Neurosedation in dentistry of the disabled patient: the use of midazolam, propofol, and remifentanil.

AIM: This prospective randomized study, deals with neurosedation in dental treatment of 200 disabled patients and unable to cooperate, subdivided in 4 groups of 50 male only patients, with age ranging from 28 to 59 (39+/-11), ASA I-III. METHODS: The pharmaceuticals used were Midazolam (group MID) Propofol (group Prop) and Remifentanil. Midazolam and Propofol were used following a bolus-infusion sequence, both separately and in combination among themselves (MID\PROP group), or with an opioid, Remifentanil (MID\PROP\REMI group). ECG, heart rate , non invasive blood pressure (NIBP), SaO(2), EtCO(2) during the procedure were monitored. Induction time, duration of the sedation, recovery time and discharge were reported. RESULTS: The statistical analysis demonstrated the superiority of the PROP group for induction time in minute (3.1+/-0.5) in comparison with the MID group (10.6+/-2.1), the MID\PROP group (4.3+/-1.3) and MID\PROP\REMI (3.7+/-1.2). The recovery and discharge times have confirmed the superiority of the MID\PROP\REMI group in comparison with the other 3 groups. CONCLUSION: This combination proved best at leveraging the synergistic characteristics of each single pharmaceutical and minimizing the collateral effects of each individually.

[The use of laryngeal mask airway in esophagogastroduodenoscopy in children]. / L'impiego della maschera laringea nelle esofagogastroduodenoscopie in età pediatrica.

BACKGROUND: The use of laryngeal mask airway (LMA) for inducing and maintaining sedation during EGDS has never been reported in the literature but for a brief letter written by Gajraj in 1996. This study proposes the use of sevoflurane administered through LMA. METHODS: At the Pediatric Clinic of the University of Rome "La Sapienza" 80 children un-derwent EGDS. After premedication, immediate 8% sevoflurane and 60/40% N2O/O2 induction was delivered. Concentration of sevoflurane was reduced to 1% for maintaining general anesthesia. Heart rate (HR), systemic blood pressure (SBP), respiratory rate (RR), EtCO2 and SpO2 were not invasively monitored. Time for induction, time for emergence as well as complications, if any, were also evaluated. RESULTS: The monitored parameters did not show any significant changes. The time for loss of eyelash reflex and the time for end of induction were of 121+/-15 sec. 3.5+/-1.3 min respectively. The time for emergence was 3.4+/-1.8 min. Only minor complications were reported. CONCLUSIONS: The results obtained show that the use of LMA associated to sevoflurane as single inhaling agent can be a valid technique for EGDS in pediatric patients.

[The PiCCO system with brachial-axillary artery access in hemodynamic monitoring during surgery of abdominal aortic aneurysm]. / PiCCO system con accesso arterioso brachio-ascellare nel monitoraggio emodinamico degli interventi per aneurisma dell'aorta addominale.

BACKGROUND: The haemodynamic monitor PiCCO System, based on transpulmonary arterial thermodilution, has been used with a brachial-axillary access instead of the femoral arterial access during abdominal aortic aneurysm surgical repair. Accuracy and limitations of pulse contour continuous cardiac output (PCCO) were evaluated on the basis of arterial thermodilution cardiac output. The patterns of cardiac index, preload, afterload and cardiac function parameters were also studied in the different phases of the surgical procedure. METHODS: Twenty consecutive patients were studied. Mean differences (bias) between PCCO and arterial thermodilution cardiac output were calculated by the Bland-Altman test. Analysis of variance with multiple comparison test of haemodynamic variables in the different phases were performed. The correlation coefficients between cardiac index and the volumetric preload variables were also obtained. RESULTS: Brachial artery catheterization was achieved without any major complication. Pulse contour continuous cardiac index (CI) and arterial thermodilution CI values showed overall mean differences (bias) of -0.04 Lámin-1. m-2 (SD 0.8) but after aortic cross-clamping and aortic unclamping they were 0.64 Lámin-1. m-2 (SD 0.57) e -0.57 Lámin-1. m-2 (SD 0.85), respectively (p<0.05). CI, global end-diastolic volume (GEDV) and intrathoracic blood volume (ITBVI) were significantly lower during aortic cross-clamping. CI was not correlated to central venous pressure (r=0.18) but instead, to GEDV (r=0.57) and ITBVI (r=0.65). CONCLUSIONS: PiCCO System with brachial-axillary arterial access was suitable for haemodynamic monitoring of the abdominal aortic aneurysm surgical repair procedures. PCCO must be recalibrated with arterial thermodilution after aortic cross-clamping and unclamping to avoid an over-estimation and an under-estimation respectively. During aortic cross-clamping GEDV and ITBVI indicated a decreased preload. Other haemodynamic variables were less valuable but EVLWI showed an interesting steady increase during the whole procedure.