Bupivacaine 0.25% with adrenaline 1:200,000, on application to exposed sockets is a simple technique that may provide useful post-operative analgesia.
BACKGROUND: Patients with obstructive sleep apnea (OSA) may be at increased risk for serious perioperative complications. The suitability of ambulatory surgery for patients with OSA remains controversial, and several national guidelines call for more evidence that assesses clinically significant outcomes. In this study, we investigate the association between OSA status (STOP-BANG risk, or previously diagnosed) and short-term outcomes and safety for patients undergoing cancer surgery at a freestanding ambulatory surgery facility. METHODS: We conducted a retrospective analysis of all patients having surgery at the Josie Robertson Surgery Center, a freestanding ambulatory surgery facility of the Memorial Sloan Kettering Cancer Center. Surgeries included more complex ambulatory extended recovery procedures for which patients typically stay overnight, such as mastectomy, thyroidectomy, and minimally invasive hysterectomy, prostatectomy, and nephrectomy, as well as typical outpatient surgeries. Both univariate and multivariable analyses were used to assess the association between OSA risk and transfer to the main hospital, urgent care center visit, and hospital readmission within 30 days postoperatively (primary outcomes) and length of stay and discharge time (secondary outcomes). Multivariable models were adjusted for age, American Society of Anesthesiologists score, robotic surgery, and type of anesthesia (general or monitored anesthesia care) and also adjusted for surgery start time for length of stay and discharge time outcomes. χ2 tests were used to assess the association between OSA risk and respiratory events and device use. RESULTS: Of the 5721 patients included in the analysis, 526 (9.2%) were diagnosed or at moderate or high risk for OSA. We found no evidence of a difference in length of stay when comparing high-risk or diagnosed patients with OSA to low- or moderate-risk patients whether they underwent outpatient (P = .2) or ambulatory extended recovery procedures (P = .3). Though a greater frequency of postoperative respiratory events were reported in high-risk or diagnosed patients with OSA compared to moderate risk (P = .004), the rate of hospital transfer was not significantly different between the groups (risk difference, 0.78%; 95% CI, –0.43% to 2%; P = .2). On multivariable analysis, there was no evidence of increased rate of urgent care center visits (adjusted risk difference, 1.4%; 95% CI, –0.68% to 3.4%; P = .15) or readmissions within 30 days (adjusted risk difference, 1.2%; 95% CI, –0.40% to 2.8%; P = .077) when comparing high-risk or diagnosed OSA to low- or moderate-risk patients. Based on the upper bounds of the CIs, a clinically relevant increase in transfers, readmissions, and urgent care center visits is unlikely. CONCLUSIONS: Our results contribute to the body of evidence supporting that patients with moderate-risk, high-risk, or diagnosed OSA can safely undergo outpatient and advanced ambulatory oncology surgery without increased health care burden of extended stay or hospital admission and avoiding adverse postoperative outcomes. Our results support the adoption of several national OSA guidelines focusing on preoperative identification of patients with OSA and clinical pathways for perioperative management and postoperative monitoring.
BACKGROUND: Information and Communication Technologies (ICTs) have affected various dimensions of modern societies, modifying even economic, politic, social and cultural structures. Therefore, it cannot be ignored the positive impacts according to social knowledge appropriation, but even in proper dimensions of social and family relationship, where ICTs usage has been compared with narcotic additions.OBJECTIVE: Explore how the use of ICTs have impacted the family interaction in Medellin city, 2016.METHODOLOGY: The study was carried out through an exploratory qualitative and a convenience sampling research. A self-administered instrument supported by a Likert scale was used, applied to a group of residents of Medellin city.RESULTS: It is observed that although ICTs have enabled a large flow of information that reinforces the nuclear family, particularly children, also have caused a detriment in communication processes and family life, generating sensations that lead to family members perceive a “distant relationship”, which goes against the current family concept.CONCLUSION: It is pertinent to encourage further researches to evaluate the impact of ICTs on the relationship processes from a qualitative vision and through longitudinal studies, and explore how new technologies have redefined the concepts of family life in modern societies.
SummaryThis study compared the quality of anaesthesia and surgical access afforded by two techniques for the administration of anaesthesia during paediatric chair dental procedures. A total of 50 ASA 1 paediatric day case patients were randomly assigned to receive anaesthesia through either the traditional Goldman nasal mask or through a nasopharyngeal airway. Patients in the nasal mask group were judged to have significantly worse airway patency (p = 0.0001) and significantly more episodes of airway obstruction (14 vs. 4; p = 0.0032) than those in the nasopharygeal airway group. Anaesthetic, surgical and oxygen saturation data did not differ significantly between the two groups. Operating conditions were universally graded as excellent in the nasopharyngeal airway group, while those in the nasal mask group were graded as excellent/good in only 79% of cases (p < 0.0001). These results suggest that better quality anaesthesia and operating conditions can be achieved by using a nasopharyngeal airway rather than the traditional nasal mask for the administration of anaesthesia to paediatric chair dental patients.Keywords Anaesthesia; dental. Equipment; nasopharyngeal airway, tracheal tube, nasal mask.. ..................................................................................... Correspondence to: Dr O. Bagshaw Accepted: 3 February 1997 Paediatric chair dental surgery is a challenge to both the anaesthetist and the surgeon. The children are outpatients, not previously assessed by an anaesthetist, unpremedicated and often frightened and uncooperative. The anaesthetist and the surgeon have to share the airway and the problems of airway obstruction, oxygen desaturation and poor surgical access are common [1, 2].The technique of using a nasopharyngeal airway for both the maintainance of airway patency and the administration of general anaesthesia is historically well described [3][4][5], but there have been no recent reports of its usefulness as an alternative to the nasal mask. Traditionally, the nasopharyngeal airway has been made from rubber and was of a fixed length, which varied depending on the size of the airway selected. Recently, we have been using this technique substituting disposable tracheal tubes for the rubber airway. These have the advantages of being single-use, the length can be readily altered and they can be easily connected to a standard anaesthetic breathing system. The aim of this study was to compare the quality of anaesthesia and surgical access afforded by these two techniques and to note any associated morbidity. MethodsLocal Ethics Committee approval for the study was obtained. The majority of children presenting for daycase chair dental surgery were eligible for inclusion in the study. Children requiring tracheal intubation for conservation work were not studied. Informed consent was obtained from a parent.A total of 50 ASA 1 children were randomly assigned to either the Nasal Mask group or the Nasopharyngeal 786ᮊ 1997 Blackwell Science Ltd Airway group. All patients were unprem...
Experience is presented of the treatment of 100 patients for routine dentistry in general dental practice under propofol (Diprivan) sedation, delivered by continuous infusion. The infusion rates were set manually according to patients' responses. There were no differences in dental treatment or propofol requirements according to gender. Propofol requirements in some cases exceeded the upper limit of the recommended dose ranges and reasons why this may have occurred are discussed. A most useful feature of propofol sedation was the associated rapid recovery, with no patients needing to remain in the surgery for the purposes of recovery. The technique met with patients' approval, as all responses returned indicated a willingness to undergo the same type of sedation in future. Propofol sedation is not appropriate for the single operator/sedationist.
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