ABSTRACT
BACKGROUND: The most known and commonly studied behavioral obstacle to dental care is dental anxiety. An obstacle that is less studied though no less problematic is excessive gag reflex, which can severely impede dental treatment. Another understudied and possibly related syndrome is emetophobia (a specific phobia of vomiting). OBJECTIVE: The aim of this study was to examine possible comorbidity amongst self-reported emetophobia, dental anxiety, and excessive gagging in the dental office. METHODS: A cross-sectional online survey was conducted using the following self-report questionnaires: Dental Anxiety Scale, Gagging Problem Assessment, Gagging Assessment Scale (GAS), and Specific Phobia of Vomiting Inventory (SPOVI). RESULTS: In all, 164 participants fully completed the questionnaires (87.8% female; mean age, 34 ± 11.07 years). Positive correlations were found amongst all variables (P < .001). High gagging (GAS > 6) was associated with a 7.29 times (P < .000) greater risk of positive emetophobia (SPOVI ≥ 10). Linear regression analyses revealed that the intensity of the reflex and the experience of gagging upon encountering odours in the dental office as well as dental anxiety and vomiting phobia significantly predicted participants' gagging scores as evaluated by GAS (R2 = 0.59; F = 21.16; P < .001). CONCLUSIONS: The study shows that excessive gagging reflex in the dental office is closely related both to dental anxiety and to emetophobia.
Subject(s)
Dental Anxiety , Dental Care , Gagging , Phobic Disorders , Vomiting , Humans , Dental Anxiety/psychology , Female , Adult , Male , Vomiting/psychology , Cross-Sectional Studies , Phobic Disorders/psychology , Surveys and Questionnaires , Dental Care/psychology , Self Report , Middle Aged , Young AdultABSTRACT
Statement of the Problem: Management of gag reflex is a challenging process during many dental treatments. Various studies have been carried out to evaluate different pharmacological and non-pharmacological techniques to control gagging. Purpose: The aim of this study is to review the available evidence on methods proposed for managing the gag reflex. Materials and Method: This systematic review adheres to the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A comprehensive search was conducted in English and Persian based on articles published from 2015 to 2022 (February) in PubMed, Scopus, Science Direct, Web of Science, Google Scholar, ISC and SID. All studies were first screened based on their title and abstract. The quality assessment of articles was carried out by two independent authors. Then, risk of bias evaluation was conducted according to Cochrane parameters. Results: In total, 1704 studies were identified via search. After reviewing title and abstract, 16 studies found eligible based on inclusion and exclusion criteria. Following quality and risk of bias assessment, 9 studies included in the systematic review. Conclusion: Based on the finding of this review, distraction techniques, nitrous oxide, and low-level laser therapy were found effective in management of gag reflex. The dentist should consider gag reflex management based on the type of dental treatment, gag severity, patient's age, and available capabilities.
ABSTRACT
Dysphagia occurs in various diseases and constitutes a major concern in patients with psychiatric disorders. The Mann Assessment of Swallowing Ability (MASA) comprises 24 clinical parameters designed to identify swallowing disorders. One item in MASA, the "gag reflex", involves an unpleasant stimulus, which means that it is often omitted when the test is administered. The aims of this study were to determine the presence/absence of dysphagia in patients with psychiatric disorders using the MASA and determine its diagnostic accuracy when the gag reflex item was excluded in patients with psychiatric disorders. The study participants comprised patients admitted to a hospital psychiatric ward in whom dysphagia had been suspected based on oral intake status. The following items were determined: age, total MASA score (23 out of 24 items, giving a score out of 195 points), body mass index score, milligram equivalents of chlorpromazine, and the Food Intake Level Scale score. The patients were divided into two groups according to the presence or absence of swallowing problems as assessed by videoendoscopic or videofluoroscopic examination. The scores for each item investigated in the MASA, including the total score, were compared between the two groups. Receiver operating characteristic curve analysis was carried out to determine the optimum cut-off value. The total MASA score, which excluded the "gag reflex" item, was lower in the problematic swallowing group than in the non-problematic swallowing group. The MASA scores for cooperation, respiratory, dysphasia, tongue coordination, oral preparation, pharyngeal phase, and pharyngeal response tended to be lower in the problematic swallowing group. Furthermore, an optimum cut-off value of 169 points (sensitivity, 0.92; specificity, 0.68; likelihood ratio, 2.84) was identified. These results indicate that the cut-off MASA score is effective in screening for dysphagia, even when the "gag reflex" item is excluded.
Subject(s)
Deglutition Disorders , Mental Disorders , Humans , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Deglutition/physiology , ROC Curve , ChlorpromazineABSTRACT
Objective: whether gag reflex, a common problem encountered during dental procedures, is associated with the different types of the soft palate has not been addressed so far. This preliminary study sought to assess the potential association between the different types of soft palate and gag reflex. Material and Methods: one hundred dental patients were recruited. The type of soft palate was determined. Subjective (self-reported) gag reflex was recorded based on many questions and past experience and on a 0-6 VAS. Objective assessment of gag reflex was done using different maneuvers where the posterior part of the tongue and the soft palate were touched by dental mirror, and by taking impression for the upper arch. The association between the types of soft palate and the subjective and objective recorded gag reflex were statistically tested. Results: there were 53 (53%), 33 (33%) and 14 (14%) of the participants with class I, class II and class III soft palate, respectively. A significant association was found between the type of the soft palate and gag reflex in response to one of the subjective items (P= 0.039), more prominent among females (P= 0.009). Concerning the objective assessment, no significant associations were found among males. Meanwhile more females with class II and class III suffered gag reflex and/or actual gagging upon taking the impression (P = 0.001). Conclusion: this study illustrated an association between the type of soft palate and gag reflex, and its severity in females (more specifically soft palate types II and III) more than in males (AU)
Objetivo: o reflexo de vômito, um problema comum encontrado durante procedimentos odontológicos, está ou não associado aos diferentes tipos de palato mole, não foi ainda abordado até o momento. Este estudo preliminar procurou avaliar a possível associação entre os diferentes tipos de palato mole e o reflexo de vômito. Material e Métodos:cem pacientes odontológicos foram recrutados. O tipo de palato mole foi determinado. O reflexo de vômito subjetivo (auto-relatado) foi registrado com base em muitas perguntas e experiências anteriores e em um VAS de 0-6. A avaliação objetiva do reflexo de vômito foi feita por meio de diferentes manobras onde a parte posterior da língua e o palato mole foram tocados por espelho dental e por meio de moldagem da arcada superior. A associação entre os tipos de palato mole e o reflexo de vômito subjetivo e objetivo registrado foi testada estatisticamente. Resultados: houve 53 (53%), 33 (33%) e 14 (14%) participantes com palato mole classe I, classe II e classe III, respectivamente. Foi encontrada associação significativa entre o tipo de palato mole e o reflexo de vômito em resposta a um dos itens subjetivos (P= 0,039), mais proeminente no sexo feminino (P= 0,009). Em relação à avaliação objetiva, não foram encontradas associações significativas entre os homens. Enquanto isso, mais mulheres com classe II e classe III sofreram reflexo de vômito e/ou engasgo real ao receber a impressão (P = 0,001). Conclusão: este estudo ilustrou uma associação entre o tipo de palato mole e reflexo de vômito e sua gravidade em mulheres (mais especificamente palato mole tipos II e III) mais do que em homens. (AU)
Subject(s)
Humans , Palate, Soft , Dental Prosthesis , Dental Materials , Dentistry , NauseaABSTRACT
Aims: The aim of this study is to see if microcurrent electrical stimulation on two acupoints, auricular and Hegus, can help patients prevent their gag reflex. Settings and Design: This was an in vivo cross-sectional study. Materials and Methods: Thirty patients were randomly assigned to three groups: A, B, or C, of ten patients present in each group. Group A and Group B undergone electroacupuncture (microcurrent electrical stimulation) using electroacupuncture device on auricular point and Hegus point (Li 4), respectively, for 1 min and Group C formed the placebo group, point Shou San Li (Li 10). The gag severity index and the gag prevention index were used to measure the gag reflex, which was done in two steps. Statistical Analysis Used: SPSS (SPSS Inc., Chicago IL, USA) version 24 software was used for statistical analysis. Paired t-test, one-way analysis of variance test, post hoc Bonferroni test was used to analyse and compare the data. Results: It was found that Point A and Point B were significantly effective in reducing the severity of gag reflex. Point C demonstrated insignificant results. In addition, Point B (Hegus [Li4]) is more effective than Point A (auricular) in controlling the gag reflex in patients within the set age group of 20-70 years of age. Conclusions: Microcurrent electrical stimulation is a useful adjuvant in the treatment of unfavorable gag reflexes during routine dental procedures. Point Hegus and point auricular acupuncture are both useful in decreasing the severity of gag reflex, with point Hegus being more effective than point auricular.
Subject(s)
Acupuncture, Ear , Gagging , Humans , Young Adult , Adult , Middle Aged , Aged , Cross-Sectional Studies , Gagging/prevention & control , Gagging/physiology , Acupuncture Points , Electric StimulationABSTRACT
OBJECTIVE: The purpose of this study was to investigate the effect of laser acupuncture on controlling gag reflexes by stimulating pericardium 6 (PC6) and conception vessel 24 (CV24) acupuncture points in patients in need of taking dental impressions. METHODS: In this randomized controlled double-blinded clinical trial study, in 30 patients aged 20-60 years, alginate impressions were taken in the prosthetic and orthodontic clinic at the Dental School of Mashhad University of Medical Sciences, Mashhad, Iran. The participants were randomly divided into 2 groups. The intervention and the control group each included 15 subjects. Both groups were in the exact status of age, gender, and indexes, including the Gagging Severity Index (GSI), Subjective Severity of Gag Reflex (SSGR), Vomiting Number (VN), as well as the Improvement Index, measured. Both groups underwent alginate impressions pre-and postintervention. PC6 and CV24 acupuncture points were irradiated for 4 seconds in contact mode with a laser prob pressure on the skin that was slightly bleached without causing pain for the patient. The laser energy was 0.8â¯J with an energy density of 2.854â¯J/cm2 at the surface of the probe (spot size, 0.28 cm2). The total radiation dose was 45.7â¯J/cm2, and the power density was 714.2â¯w/cm2. RESULTS: The findings showed that SSGR and VN significantly improved (Pâ¯≤â¯.05) in the intervention group compared to the control group, but GSI was higher in the intervention group. In the intragroups analysis for the comparison between before and after the intervention, it was found that although the average GSI was elevated after the intervention rather than before, the difference was insignificant (Pâ¯=â¯.083). Also, after the intervention, the average SSGR was significantly reduced (P< .001), and VN was insignificantly lessened (Pâ¯=â¯.334). Moreover, it was observed after the intervention rather than before that GSI was significantly increased (P< .001), whereas SSGR significantly declined (P< .001), and VN meaningfully decreased (Pâ¯=â¯.001). The observations demonstrated that the Improvement Index status was significantly better in the intervention group compared to the control group (Pâ¯=â¯.002). CONCLUSION: This study found that the application of laser acupuncture on PC6 and CV24 acupuncture points might be effective in reducing the gag reflex and can be used as a noninvasive technique while taking dental impressions.
Subject(s)
Acupuncture Therapy , Gagging , Acupuncture Points , Acupuncture Therapy/methods , Alginates , Gagging/prevention & control , Humans , LasersABSTRACT
@#Patients with hyperactive gag reflexes pose challenges when undergoing routine dental procedures, and this can create difficulties in their treatment. The subsequent issues that dentists face in executing the proposed treatment plan could hinder optimal patient care and reduce the overall success of the treatment. The clinician should be skilled in diagnosing as well as competent when managing the care of patients presenting with a hyperactive gag reflex. This paper discusses a technique utilizing telescopic copings and a long-span fixed partial denture as an alternative to fixed implant restoration on a patient with a pronounced gag reflex.
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Subcutaneous facial emphysema is a rare complication of tonsillectomy that can lead to infection, upper airway obstruction or invasion into the thorax. The latter can cause pneumomediastinum or pneumothorax, with possible subsequent cardiorespiratory function impairment. Although multiple causes are suggested in the literature, the main causative factor is still unclear. Moreover, the rationale for its management is inconsistent and the outcomes are unpredictable. We report a case of a 14-year-old pediatric male patient, known to have a hypersensitive gag reflex, who developed post-tonsillectomy cervicofacial subcutaneous emphysema; management has achieved complete clinical resolution after two weeks of complication onset. Additionally, we present a literature review that showcases the potential causes and management of subcutaneous emphysema.
ABSTRACT
BACKGROUND: Gagging condition is among factors contributing to avoidance behavior to seek the dental treatment, and rigorous management is still under investigation. This study aims to explore the effect of listening to the self-preference music in reducing the gagging condition during dental impression procedure towards gagging patient. Physiology and psychological impact to the procedure with and without musical intervention are investigated. METHOD AND MATERIAL: A group of twenty-five patients that will undergo impression procedure was randomly selected. Self-reported Gagging Problem Assessment (GPA-pa-SF) questionnaires was then administered to determine the severity of gagging. Maxillary impression was taken twice within the same patient in two different time intervals (1st without any intervention and 2nd with musical intervention). During both procedures, the pulse rate/minutes (BPM) and arterial oxygen saturation of haemoglobin (SpO2%) were recorded and psychometric assessment was evaluated through the Oral Health Impact Profile (OHIP-14). RESULT: Mean value of BPM was significantly reduced with music (p < 0.05) while SpO2 was considerably has positive effect although was found no significant. The OHIP 14 demonstrated that functional limitation and psychological disability were the most affected before the intervention. Overall, musical stimuli had a significant effect on stress reduction in both physiological (p < 0.05) and psychological (p < 0.05) outcomes except for social disability and handicap items. CONCLUSION: Listening to self-preference music during impression taking had improved physiology and psychology of gagging patients thus, can be attributed to the better dental management.
Subject(s)
Music , Quality of Life , Gagging , Humans , Psychometrics , Surveys and QuestionnairesABSTRACT
This randomized trial aimed to compare the safety and efficacy of the GAGLESS mouthpiece for esophagogastroduodenoscopy (EGD) with that of the conventional mouthpiece. In all, 90 participants were divided into the GAGLESS mouthpiece and conventional mouthpiece groups. The primary endpoint was the severity of pain using the visual analog scale (VAS), and secondary endpoints were examination time, past history of endoscopy, success of the procedure, systolic (SBP) and diastolic (DBP) blood pressure, oxygen saturation, pulse rate before and after EGD, and adverse events. Endoscopy was completed in all cases, and no complications were observed. VAS, when passing the scope through the pharynx, was 2.5 ± 2.4 and 2.0 ± 1.9 cm (p = 0.24) in the conventional and GAGLESS groups, respectively, and that, throughout the examination, was 2.5 ± 2.4 and 1.7 ± 1.5 cm (p = 0.06), respectively. The difference in blood pressure between the GAGLESS and conventional groups was not significant for SBP (p = 0.08) and significant for DBP (p = 0.03). The post-EGD difference in DBP was significantly lower in the GAGLESS group than in the conventional group. The results indicate that GAGLESS mouthpieces had a lower VAS during endoscopy than the conventional mouthpieces, and the changes in blood pressure were smaller with the GAGLESS mouthpiece.
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Objective: Gagging is a problem for many dental patients, as well as patients undergoing medical procedures, such as intubation. Research to date on the gag reflex has been limited by a lack of objective measures for measuring this reflex. Materials and Methods: A validated quantitative method was used to measure if acupuncture or transcutaneous electrical acupoint stimulation (TEAS) at Pericardium 6 (PC 6) and Stomach 36 (ST 36) suppressed the gag reflex, compared with a sham placebo. The subjects were 60 healthy adults randomly chosen to receive acupuncture, TEAS, or sham-TEAS on PC 6, located on the forearm, and ST 36, located on the lower leg. The gag reflex was measured by inserting a saliva ejector slowly down each participant's throat to determine the maximum tolerance of the gag reflex; the insertion length was used as an index of this reflex. Results: There was a significant difference in pre- and postintervention insertion lengths in all groups (paired t-test; all groups; P < 0.001). The differences in the insertion length among the groups (P = 0.76) and the interaction effect (group × time) were not significant (P = 0.79; 2-way analysis of variance). Conclusions: This study suggested that PC 6 and ST 36 stimulation was no different than placebo for alleviating the gag reflex.
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OBJECTIVES: This study compared the impact of transoral rigid laryngoscopy (TORL) and transnasal flexible laryngoscopy (TNFL) methods on intraocular pressure (IOP). METHODS: This study included 100 patients, with 50 patients undergoing a TORL, and 50 patients a TNFL. Before procedure IOP values were recorded by an ophthalmologist using Icare Pro tonometry, also immediately post procedure, and at the 15th, 30th and 60th minute after laryngoscopy. RESULTS: Both groups were similar in terms of age, gender, mean body mass index (BMI), and pre-laryngoscopy IOP values. When the TNFL and TORL groups were compared, no significant differences were observed between pre-laryngoscopy, and 60th minute IOP values (p = 0.891, p = 0.149, respectively). IOP values measured immediately after laryngoscopy, and at the 15th and 30th minute were significantly higher in the TORL group (p < 0.001, p < 0.001, p = 0.002, respectively). CONCLUSIONS: We demonstrated higher IOP fluctuations in the TORL group, when compared to the TNFL group. For this reason, TNFL may be considered a safer method for evaluating laryngeal tissues in conditions that require lower IOP fluctuation as in glaucoma. However, further studies are required to clarify the exact effects of IOP fluctuations during TNFL and TORL in patients with glaucoma.
Subject(s)
Glaucoma/diagnostic imaging , Intraocular Pressure , Laryngoscopy/methods , Adult , Female , Humans , Larynx , Male , Prospective Studies , Tonometry, OcularABSTRACT
PURPOSE: To evaluate the effect of interactive distraction technique on the severity of gagging and success of impression taking in children between age 5 and 10 years. METHODS: This single blind, randomised controlled trial recruited 48 children aged 5-10 years requiring maxillary impressions. Selected children were randomly allocated to one of the two groups: (1) Test group, use of interactive distraction, and (2) Control group, no use of interactive distraction, during impression taking. Dental anxiety was scored using Facial Image Scale (FIS) before and after impression taking. Gagging-related Impression Success Scale (GISS) and Gagging Severity Index (GSI) were recorded by a blinded assessor. Nonparametric tests were used to compare the variables between the groups. RESULTS: Maxillary impressions were successfully recorded in all children in the Test group; either with no gag (87.5%) or with gag (12.5%). In 33.3% control children impressions could not be recorded. Statistically significant, strong association was found between the interactive distraction and GISS (p = 0.003, Cramer's V = 0.32). Mean GSI and post-impression FIS scores were significantly lesser in the Test group (p = 0.029 and p = 0.048, respectively). Significant increase in the mean FIS scores was observed after recording impression in the Control group. Post-impression FIS showed significant positive correlation with GSI (Test: p = 0.003, Control: p = 0.009) and significant inverse correlation with GISS (Test: p = 0.003, Control: p = 0.01). CONCLUSION: Interactive distraction technique used in this study is a simple, non-invasive and cost-effective method to effectively manage gagging and successfully record a maxillary impression in children between age 5 and 10 years.
Subject(s)
Dental Impression Technique , Gagging , Maxilla , Child , Child, Preschool , Face , Humans , Single-Blind MethodABSTRACT
Infantile tremor syndrome (ITS) owing to vitamin B12 deficiency usually presents with tremors, anaemia, pigmentary skin changes, neuro-regression and hypotonia. A 10-month-old boy with ITS and respiratory failure owing to bilateral diaphragmatic palsy who responded to high parenteral doses of vitamin B12 is presented. As far as we are aware, this is the first report of diaphragmatic palsy associated with ITS and vitamin B12 deficiency.
Subject(s)
Respiratory Insufficiency/drug therapy , Respiratory Paralysis/complications , Tremor/drug therapy , Vitamin B 12 Deficiency/complications , Vitamin B 12/therapeutic use , Humans , Infant , Male , Respiratory Insufficiency/etiology , Tremor/etiologyABSTRACT
Background: Gagging during transesophageal echocardiography examination (TEE) can be distressing and even dangerous for patients. The needling of acupuncture point CV24 was described to be effective in reducing the gag reflex during TEE in patients with ischemic stroke or transient ischemic attack. Methods: We describe a proposal for a prospective, randomized, patient, practitioner and assessor-blinded, single-center trial with two arms/groups; real acupuncture will be compared to placebo acupuncture. A total of 60 (30 per group) patients scheduled for elective TEE in order to exclude a cardiac embolic source, endocarditis or for valve failure evaluation will be recruited according to patients' selection criteria and receive either indwelling fixed intradermal needles at acupoints CV24 and bilateral PC6 or placebo needles at the same areas. Patients, the practitioners who will perform the TEE procedure, and the assessor of the outcome measures will be unaware of the group's (real or placebo) allocation. Results: The primary outcome is the intensity of gagging, measured using verbal rating scale (VRS-11) from 0 = no gagging to 10 = intolerable gagging. Secondary outcomes include the incidence of gagging, the use of rescue medication, patients' satisfaction with relief of unwanted side effects during TEE procedure, success of patients' blinding (patients' opinion to group allocation), heart rate and oxygen saturation measured by pulse oxymetry. Conclusions: To study the effects of acupuncture against gagging during TEE, we test the needling of acupoints CV24 and PC6 bilaterally. A placebo acupuncture is used for the control group. Trial registration number: NCT NCT0382142.
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Excessive gag reflex could be problematic for adequate dental care. Although various factors may increase the susceptibility to gagging, its contributing factors have not been fully determined. This study aimed to determine whether gag reflex was associated with tactile sensitivity and psychological characteristics. Fifteen volunteers of healthy males and females each were recruited for this study. After completing a questionnaire describing the self-perceived gag reflex activity, a disposable saliva ejector was inserted along the palate into the mouth until gagging was evoked. The ratio of the insertion depth to the palatal length was used as an index for the gagging threshold. The two-point discrimination (TPD) and Semmes-Weinstein monofilament (SWM) tests were performed to assess the tactile sensitivity of the palatal regions (hard palate, anterior and posterior soft palate). The Symptom Checklist-90-Revised was used to investigate the relationship between the gagging threshold and the psychological status. Our findings showed that the gagging threshold had a significant positive correlation with the TPD and SWM thresholds on the hard palate. The psychological profiles of psychoticism and hostility score were also significantly correlated with the gagging threshold. However, there were no significant differences in the tactile and gagging thresholds, as well as the psychological profiles, between males and females. Our results suggested that the tactile sensitivity of the anterior palate is a determining factor for the gagging threshold and implied that the initial response of the oral entry site to stimulation may lead to the development of gag reflex.
Subject(s)
Gagging , Mouth , Dental Care , Female , Humans , Male , Pilot Projects , PsychometricsABSTRACT
BACKGROUND AND AIM: Discomfort associated with the gag reflex during transoral endoscopy can be troublesome. To overcome this problem during esophagogastroduodenoscopy (EGD), we recently developed a novel mouthpiece. The aim of the present study was to compare acceptance and tolerability of transoral EGD with conventional and new mouthpieces in unsedated patients and analyze the effects of the new mouthpiece. METHODS: This study consisted of two phases of cephalometric and EGD examinations to analyze the effects of the new mouthpiece. Cephalometry was carried out in six subjects to evaluate differences in the size of the pharynx (anteroposterior diameter of the oropharynx and longitudinal diameter of the oral cavity) when subjects held the conventional mouthpiece (MAJ674) or the new mouthpiece in their mouths. EGD was done in 10 subjects using the conventional or new mouthpiece to evaluate the number of times the gag reflex occurred, examinee discomfort, and endoscope operability during EGD using a visual analogue scale (VAS). RESULTS: Anteroposterior diameter of the oropharynx and longitudinal diameter of the oral cavity were significantly larger with the new mouthpiece than with the conventional mouthpiece (oropharynx: P = 0.03; oral cavity: P = 0.03). With the new mouthpiece during EGD, subjects had significantly fewer instances of the gag reflex (P = 0.01); VAS score for discomfort was significantly lower (P < 0.01) and score for endoscope operability was significantly higher (P = 0.04). CONCLUSION: The new mouthpiece we developed reduced the gag reflex during EGD by extending the pharynx, thus decreasing examinee discomfort and increasing endoscopic operability.
Subject(s)
Endoscopy, Digestive System/adverse effects , Endoscopy, Digestive System/instrumentation , Gagging/prevention & control , Mouth Protectors , Natural Orifice Endoscopic Surgery/adverse effects , Natural Orifice Endoscopic Surgery/instrumentation , Adult , Body Size , Cephalometry , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Extubation failure may have several causes, including swallowing dysfunction, aspiration, and excessive upper airway secretions. We hypothesized that a bedside global swallowing pattern assessment including 9 criteria (volume of pharyngeal secretions, 5 swallowing motor items, swallowing reflex, and 2 gag reflexes) performed prior to extubation could identify patients at risk of extubation failure. METHODS: In a multicenter prospective observational study, all consecutive patients intubated and mechanically ventilated for ≥6 d were included. Before a planned extubation, a physiotherapist evaluated the 9 criteria of the swallowing assessment. The final extubation decision was left to the physician's discretion, blinded to the swallowing assessment. Extubation failure was defined as the need for re-intubation related to aspiration or excessive upper airway secretions within the first 72 h after extubation. Results are expressed as median (interquartile range [IQR]). RESULTS: The study included 159 subjects (age 61 y [IQR 48-75]; male/female ratio 1.5; Simplified Acute Physiologic score II 54 [IQR 42-66]; duration of mechanical ventilation 11 d [IQR 8-17]). A total of 23 subjects (14.5%) required re-intubation, with 16 occurring within the first 72 h after extubation and 7 related to aspiration or excessive secretions. Swallowing assessment was significantly lower in subjects with re-intubation related to aspiration or excessive secretions within the first 72 h after extubation versus those not re-intubated for aspiration or excessive secretions (6 [IQR 5-7] vs 8 [IQR 7-8], P = .008, respectively). Among the 9 swallowing assessment criteria, normal right pharyngeal gag reflex was associated with a lower incidence of re-intubation related to aspiration or excessive secretions (odds ratio 0.12, 95% CI 0.03-0.59, P = .01), as well as normal left pharyngeal gag reflex (odds ratio 0.13, 95% CI 0.03-0.63, P = .01), with a negative predictive value of 0.98 for each reflex. CONCLUSIONS: In subjects with prolonged ventilation, the presence of one or both gag reflexes could predict a reduction in extubation failure related to aspiration or excessive upper airway secretions. (Clinical trials.gov registration NCT00780078.).
Subject(s)
Airway Extubation , Deglutition , Pharynx/physiopathology , Aged , Bodily Secretions , Female , Gagging , Humans , Intensive Care Units , Larynx/physiopathology , Male , Middle Aged , Prospective Studies , Respiration , Respiration, Artificial , Ventilator Weaning/methodsABSTRACT
Isolated palsy of the glossopharyngeal nerve is rare. We report the case of an elderly patient with unilateral right glossopharyngeal nerve palsy secondary to extra cranial ischemia. On examination there was no other deficit other than an absent right gag reflex. She was diagnosed clinically with ischemic stroke of the ninth nerve, and her daily dose of aspirin was increased from 81 mg to 325 mg. Magnetic resonance imaging of the brain showed a normal brainstem and cerebellum with patent intracranial circulation. Total resolution of the paralysis was seen 2 months later. The possible mechanisms suspected were diabetic or hypertensive stenosis of the vasa nervorum or compression of the ninth nerve by an internal carotid artery dissection or aneurysm. This article discusses the various etiologies and mechanisms of this rare condition. It is unique because of the nerve's location and relationship to other structures.
Subject(s)
Glossopharyngeal Nerve/physiopathology , Ischemic Stroke , Paralysis , Aged , Female , Humans , Ischemic Stroke/complications , Ischemic Stroke/physiopathology , Paralysis/etiology , Paralysis/physiopathologyABSTRACT
BACKGROUND: Irreversible hydrocolloid impression materials have been a staple in dentistry and useful for the fabrication of dental prosthesis. Gagging is most commonly experienced during maxillary impression making, which may affect the clinical management of the patient. Different techniques have been described to alleviate this problem. One of them is mixing lignocaine local anesthetic solution in irreversible hydrocolloid impression material before making the impression. The objective of this study was to evaluate the effect of lignocaine addition in irreversible hydrocolloid impression on the properties of irreversible hydrocolloid impression materials. METHODS: Irreversible hydrocolloid was mixed with water (Control group) or water and adrenalin (Lidocaine hydrochloride) (Experimental group). Compressive strength, tear strength and setting time were measured according to ISO1567 and ANSI/ADA specifications 18. The structural analysis of both groups was also evaluated by Fourier Transform Infrared Spectroscopy (FTIR). RESULTS: In the experimental group, insignificant decrease was observed in compressive and tear strength of irreversible hydrocolloid (p>0.05). There was significant (p<0.05) increase in setting time of irreversible hydrocolloid impression material. FTIR analysis indicated no change in chemistry of irreversible hydrocolloid before and after setting. CONCLUSIONS: Addition of lignocaine in irreversible hydrocolloid impression material may result in control of gag reflex without affecting its mechanical and chemical properties.