Effect of audio distraction with thermomechanical stimulation on pain perception for inferior alveolar nerve block in children: a randomized clinical trial.

Background: Pain control is a crucial aspect of pediatric dentistry for patient management. Thermo-mechanical devices (Buzzy™ Pain Care Labs, USA) work on the concept of vibration and cooling and have shown promising results in pain control during local anesthesia in pediatric dentistry. On the other hand, audio distraction has also been used for pain management. The amount of pain endured is determined by the patient's perception and attentiveness. Thus, if audio function is added to the thermomechanical device it might increase its efficiency. Hence, the present study aimed to compare pain on injection using a thermo-mechanical device with and without audio during inferior alveolar nerve block (IANB) injection in children aged 5-10 years old. Methods: Twenty-eight children aged between 5 and 10 indicated for IANB were included in this randomized study. Children who were undergoing the dental procedure were divided into 2 groups, with 14 children in each group. The study group was the thermo-mechanical device with audio distraction; the control group was the thermo-mechanical device without audio distraction. IANB was administered. Subjective pain evaluation was performed using the Wong-Baker Faces Pain Rating Scale (WBFPR) and objective pain evaluation was done using the Faces, Leg, Activity, Consolability, Cry (FLACC) scale. Results: The outcome depicted a significant reduction in pain on injection for both objective and subjective evaluations in the thermo-mechanical device with an audio distraction group. Conclusions: Less pain on injection was observed, when a thermo-mechanical device was used with audio distraction for IANB procedures.

Peripheral skin cooling during hyper-gravity: hemodynamic reactions.

Introduction: Orthostatic dysregulation occurs during exposure to an increased gravitational vector and is especially common upon re-entering standard Earth gravity (1 g) after an extended period in microgravity (0 g). External peripheral skin cooling (PSC) has recently been described as a potent countermeasure against orthostatic dysregulation during heat stress and in lower body negative pressure (LBNP) studies. We therefore hypothesized that PSC may also be an effective countermeasure during hyper-gravity exposure (+Gz). Methods: To investigate this, we designed a randomized short-arm human centrifuge (SAHC) experiment ("Coolspin") to investigate whether PSC could act as a stabilizing factor in cardiovascular function during +Gz. Artificial gravity between +1 g and +4 g was generated by a SAHC. 18 healthy male volunteers completed two runs in the SAHC. PSC was applied during one of the two runs and the other run was conducted without cooling. Each run consisted of a 10-min baseline trial followed by a +Gz step protocol marked by increasing g-forces, with each step being 3 min long. The following parameters were measured: blood pressure (BP), heart rate (HR), stroke volume (SV), total peripheral resistance (TPR), cardiac output (CO). Furthermore, a cumulative stress index for each subject was calculated. Results: +Gz led to significant changes in primary as well as in secondary outcome parameters such as HR, SV, TPR, CO, and BP. However, none of the primary outcome parameters (HR, cumulative stress-index, BP) nor secondary outcome parameters (SV, TPR, CO) showed any significant differences-whether the subject was cooled or not cooled. Systolic BP did, however, tend to be higher amongst the PSC group. Conclusion: In conclusion, PSC during +Gz did not confer any significant impact on hemodynamic activity or orthostatic stability during +Gz. This may be due to lower PSC responsiveness of the test subjects, or an insufficient level of body surface area used for cooling. Further investigations are warranted in order to comprehensively pinpoint the exact degree of PSC needed to serve as a useful countermeasure system during +Gz.

Mild Hypothermia via External Cooling Improves Lung Function and Alleviates Pulmonary Inflammatory Response and Damage in Two-Hit Rabbit Model of Acute Lung Injury.

OBJECTIVES: Targeted temperature management (TTM) with therapeutic hypothermia (TH) has an organ-protective effect by mainly reducing inflammatory response. Here, our objective was to determine, for the first time, whether mild TH with external cooling, a simple and inexpensive method, could be safe or even beneficial in two-hit rabbit model of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). METHODS: Twenty-two New Zealand rabbits (6-month-old) were randomly divided into healthy control (HC) with conventional ventilation, but without injury, model group (ALI), and hypothermia group with external cooling (ALI-HT). After induction of ALI/ARDS through mild lung-lavages followed by non-protective ventilation, mild hypothermia was started in ALI-HT group (body temperature of 33-34 °C). All rabbits were conventionally ventilated for an additional 6-h by recording respiratory parameters. Finally, lung histopathology and inflammatory response were evaluated. RESULTS: Hypothermia was associated with higher oxygen saturation, resulting in partial improvement in the P/F ratio (PaO2/FiO2), oxygenation index, mean airway pressure, and PaCO2, but did not affect lactate levels. The ALI-HT group had lower histopathological injury scores (hyperemia, edema, emphysema, atelectasis, and PMN infiltration). Further, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6 and -8 levels in lung tissue and serum samples markedly reduced due to hypothermia. CONCLUSION: Mild TH with external cooling reduced lung inflammation and damage, whereas it resulted in partial improvement in gas exchanges. Our findings highlight that body temperature control may be a potentially supportive therapeutic option for regulating cytokine production and respiratory parameters in ALI/ARDS.

Effects of different external cooling placements prior to and during exercise on athletic performance in the heat: A systematic review and meta-analysis.

Background: Nowadays, many high-profile international sport events are often held in warm or hot environments, hence, it is inevitable for these elite athletes to be prepared for the challenges from the heat. Owing to internal cooling may cause gastrointestinal discomfort to athletes, external cooling technique seems to be a more applicable method to deal with thermal stress. Central cooling mainly refers to head, face, neck and torso cooling, can help to reduce skin temperature and relieve thermal perception. Peripheral cooling mainly refers to four limbs cooling, can help to mitigate metabolic heat from muscular contrac to effectively prevent the accumulation of body heat. Hence, we performed a meta-analysis to assess the effectiveness of different external cooling placements on athletic performance in the heat Methods: A literatures search was conducted using Web of Science, MEDLINE and SPORTDiscus until September 2022. The quality and risk of bias in the studies were independently assessed by two researchers. Results: 1,430 articles were initially identified (Web of Science = 775; MEDLINE = 358; SPORTDiscus = 271; Additional records identified through other sources = 26), 60 articles (82 experiments) met the inclusion criteria and were included in the final analysis, with overall article quality being deemed moderate. Central cooling (SMD = 0.43, 95% CI 0.27 to 0.58, p < 0.001) was most effective in improving athletic performance in the heat, followed by central and peripheral cooling (SMD = 0.38, 95% CI 0.23 to 0.54, p < 0.001), AND peripheral cooling (SMD = 0.32, 95% CI 0.07 to 0.57, p = 0.013). For the cooling-promotion effects on different sports types, the ranking order in central cooling was ETE (exercise to exhaustion), TT (time-trial), EWT (exercise within the fixed time or sets), IS (intermittent sprint); the ranking order in peripheral cooling was EWT, TT, ETE and IS; the ranking order in central and peripheral cooling was ETE, IS, EWT and TT. Conclusion: Central cooling appears to be an more effective intervention to enhance performance in hot conditions through improvements of skin temperature and thermal sensation, compared to other external cooling strategies. The enhancement effects of peripheral cooling require sufficient re-warming, otherwise it will be trivial. Although, central and peripheral cooling seems to retain advantages from central cooling, as many factors may influence the effects of peripheral cooling to offset the positive effects from central cooling, the question about whether central and peripheral cooling method is better than an isolated cooling technique is still uncertain and needs more researchs to explore it.

The Efficacy of External Cooling and Vibration on Decreasing the Pain of Local Anesthesia Injections During Dental Treatment in Children: A Randomized Controlled Study.

PURPOSE: This study was performed to assess the efficacy of external cooling and vibration devices on the pain of injections applied to the site of local anesthesia in children during dental treatment. DESIGN: This study is a randomized controlled trial. METHODS: This study was conducted with 60 children requiring mandibular baby teeth extraction. The children in the experimental group were anesthetized after cold application, and a vibration device was administered on the application site 2 minutes before and during the anesthesia process, whereas those in the control group were only given local mandibular anesthesia without any other procedure. FINDINGS: It was found that the mean pain score was lower in the experimental group with a significant difference between the groups (P < .05). CONCLUSIONS: This study found that the application of external cooling and vibration on the site of local anesthesia had a significant effect on the injection pain experienced by children during dental treatment.

Experimental investigation of temperature rise in bone drilling with cooling: A comparison between modes of without cooling, internal gas cooling, and external liquid cooling.

Bone fracture occurs due to accident, aging, and disease. For the treatment of bone fractures, it is essential that the bones are kept fixed in the right place. In complex fractures, internal fixation or external methods are used to fix the fracture position. In order to immobilize the fracture position and connect the holder equipment to it, bone drilling is required. During the drilling of the bone, the required forces to chip formation could cause an increase in the temperature. If the resulting temperature increases to 47 °C, it causes thermal necrosis of the bone. Thermal necrosis decreases bone strength in the hole and, subsequently, due to incomplete immobilization of bone, fracture repair is not performed correctly. In this study, attempts have been made to compare local temperature increases in different processes of bone drilling. This comparison has been done between drilling without cooling, drilling with gas cooling, and liquid cooling on bovine femur. Drilling tests with gas coolant using direct injection of CO2 and N2 gases were carried out by internal coolant drill bit. The results showed that with the use of gas coolant, the elevation of temperature has limited to 6 °C and the thermal necrosis is prevented. Maximum temperature rise reached in drilling without cooling was 56 °C, using gas and liquid coolant, a maximum temperature elevation of 43 °C and 42 °C have been obtained, respectively. This resulted in decreased possibility of thermal necrosis of bone in drilling with gas and liquid cooling. However, the results showed that the values obtained with the drilling method with direct gas cooling are independent of the rotational speed of drill.

Physiological responses to incremental exercise in the heat following internal and external precooling.

Twelve males completed three incremental, discontinuous treadmill tests in the heat [31.9(1.0) °C, 61.9(8.9)%] to determine speed at two fixed blood lactate concentrations (2 and 3.5 mmol/L), running economy (RE), and maximum oxygen uptake ( V ˙ O 2 m a x ). Trials involved 20 min of either internal cooling (ICE, 7.5 g/kg ice slurry ingestion) or mixed-methods external cooling (EXT, cold towels, forearm immersion, ice vest, and cooling shorts), alongside no intervention (CON). Following precooling, participants ran 0.3 km/h faster at 2 mmol/L and 0.2 km/h faster at 3.5 mmol/L (P = 0.04, partial η(2) = 0.27). Statistical differences were observed vs CON for ICE (P = 0.03, d = 0.15), but not EXT (P = 0.12, d = 0.15). There was no effect of cooling on RE (P = 0.81, partial η(2) = 0.02), nor on V ˙ O 2 m a x (P = 0.69, partial η(2) = 0.04). An effect for cooling on physiological strain index was observed (P < 0.01, partial η(2) = 0.41), with differences vs CON for EXT (P = 0.02, d = 0.36), but not ICE (P = 0.06, d = 0.36). Precooling reduced thermal sensation (P < 0.01, partial η(2) = 0.66) in both cooling groups (P < 0.01). Results indicate ICE and EXT provide similar physiological responses for exercise up to 30 min duration in the heat. Differing thermoregulatory responses are suggestive of specific event characteristics determining the choice of cooling. Precooling appears to reduce blood lactate accumulation and reduce thermoregulatory and perceptual strain during incremental exercise.