Effect of an N95 respirator and a surgical mask-covered N95 on the cardiovascular responses of dentists treating paediatric patients: A crossover clinical trial.

BACKGROUND: The studies on cardiovascular alterations when using an N95 respirator or surgical mask-covered N95 during dental treatments are limited. AIM: To investigate and compare the cardiovascular responses of dentists treating paediatric patients while wearing an N95 respirator or a surgical mask-covered N95. DESIGN: This was a crossover clinical trial in 18 healthy dentists wearing an N95 respirator or surgical mask-covered N95 during the dental treatment of paediatric patients. Oxygen saturation (SpO2 ), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were monitored at baseline, intraoperation, and postoperation. The data were analyzed using the generalized estimating equation. RESULTS: The mean SpO2 , HR, SBP, DBP, and MAP significantly changed from baseline up to the end of the procedures after wearing an N95 by 3.1%, 19.3%, 11.5%, 17.7%, and 13.8% and after wearing a surgical mask-covered N95 by 3.0%, 20.2%, 5.3%, 13.9%, and 8.8%, respectively (p < .05). No significant differences in these values were found between groups (p > .05). CONCLUSIONS: N95 respirators and surgical mask-covered N95s significantly impact the cardiovascular responses of dentists treating paediatric patients with no differences between the two types of masks.

What factors predict craniomandibular disorders in severe COVID-19 survivors after prolonged intubation?

PURPOSES: To estimate and identify predictors of craniomandibular disorders (CMDs) in severe COVID-19 survivors after prolonged intubation ≥ 1 week (SCOVIDS-PI). METHODS: This retrospective study enrolled two cohorts of SCOVIDS-PIs with vs. without CMD during a one-year period. The predictor variables were demographic, dental, anesthetic, and laboratory parameters. The main outcome was presence of CMD until six post-PI months (yes/no). Appropriate statistics were computed with α = 95%. RESULTS: The sample comprised 176 subjects aged 59.2 ± 17.2 years (range, 27-89; 11.9% with CMDs; 30.1% females). CMDs were significantly associated with (1) bilateral posterior tooth loss (P = 0; number needed to screen [NNS] = 1.6), (2) dentofacial skeletal class II/convex face (P = .01; NNS = 2.2), and (3) peak CRP during intensive care ≥ 40 mg/l (P = .01; NNS = 3.5). With combined predictors, NNS became 2 to 4.3. CONCLUSIONS: Three predictors of CMDs in SCOVIDS-PIs: bilateral molar loss, convex face, and CRP ≥ 40 mg/l, indicate CMD screening and/or referral to a CMD specialist, regardless of patients' age, gender, underlying CMDs, or previous dental checkups. Screening ∼2 to 4 "SCOVIDS-PIs with ≥ one predictor" will identify one CMD events/patients during the first six post-PI months.

Postoperative Pain Management Using Supplemental Bupivacaine After Mandibular Orthognathic Surgery: A Triple-Blind Randomized Controlled Clinical Trial.

PURPOSE: The objective of this triple-blind, randomized, placebo-controlled trial was to assess the clinical analgesic efficacy of 0.5% bupivacaine in acute postoperative pain management after bilateral sagittal split ramus osteotomy (BSSO). METHODS: Patients were randomly allocated into the experimental (0.5% bupivacaine with 1:200000 epinephrine) or control group (normal saline - placebo) using block randomization. The interventions were administered at the inferior alveolar nerve block and buccal nerve block sites bilaterally after the BSSO surgery. Analgesic efficacy was assessed in terms of the patient's pain perception measured by a numerical rating scale (0 to 10), rescue drug requirement, and duration of analgesia for 24 hours after the surgery. The statistical analysis was blinded to the allocation groups, and P-value of <.05 was considered as a significant difference for all tests. RESULTS: In total, 28 patients underwent BSSO (ie, 14 in each group). There was no significant difference in pain perception of patients injected with 0.5% bupivacaine and those administered with placebo during the 24 hours after the surgery (P > .05). Three patients in the bupivacaine group took the rescue drug after the surgery (mean duration - 268 minutes) and 1 patient in the placebo group took the rescue drug after 27 minutes. CONCLUSIONS: Postoperative use of bupivacaine did not show a superior analgesic efficacy when compared with normal saline in controlling acute postoperative pain after BSSO.

Complications associated with intravenous midazolam and fentanyl sedation in patients undergoing minor oral surgery.

BACKGROUND: Anxiety control remains an important concern in dental practice. We evaluated the incidence, nature, and sequelae of complications during and after minor oral surgeries performed under intravenous midazolam and fentanyl sedation using the titration technique. METHODS: The medical records of patients who had undergone minor oral surgeries under moderate intravenous midazolam and fentanyl sedation at our institution between January 1, 2015 and December 31, 2015 were retrospectively evaluated. Age, sex, body mass index, medical history, American Society of Anesthesiologists (ASA) classification, indications for sedation, amount of sedative used, surgical duration, and recovery time were evaluated for all patients. RESULTS: In total, 107 patients aged 9-84 years were included. ASA class I and class II were observed for 56.1% and 43.9% patients, respectively. Complications associated with sedation occurred in 11 (10.2%) patients. There were no serious adverse events. Oxygen saturation reached 95% during the procedure in six patients; this was successfully managed by stimulating the patients to take a deep breath. Two patients exhibited deep sedation and one exhibited paradoxical excitement. After the procedure, one patient experienced nausea without vomiting and one exhibited a prolonged recovery time. The surgical procedures were completed in all patients. Obesity was found to be significantly associated with sedation-related complications. CONCLUSIONS: Our results suggest that complications associated with intravenous midazolam and fentanyl sedation using the titration technique for minor oral surgeries are mostly minor and can be successfully managed with no prolonged sequelae.

Postoperative nausea and vomiting after general anesthesia for oral and maxillofacial surgery.

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most common postoperative complications. Despite this, few papers have reported the incidence and independent risk factors associated with PONV in the context of oral and maxillofacial surgery (OMFS). Therefore, we sought to determine the incidence of PONV, as well as to identify risk factors for the condition in patients who had undergone OMFS under general anesthesia. METHODS: A total of 372 patients' charts were reviewed, and the following potential risk factors for PONV were analyzed: age, sex, body mass index, smoking status, history of PONV and/or motion sickness, duration of anesthesia, amount of blood loss, nasogastric tube insertion and retention and postoperative opioid used. Univariate analysis was performed, and variables with a P-value less than 0.1 were entered into a multiple logistic regression analysis, wherein P-values < 0.05 were considered significant. RESULTS: The overall incidence of PONV was 25.26%. In the multiple logistic regression analysis, the following variables were independent predictors of PONV: age < 30 years, history of PONV and/or motion sickness, and anesthesia duration > 4 h. Furthermore, the number of risk factors was proportional to the incidence of PONV. CONCLUSIONS: The incidence of PONV in patients who have undergone OMFS varies from center to center depending on patient characteristics, as well as on anesthetic and surgical practice. Identifying the independent risk factors for PONV will allow physicians to optimize prophylactic, antiemetic regimens.

Evaluation of the advantageous anesthetic properties of dexmedetomidine used as hypotensive agent compared with nitroglycerin in orthognathic surgery.

PURPOSE: To evaluate the advantageous anesthetic properties, such as the decrease of intraoperative analgesic requirement, time to extubation and recovery, and early postoperative pain, of dexmedetomidine used as hypotensive agent compared with nitroglycerin in orthognathic surgery. MATERIALS AND METHODS: The authors implemented a prospective, single-blinded, randomized clinical trial. The sample was composed of healthy patients who were admitted for bimaxillary osteotomies and were assigned to 1 of 2 groups by a computer-generated random number and blinded to the group. Dexmedetomidine or nitroglycerin was used as the hypotensive drug for each group. All patients underwent hypotensive anesthesia and surgery according to standard protocol. Intraoperative amount of fentanyl, time to eye opening, time to follow basic verbal commands, time to extubation, early postoperative pain scores, and analgesics were recorded. Compared means were analyzed using the unpaired Student t test. A 2-sided statistical test was used. A P value less than .05 was considered significant. RESULTS: The sample was composed of 40 participants. The intraoperative fentanyl requirement was significantly lower in the dexmedetomidine group than in the nitroglycerin group (168.75±56.29 and 222.50±96.12 µg, respectively; P=.037). Times to eye opening and following commands were considerably longer in the dexmedetomidine group, but the time to extubation showed no meaningful difference. Early postoperative pain after 30 and 60 minutes and the requirement for meperidine were not meaningfully different between the 2 groups. CONCLUSIONS: Dexmedetomidine, used as a hypotensive drug, has anesthetic benefits compared with nitroglycerin. Dexmedetomidine decreases the intraoperative fentanyl requirement and does not meaningfully change the time to extubation, early postoperative pain, and analgesic drug requirement.

Factors that determine intraoperative blood loss in bimaxillary osteotomies and the need for preoperative blood preparation.

PURPOSE: To define factors that influence blood loss in bimaxillary osteotomies and the need for blood preparation at the Faculty of Dentistry, Mahidol University, Bangkok, Thailand. PATIENTS AND METHODS: We retrospectively studied 208 patients who underwent bimaxillary osteotomies during 2005 to 2009. Possible factors for intraoperative blood loss such as age, body weight, gender, operative time, experience of the surgeons, and different operative procedures were statistically analyzed. RESULTS: Female patients had a significantly higher percentage of blood loss from allowable blood loss than male patients (P = .006). Experience of the surgeons had a significant influence on blood loss (P = .02) and operative time (P < .001). No significant difference in blood loss was found among the 4 groups classified by operation (P = .852). Simple regression analysis showed a significantly positive correlation between blood loss and duration of operation (R(2) = 0.15, P < .001). There was no correlation between blood loss and patient age (P = .35). CONCLUSION: The factors that influence blood loss include patient gender, experience of the surgeon, and operative time. Blood preparation should be considered in women, especially small individuals in whom a long operative time is expected and who are being operated on by an inexperienced surgeon. Because of the low rate of transfusion, a group-and-save policy is appropriate.

Does tranexamic acid in an irrigating fluid reduce intraoperative blood loss in orthognathic surgery? A double-blind, randomized clinical trial.

PURPOSE: The aim of this study was to investigate the efficacy of tranexamic acid in an irrigant fluid in decreasing intraoperative blood loss during orthognathic surgery. MATERIALS AND METHODS: This was a prospective, randomized, double-blind, placebo-controlled trial of elective bimaxillary osteotomy. Forty patients were included in the study and 20 were randomly assigned to each group. Drawing of random lots determined whether 0.05% tranexamic acid in normal saline solution or normal saline was used as an irrigant fluid during surgery. All patients underwent hypotensive anesthesia and surgery according to standard protocol. Intraoperative blood loss, operative and hypotensive times, preoperative and postoperative hematocrit levels, transfusion of blood product, and amount of irrigant fluid were recorded. Parametric data were reported as mean ± standard deviation and nonparametric data were counted. Changes in parametric variables were analyzed using unpaired Student t test. Two-sided significance tests were used. P < .05 was accepted as statistically significant. RESULTS: Blood loss during bimaxillary surgery was not decreased significantly in the tranexamic acid group compared with the control group (832.5 ± 315.5 vs 917.5 ± 424.0 mL, respectively, P = .47). CONCLUSIONS: Tranexamic acid in an irrigant fluid does not significantly decrease intraoperative blood loss compared with placebo during orthognathic surgery.

Efficacy and safety of oral propranolol premedication to reduce reflex tachycardia during hypotensive anesthesia with sodium nitroprusside in orthognathic surgery: a double-blind randomized clinical trial.

PURPOSE: The present study sought to determine whether premedication with oral propranolol 10 mg before hypotensive anesthesia with sodium nitroprusside could reduce reflex tachycardia, the amount of sodium nitroprusside used, and blood loss during hypotensive anesthesia for orthognathic surgery. PATIENTS AND METHODS: A total of 60 patients undergoing bimaxillary surgery were studied in a prospective, randomized, and double-blind study of oral propranolol 10 mg or placebo as premedication before hypotensive anesthesia with sodium nitroprusside. Hemodynamic variables, the amount of sodium nitroprusside used, and blood loss were statistically analyzed. RESULTS: The heart rate and amount of sodium nitroprusside used were highly significantly less (P < .01) in the propranolol group, but no significant difference was found in blood loss between the 2 groups. No clinically significant complications were observed in either group. CONCLUSION: Premedication with oral propranolol 10 mg before hypotensive anesthesia with sodium nitroprusside is safe and effective to reduce reflex tachycardia and the amount of sodium nitroprusside used.