Prophylactic administration of diphenhydramine/paracetamol reduced emergence agitation and postoperative pain following maxillofacial surgeries: a randomized controlled trial.

BACKGROUND: Emergence agitation after maxillofacial surgeries is an anxious and problematic complication for the surgeon and anesthesiologist that may lead to self-extubation, haemorrhage, and surgical destruction. In this study, we investigated the effects of preemptive administration of diphenhydramine on emergence agitation and quality of recovery after maxillofacial surgery in adult patients. METHODS: Eighty-five patients undergoing maxillofacial surgery were randomized into two groups. The diphenhydramine group (Group D, n = 40) received diphenhydramine premedication 0.5 mg/kg before anesthesia induction, while the control group (Group C, n = 40) received volume-matched normal saline as a placebo. Before incision, all patients receive 0.1 mg/kg morphine sulfate slowly intravenously within 5 min. Continuous infusion of remifentanil 0.2 µg/kg/h and inhalation of isoflurane was maintained during the anesthesia period. Paracetamol 1 g was infused 15 min before extubation. We evaluated the incidence of agitation during the extubation period after general anesthesia, hemodynamic parameters, and recovery characteristics during the postoperative period. RESULTS: During extubation time, the incidence of emergence agitation was lower in Group D than in Group C (16% vs. 49%, P = 0.041). The time from isoflurane discontinuation to extubation (7.7 min in Group D vs. 6.8 min in Group C, P = 0.082) was not different. Grade of cough during emergence, the severity of pain, analgesic requirements, and hemodynamic changes were lower in group D compared with Group C. CONCLUSIONS: Preemptive administration of diphenhydramine provided smooth emergence from anesthesia. It also improved the quality of recovery after maxillofacial surgery. TRIAL REGISTRATION NUMBER: This study was registered at http://irct.ir (registration number IRCT20130304012695N3).

Thickness of Buccal and Lingual Alveolar Bone Plates according to the Position of Impacted Mandibular Third Molars on Cone-Beam Computed Tomography Scans.

OBJECTIVES: This study sought to assess the thickness of buccal and lingual alveolar bone plates according to the position of impacted mandibular third molars on cone-beam computed tomography (CBCT) scans. MATERIALS AND METHODS: Eighty-four CBCT scans of impacted mandibular third molars were evaluated in this retrospective study. All images had been obtained by ProMax 3D CBCT system with the exposure settings of 78 kVp, 12 mA, 16 s time, 0.2 mm voxel size and 10 × 9 cm field of view. The impaction angle of teeth and the thickness of buccal and lingual cortical plates were determined on images by drawing lines in the anterior, middle, posterior, superior, central and inferior regions. Thickness of bone plates was analyzed according to the position of impacted molars relative to the buccal and lingual plates using the Student t-test and relative to the second molars using one-way ANOVA and Tukey's test. RESULTS: In the buccolingual direction, the buccal plate thickness was maximum in lingual position followed by central position, and minimum in buccal position of the teeth. The lingual plate thickness was minimum in horizontal and distoangular positions and maximum in the mesioangular position of impacted teeth. CONCLUSION: Risk of lingual plate preformation is higher in surgical removal of impacted third molars with distoangular and horizontal positions. Thus, further attention must be paid by the surgeons to such cases.

Cytotoxic Effect of Thiabendazole on Hn5 Head and Neck Squamous Cell Carcinoma Cell Line.

STATEMENT OF THE PROBLEM: Evidence shows thiabendazole has the potential to inhibit angiogenesis in melanoma and fibrosarcoma; however, its effect on oral squamous cell carcinoma has not been previously studied. PURPOSE: This study sought to assess the cytotoxic effects of thiabendazole on HN5 head and neck squamous carcinoma cell line. MATERIALS AND METHOD: HN5 cell lines were exposed to different concentrations of thiabendazole (prepared from 99% pure powder) for 24, 48 and 72 hours. Cell viability was assessed by the methyl thiazol tetrazolium assay, and IC50 of thiabendazole was calculated. Cells were also exposed to different concentrations of thiabendazole for 48 hours to determine its effect on expression and transcription of vascular endothelial growth factor gene. Expression of vascular endothelial growth factor mRNA was assessed by real-time polymerase chain reaction. The vascular endothelial growth factor release was assessed by the enzyme-linked immunosorbent assay test. RESULTS: In all concentrations of thiabendazole except for 200 and 550µM, cell viability was significantly different at different time points (p< 0.05). At 48 and 72 hours, cell viability at all concentrations of thiabendazole (100-650µM) significantly decreased compared to the control group (zero concentration). In addition, cell viability significantly decreased with an increase in thiabendazole concentration. At 48 hours, expression of vascular endothelial growth factor mRNA was significantly lower in presence of 500µM thiabendazole compared to the control group (p< 0.001) and release of vascular endothelial growth factor was inhibited in a dose-dependent manner. CONCLUSION: Thiabendazole inhibited the proliferation of HN5 cells in a dose-dependent and time-dependent manner. It also inhibited the expression of vascular endothelial growth factor gene.