Plaque removal efficacy of powered and manual toothbrushes under supervised and unsupervised conditions: a comparative clinical study.

The present study was undertaken to determine and compare the efficacy of manual and powered toothbrushes under supervised and unsupervised conditions in 200 school-going children between 6 and 13 years of age. Two hundred school-going children aged between 6 and 13 years were selected. Children were randomly divided into two groups of 100 in each. Group 1 children were given manual brushes, while group 2 children were given powered brushes. The groups were further divided into two subgroups, with supervised brushing in subgroup A and unsupervised brushing in subgroup B. At 3, 6, 9 and 12 weeks, plaque was recorded according to Turseky-Gilmore-Glickman modification of Quingley Hein index and oral hygiene performance index. Data were statistically analyzed. Both brushes significantly reduced the plaque accumulation, though to different degrees. Powered brushes showed significant plaque reduction as compared to the manual brushes. Supervised group of both brushes showed a greater plaque reduction.

Obstacles to promotion? Values of women faculty about career success and recognition. Committee on the Status of Women and Minorities, Virginia Commonwealth University, Medical College of Virginia Campus.

PURPOSE: To assess attitudes of female faculty about career progress, resources for career development, and values related to academic success and recognition. METHOD: In 1997, the authors surveyed all faculty at Virginia Commonwealth University School of Medicine and its associated Veterans Affairs Medical Center. RESULTS: Of 918 faculty, 567 (62%) responded to the survey; 33% of the respondents were women. Compared with men, women faculty were less likely to be tenured or at the level of professor, spent more time in clinical activities, had less time for scholarly activity, and reported slower career progress. Women were more likely to report that promotion and tenure criteria had not been reviewed with them. Significant differences were found between female physicians and non-physician faculty; female physicians reported the least time for scholarly activities and poorest understanding of promotion and tenure criteria. When the authors asked faculty how they valued certain indicators of career success, women were less likely to value leadership than were men. Female physicians were less likely to value scholarship and national recognition as indicators of their career success. CONCLUSION: This survey found important differences in career progress of male and female faculty, with women reporting less time for career development. In addition, there were differences in values related to career success and recognition, which were most pronounced for female physicians. These differences may have an important impact on promotion for women in general and particularly for female physicians.

Remifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia. The Remifentanil/Alfentanil Outpatient TIVA Group.

The purpose of this study was to test the hypothesis that using a 1:4 ratio of remifentanil to alfentanil, a remifentanil infusion would provide better suppression of intraoperative responses and comparable recovery profiles after ambulatory laparoscopic surgery than an alfentanil infusion, as part of total intravenous anesthesia. Two hundred ASA physical status I, II, or III adult patients participated in this multicenter, double-blind, parallel group study. Patients were randomly assigned 2:1 to either the remifentanil-propofol or alfentanil-propofol regimens. The anesthesia sequence was propofol (2 mg/kg intravenously [IV] followed by 150 micrograms.kg-1.min-1), and either remifentanil (1 microgram/kg IV followed by 0.5 microgram.kg-1.min-1)of alfentanil (20 micrograms/kg IV followed by 2 micrograms.kg-1.min-1), and vecuronium. After trocar insertion, infusion rates were decreased (propofol to 75 micrograms.kg-1.min-1; remifentanil to 0.25 microgram.kg-1.min-1; alfentanil to 1 microgram.kg-1.min-1). Alfentanil and propofol were discontinued at 10 and 5 min, respectively, before the anticipated end of surgery (last surgical suture); remifentanil was discontinued at the end of surgery. Recovery times were calculated from the end of surgery. The median duration of surgery was similar between groups (39 min for remifentanil versus 34 min for alfentanil). A smaller proportion of remifentanil patients than alfentanil patients had any intraoperative responses (53% vs 71%, P = 0.029), had responses to trocar insertion (11% vs 32%, P < 0.001), or required dosage adjustments during maintenance (24% vs 41%, P < 0.05). Early awakening times were similar. Remifentanil patients qualified for Phase 1 discharge later and were given postoperative analgesics sooner than alfentanil patients (P < 0.05). Actual discharge times from the ambulatory center were similar between groups (174 min for remifentanil versus 204 min for alfentanil) (P = 0.06). In conclusion, remifentanil can be used for maintenance of anesthesia in a 1:4 ratio compared with alfentanil, for total IV anesthesia in ambulatory surgery. This dose of remifentanil provides more effective suppression of intraoperative responses and does not result in prolonged awakening.

Intravenous dolasetron for the prevention of postoperative nausea and vomiting after outpatient laparoscopic gynecologic surgery.

The newer 5-hydroxytryptamine type 3 (5-HT3) antagonists are sometimes considered for routine prophylaxis of postoperative nausea and vomiting (PONV) in high-risk patients. This multicenter, randomized, double-blind, placebo-controlled study compared the efficacy and safety of three single intravenous (IV) doses of dolasetron mesylate salt (12.5, 25, or 50 mg) for the prevention of PONV in 635 females undergoing outpatient laparoscopic gynecologic surgery. Antiemetic efficacy was evaluated over a 24-h postoperative period by recording the number and timing of emetic episodes; effects on nausea were evaluated by a visual analog scale (VAS). The proportion of complete responders (no emetic episodes and no escape medication in 24 h) was significantly higher with each dolasetron mesylate dose (> 50% for each dose; P < or = 0.0003) than with placebo (30.6%). Fewer patients given dolasetron required or requested escape antiemetic medication compared with placebo (P < 0.0003). Dolasetron-treated patients had significantly (P < 0.0357) lower median postdose maximum nausea VAS scores compared with placebo-treated patients. Patient satisfaction with dolasetron was high and, overall, was significantly (P = 0.0131) greater than that with placebo. Dolasetron was an effective and well tolerated preventive treatment for PONV resulting from laparoscopic gynecologic surgery.

A multicenter comparison of maintenance and recovery with sevoflurane or isoflurane for adult ambulatory anesthesia. The Sevoflurane Multicenter Ambulatory Group.

Sevoflurane was compared with isoflurane in 246 adult ASA class I-III patients undergoing ambulatory surgery. After administration of midazolam 1-2 mg and fentanyl 1 microgram/kg, anesthesia was induced with propofol 2 mg/kg and maintained with either sevoflurane or isoflurane in 60% nitrous oxide to maintain arterial blood pressure at +/- 20% of baseline. Fresh gas flows were 10 L/min during induction and 5 L/min during maintenance. Times to eye opening, command response, orientation, and ability to sit without nausea and/or dizziness were significantly faster after sevoflurane. Significantly more sevoflurane patients met Phase 1 of postanesthesia care unit (PACU) Aldrete recovery criteria (> or = 8) at arrival, 95% vs 81%. Also, significantly more sevoflurane patients were able to complete psychomotor recovery tests during the first 60 min postanesthesia. Discharge times were not different. Sevoflurane patients had significantly lower incidences of postoperative somnolence (15% vs 26%) and of nausea both in the PACU (36% vs 51%) and in the 24-h postdischarge period (9% vs 24%). Patient satisfaction was high overall (sevoflurane 97%, isoflurane 93%). We conclude that sevoflurane is a useful inhaled anesthetic for maintenance of ambulatory anesthesia.

Ondansetron prevents postoperative nausea and vomiting in women outpatients.

Three doses of intravenous (i.v.) ondansetron, 1 mg, 4 mg, and 8 mg, were compared to placebo for their antiemetic effect and safety. The drugs or placebo were administered in a double-blind manner, prophylactically to 589 women undergoing elective outpatient surgical procedures under nitrous oxide opioid-based general endotracheal anesthesia. In the postanesthesia care unit, the number of emetic episodes, periodic assessments of nausea severity using an 11-point scale (0 = no nausea; 10 = worst nausea), vital signs, and adverse events were collected by an independent observer for 2 h. Upon discharge, identical information, with the exception of vital signs, was collected from the patients' diary and via phone call. One pre- and two poststudy blood specimens for hematology and chemistries were evaluated. During the initial 2 h, patients receiving any dose of ondansetron had significantly better complete response rates (no emesis) than those receiving placebo. Over the 24-h study period, patients who received either 4 mg or 8 mg ondansetron continued to have significantly greater complete response rates. Adverse events were minor, and ondansetron-treated patients had profiles similar to those of the placebo. Heart rate, blood pressure, respiratory rate, and laboratory safety variables were not different among the groups. Ondansetron did not prolong awakening time. This study indicates that ondansetron is a safe and effective prophylactic antiemetic for women who have outpatient surgery under nitrous oxide opioid-based general anesthesia.

Single-dose intravenous H2 blocker prophylaxis against aspiration pneumonitis: assessment of drug concentration in gastric aspirate.

This placebo-controlled trial compared the effects of preoperative, intravenous cimetidine (300 mg) or ranitidine (50 mg) on gastric pH and gastric volume in 31 adult patients requiring general anesthesia. The elapsed time from drug administration to initial gastric sampling did not differ significantly between ranitidine (45 minutes), cimetidine (48 minutes), or placebo (52 minutes) treated patients. Ranitidine, but not cimetidine, significantly (P = 0.02) increased gastric pH when compared with placebo. Gastric pH correlated (r = 0.7, P = 0.01) with cimetidine concentration in gastric fluid at induction. Gastric pH was directly proportional to ranitidine concentration in gastric fluid at induction, but the correlation was weak (r = 0.54, P = 0.1). The H2 blockers did not significantly alter gastric volume when compared with placebo. The number of patients with gastric pH less than = 2.5 and gastric volume = greater than 25 ml did not differ significantly between cimetidine (8%), ranitidine (10%), and placebo (22%). No clinical evidence of aspiration pneumonitis was found in our study patients.

Reducing the risk of aspiration pneumonitis.

Regurgitation of gastric contents with subsequent aspiration into the lungs contributes significantly to morbidity and mortality in surgical and nonsurgical patients. The consequences of aspiration pneumonitis depend on the volume and the acidity of the aspirate, and the presence of particulate and bacteria in the aspirate. The occurrence of aspiration pneumonitis may be prevented by correction of risk factors, careful monitoring, and appropriate airway management. The goal of aspiration pneumonitis prophylaxis is to minimize pulmonary complications by controlling risk factors for gastric regurgitation, which include gastric pH less than or equal to 2.5, gastric volume greater than 25 mL, lower esophageal sphincter incompetence, and delayed peristalsis. Prophylactic techniques include nasogastric decompression, acid neutralization, acid suppression, and increased gastric peristalsis. The ability of drugs to alter risk factors does not guarantee that aspiration will not occur, but it does reduce the likelihood of secondary respiratory complications. The ideal prophylactic agent should consistently reduce all risk factors, produce a prompt and sustained response, and possess few adverse effects and drug interactions.

Cimetidine versus ranitidine: single-dose, oral regimen for reducing gastric acidity and volume in ambulatory surgery patients.

This placebo-controlled trial compared the efficacy of single oral doses of cimetidine or ranitidine in maintaining intragastric pH and volume greater than 2.5 and less than 25 ml, respectively, in ambulatory surgery patients requiring general anesthesia. Patients were randomized to receive either placebo, ranitidine HCl 150 mg, or cimetidine HCl 400 mg upon rising on the morning of surgery. At induction, the cimetidine and ranitidine groups had significantly higher (p less than 0.05) gastric pH values than the placebo group. At extubation, the ranitidine group had a significantly higher (p less than 0.05) gastric pH than either the cimetidine or placebo group. Both H2-blocker groups had lower volumes when compared with the placebo group at extubation (p less than 0.05). There were more patients at risk for aspiration pneumonitis (pH less than 2.5 and/or volume greater than 25 ml) in the cimetidine group (46 percent) than in the ranitidine group (15 percent). All placebo-treated patients were at risk for aspiration pneumonitis. We did not find subjective clinical evidence of aspiration pneumonitis in our patients. We conclude that both ranitidine and cimetidine are superior to placebo, but ranitidine may be the preferred agent because of its more consistent effect on gastric pH and volume.