Objective To compare the effectiveness of conventional (CF), laser (LF), and Z-plasty (ZF) frenotomies for the treatment of ankyloglossia in the pediatric population. Data Sources A comprehensive search of PUBMED, EMBASE, and COCHRANE databases was performed. Review Methods Relevant articles were independently assessed by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results Thirty-five articles assessing CF (27 articles), LF (4 articles), ZF (3 articles), and/or rhomboid plasty frenotomy (1 article) were included. A high level of outcome heterogeneity prevented pooling of data. All 7 randomized controlled trials (RCTs) were of low quality. Both CF (5 articles with 589 patients) and LF (2 articles with 78 patients) were independently shown to reduce maternal nipple pain on a visual analog or numeric rating scale. There were reports of improvement with breastfeeding outcomes as assessed on validated assessment tools for 88% (7/8) of CF articles (588 patients) and 2 LF articles (78 patients). ZF improved breastfeeding outcomes on subjective maternal reports (1 article with 18 infants) only. One RCT with a high risk of bias concluded greater speech articulation improvements with ZF compared to CF. Only minor adverse events were reported for all frenotomy techniques. Conclusions Current literature does not demonstrate a clear advantage for one frenotomy technique when managing children with ankyloglossia. Recommendations for future research are provided to overcome the methodological shortcomings in the literature. We conclude that all frenotomy techniques are safe and effective for treating symptomatic ankyloglossia.
SummaryPrevious volunteer studies of an effect-site controlled, patient-maintained sedation system using propofol have demonstrated a risk of over-sedation. We have incorporated a reaction-time monitor into the handset of the patientmaintained sedation system to add an individualised patient-feedback mechanism. This study assessed if such reactiontime feedback modification would reduce the risk of over-sedation in 20 healthy volunteers deliberately attempting to over-administer themselves propofol. All the volunteers successfully sedated themselves without reaching any unsafe endpoints. All volunteers maintained verbal contact throughout, in accordance with the definition of conscious sedation. The mean (SD) lowest S p O 2 was 97 (1.7) % when breathing room air and no volunteer required supplementary oxygen. The mean (SD) maximum effect-site propofol concentration reached was 1.7 (0.4) lg.ml . The present system was found to be safer than its predecessors, allowing conscious sedation, but preventing over-sedation. Accepted: 9 September 2012Effect-site controlled, patient-maintained sedation with propofol allows the patient to control their level of sedation using a hand-held demand button. The system sets a target effect-site concentration [1] at a low level that can then be increased when the patient presses the handset button twice within 1 s. The system increases the plasma concentration to twice that of the target effect-site concentration to 'force' the drug rapidly into the effect-site, and then reduces the plasma concentration as the target effect-site concentration is approached.Instead of a traditional lockout period, the patient cannot initiate a further increment until the plasma concentration decreases to within 10% of the target effect-site concentration. As the brain is the site of action of propofol, this paradigm allows equilibration between the blood and brain to occur. We have found this technique to be safe and effective in patients undergoing dental surgery [2], but before such systems can be used safely in the absence of an anaesthetist, it is necessary to demonstrate that patients are unable to
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