID-19 regulation were issued in the NC). RESULTS: The mean age of the battalion soldiers was 21.29 ± 4.06 (range 18-50), 81.34% male. Most restrictions were issued on day 18. On day 53, 98.85% of the personnel in the battalions were kept active and asymptomatic in their units. CONCLUSIONS: Despite the limited availability of laboratory testing for COVID-19 our actions enabled us to lead a strict risk-management policy while maintaining most of the available workforce.