Uso de óxido nitroso como sedação consciente por profissionais de odontologia no Rio Grande do Sul: um estudo transversal / Prevalence of nitrous oxide use as conscious sedation by dentistry professionals in Rio Grande do Sul: a cross-sectional study

Objetivo: Avaliar fatores associados, percepção e prevalência do uso de óxido nitroso por cirurgiões-dentistas do Rio Grande do Sul, Brasil. Metodologia: Realizou-se um estudo transversal, de base eletrônica, com profissionais registrados no Rio Grande do Sul. A coleta de dados baseou-se no envio, por e-mails e campanhas no Instagram, de um questionário via plataforma Google Forms contendo 27 questões acerca do uso de óxido nitroso em atendimentos odontológicos, bem como o perfil e as percepções dos profissionais sobre a técnica. Resultados: Dos 220 participantes, apenas 12,3% utilizava o óxido nitroso em sua prática clínica, sendo as especialidades que mais utilizavam, cirurgia e odontopediatria. Dentre os que reportaram utilizar a técnica, 81,5% tinham mais de 29 anos (p<0,001) e possuíam curso de pós-graduação, sendo que destes, 55,6% realizou o curso de habilitação (p<0,01) e mais da metade (55,6%) relatou utilizar em pacientes adultos (p<0,001). O alto custo do equipamento, bem como a falta de interesse dos profissionais, foram as principais razões para o não uso da técnica. Conclusão: A técnica de sedação consciente com óxido nitroso é pouco usada pelos cirurgiões-dentistas no Estado do Rio Grande do Sul. É possível que a ampliação do conhecimento acerca da indicação e aplicação do óxido nitroso, ainda durante a graduação, possa expandir o uso e contribuir para uma melhor qualidade no atendimento de pacientes com medo e ansiedade odontológicos. (AU)

Objective: The aim of this study is to evaluate associated factors, perception and prevalence of nitrous oxide use by dental surgeons in Rio Grande do Sul, Brazil. Methodology: A cross-sectional, electronic-based study was carried out with professionals registered in Rio Grande do Sul. Data collection was based on sending, via emails and Instagram campaigns, a questionnaire via the Google Forms platform containing 27 questions about the use of nitrous oxide in dental care, as well as the profile and perceptions of professionals about the technique. Results: Of the 220 participants, only 12.3% used nitrous oxide in their clinical practice, the specialties they used most being surgery and pediatric dentistry. Among those who reported using the technique, 81.5% were over 29 years old (p<0.001) and had a postgraduate course, of which 55.6% completed the qualification course (p<0.01) and more than half (55.6%) reported using it in adult patients (p<0.001). The high cost of the equipment, as well as the lack of interest from professionals, were the main reasons for not using the technique. Conclusion: The conscious sedation technique with nitrous oxide is little used by dental surgeons in the State of Rio Grande do Sul. It is possible that expanding knowledge about the indication and application of nitrous oxide, even during graduation, can expand its use and contribute to a better quality of care for patients with dental fear and anxiety. (AU)

Quality of psychomotility recovery after propofol sedation for painless gastroscopy and colonoscopy / 北京大学学报(医学版)

OBJECTIVE@#To study the effect of propofol used for painless gastroscopy and colonoscopy on psychomotility recovery.@*METHODS@#One hundred adult patients undergoing painless gastroscopy and colonoscopy were recruited, aged 18-72 years, with American Society of Anesthesiologist (ASA) physical status Ⅰ-Ⅱ. According to age, the patients were divided into youth group (20-39 years old, 27 cases), middle age group (40-54 years old, 37 cases), and elder group (55-64 years old, 36 cases). Propofol was continuously infused according to the patients' condition to mantain the bispectal index (BIS) score 55-64. All the patients received psychomotility assesment 30 min before the operations when the discharge criteria were met including number cancellation test, number connection test and board test. The heart rate, blood pressure, saturation of pulse oximetry, electrocardiograph and BIS were monitored during the operation. The operating time, recovery time, total volume of propofol and discharge time were recorded. If the results obtained were inferior to those before operation, a third assessment was taken 30 minutes later until the results recovered or being superior to the baseline levels.@*RESULTS@#All the patients completed the first and second assessments, and 25 patients had taken the third assessment. There was no statistically significant difference in the results of psychomotility assessment when the patients met the discharge standard. Furthermore, the results were analyzed by grouping with age, and there was no statistical difference in the test results of the youth and middle age groups compared with the preoperative group, among which, the efficiency of the number cancellation test was significantly better than that before operation in the youth group (P < 0.05). However, in the elderly patients the number cancellation efficiency, number connection test and board test were significantly inferior to that before operation (P < 0.05). There was no significant difference in the accuracy of number cancellation compared with that before operation. The patients who needed the third test in the elder group were significantly more than in the other groups (P < 0.05). Compared with the preoperative results, there was no statistical difference in the test results of those who completed the third test.@*CONCLUSION@#The psychomotility function of the patients who underwent painless gastroscopy and colonoscopy was recovered when they met discharge criteria. The elderly patients had a prolonged recovery period.

Técnica minimalista para valvuloplastía aórtica percutánea / Minimally invasive balloon aortic valve valvuloplastyBackground

RESUMEN: ANTECEDENTES: La valvuloplastía aórtica es un procedimiento paliativo o como puente al reemplazo aórtico percutáneo o quirúrgico. Nuestro abordaje incluye una técnica minimalista y la utilización de balones de mayor tamaño que lo estándar. OBJETIVO: Evaluar los resultados clínicos inmediatos y alejados de pacientes tratados mediante esta técnica modificada. MÉTODOS: Se incluyó a todos los pacientes sometidos a balonplastía aórtica entre Julio del 2012 y Agosto del 2019 en nuestro centro. El procedimiento se realizó bajo sedación consciente mediante un único acceso femoral y sin instalación de un marcapasos transitorio. El éxito de la intervención se definió como caída de gradiente basal en 50% o más en ausencia de complicación mayor. RESULTADOS: Se realizaron un total de 52 procedimientos en 49 pacientes. La edad promedio fue 76 ± 9,9 años. Un tercio de los pacientes tenía una fracción de eyección del ventrículo izquierdo ≤35% y similar proporción tenía un perfil de riesgo STS score > 10 puntos. La duración total promedio fue de 31,1 + 10,0 min. Se utilizó un balón #28 en el 84.6% de los casos. El éxito del procedimiento se alcanzó en 94,2% de los casos. Ocurrieron 2 muertes intraoperatorias (3,9%), ambas en pacientes de muy alto riesgo y 2 (3,9%) complicaciones vasculares mayores. La sobreviva en el seguimiento alejado fue 32,7%. CONCLUSIÓN: La valvuloplastia aórtica percutánea con técnica modificada, utilizando balones de mayor tamaño que lo habitual, es una técnica segura que logra óptimos resultados hemodinámicos.

ABSTRACT: Aortic balloon valvuloplasty (ABV) is a palliative procedure or a bridge to percutaneous or surgical aortic valve replacement. Our group proposes a minimalist approach that reduces the use of resources and also stands out for using larger balloons. AIM: To assess the safety and the immediate results of patients undergoing aortic balloon valvuloplasty using a minimally invasive procedure. METHODS: All patients who underwent ballon aortic valvuloplasty (BAV) between July 2012 and Au- gust 2019 were included. The procedure was performed under conscious sedation using a single femoral access and without the installation of a temporary pacemaker. Success was defined as a 50% drop in the mean aortic gradient plus the absence of major complications. RESULTS: 52 procedures in 49 patients were performed; the average age was 76 ± 9,9 years. A third of patients included had a left ventricular ejection fraction ≤35% and a similar proportion had a high risk profile with an STS score> 10 points. A 28 mm balloon was used in 84.6% of cases. The procedure was successful in 94,2% of cases. There were 2 (3,85%) intraoperative deaths in very high-risk patients and 2 (3,85%) major vascular complications. The survival rate at late follow up was 32,7%. CONCLUSION: Aortic balloon valvuloplasty with a minimally invasive technique using larger than usual balloons is a safe technique that achieves optimal hemodynamic results.

Guideline of nitrous oxide-oxygen inhalation sedation technique in dental outpatient / 中华口腔医学杂志

The use of nitrous oxide-oxygen inhalation sedation to relieve anxiety and pain in dental outpatient treatment has been a very mature and safe technique in the world. This technology has been introduced into China for nearly 20 years, and many clinical cases have proved its safety, practicability and effectiveness, which can meet the clinical needs of patients. To further standardize and popularize this technique, the Society of Sedation and Analgesia, Chinese Stomatological Association formed the recommended application guidelines after many discussions and revisions on the basis of widely soliciting opinions and referring to relevant literatures. It covers indications, contraindications, standardized operation procedures, occupational protection, identification and treatment of adverse reactions, training and other aspects. This guideline can be used as a reference for the use of nitrous oxide-oxygen inhalation sedation techniques in the outpatient setting of dentistry.

Incidence and predictors of respiratory adverse events in children undergoing procedural sedation with intramuscular ketamine in a paediatric emergency department

INTRODUCTION@#Although ketamine is one of the commonest medications used in procedural sedation of children, to our knowledge, there is currently no published report on predictors of respiratory adverse events during ketamine sedation in Asian children. We aimed to determine the incidence of and factors associated with respiratory adverse events in children undergoing procedural sedation with intramuscular (IM) ketamine in a paediatric emergency department (ED) in Singapore.@*METHODS@#A retrospective analysis was conducted of all children who underwent procedural sedation with IM ketamine in the paediatric ED between 1 April 2013 and 31 October 2017. Demographics and epidemiological data, including any adverse events and interventions, were extracted electronically from the prospective paediatric sedation database. The site of procedure was determined through reviewing medical records. Descriptive statistics were used for incidence and baseline characteristics. Univariate and multivariate logistic regression analyses were performed to determine significant predictors.@*RESULTS@#Among 5,476 children, 102 (1.9%) developed respiratory adverse events. None required intubation or cardiopulmonary resuscitation. Only one required bag-valve-mask ventilation. The incidence rate was higher in children aged less than three years, at 3.6% compared to 1.0% in older children (odds ratio [OR] 3.524, 95% confidence interval [CI] 2.354-5.276; p < 0.001). Higher initial ketamine dose (adjusted OR 2.061, 95% CI 1.371-3.100; p = 0.001) and the type of procedure (adjusted OR 0.190 (95% CI 0.038-0.953; p = 0.044) were significant independent predictors.@*CONCLUSION@#The overall incidence of respiratory adverse events was 1.9%. Age, initial dose of IM ketamine and type of procedure were significant predictors.

Tratamento cirúrgico de mesiodentes sob sedação consciente com óxido nitroso: relato de caso clínico / Surgical treatment of mesiodens under conscious sedation with nitrous oxide: clinical case report

Dentes supranumerários são caracterizados como um excesso no número de dentes da série normal. Os mesiodentes, definidos pela sua localização mediana aos incisivos centrais superiores, referem-se ao tipo de dente supranumerário mais comumente encontrado na cavidade oral, normalmente intraósseo e assintomático. A presença desses dentes pode ocasionar alterações na dentição permanente, mas a abordagem cirúrgica na fase da dentição mista mostra resultados satisfatórios no alinhamento dental espontâneo. Em pacientes pediátricos, a sedação consciente com óxido nitroso tem demonstrado ser uma alternativa segura e eficaz no controle do medo e da ansiedade. Objetivo: relatar um procedimento cirúrgico de remoção de dois mesiodentes em paciente pediátrico sob anestesia local associada à sedação com óxido nitroso. Relato de caso: paciente do sexo feminino, 11 anos de idade, necessitava de remoção cirúrgica de dois dentes supranumerários localizados em região anterior de maxila. Com a avaliação da tomografia computadorizada, pôde-se observar a posição em que ambos se encontravam. Realizou-se também a exodontia do elemento dentário 14, como solicitado pela ortodontista, para posterior continuidade do tratamento ortodôntico. Devido à complexidade cirúrgica e ao tempo operatório, considerando a idade da paciente e o possível aumento nos níveis de ansiedade, optou-se pela realização de sedação consciente com óxido nitroso. Conclusão: clinicamente, dentes supranumerários podem causar danos locais. O tratamento cirúrgico associado à sedação consciente mostrou-se bastante seguro e efetivo no controle comportamental, além de poder ser implementado na rotina ambulatorial.(AU)

Supernumerary teeth are defined as those in addition to the normal series. The mesiodens, is the most common supernumerary tooth and it is present in the midline between the two central incisors. It is usually intraosseous and asymptomatic. The presence of these teeth may cause changes in permanent dentition and the surgical approach in the mixed dentition phase shows satisfactory results in spontaneous dental alignment. In pediatric patients, conscious sedation with nitrous oxide has been shown to be a safe and effective alternative in controlling fear and anxiety. Objective. To report a surgical procedure for the removal of two mesiodens in a pediatric patient under local anesthesia associated with nitrous oxide sedation. Case report. 11-year-old female patient required surgical removal of two upper mesiodens. The computed tomography images assisted to indicate their exact position. The extraction of the upper right premolar (tooth #14) was also performed as requested by the orthodontist. Considering the patient's age and the possible increase in anxiety levels, along with surgical complexity and operative time, the conscious sedation with nitrous oxide was selected. Conclusion. Clinically, supernumerary teeth cause local damage and surgical treatment associated with conscious sedation has proved to be quite safe and effective in the behavioral control besides being able to be implemented in the outpatient routine.(AU)

Effects of Oral Diazepam or Inhalatory Nitrous OxideOxygen for Conscious Sedation During Third Molar Surgery: A Randomized Controled Trial, Split Mouth Design / Efectos del Diazepam Oral o la Inhalación de Óxido Nitroso-Oxígeno para la Sedación Consciente Durante la Cirugía del Tercer Molar: Un Ensayo Controlado Aleatorio, Diseño de Boca Dividida

ABSTRACT: Anxiety in dental surgery may lead to behavioral and physiological changes for the patient and constitute a frequent challenge for the oral surgeon. The objective of this study was to compare the effect of inhalatory nitrous oxide and oxygen (N2O/O2) with oral diazepam conscious sedation in vital signs of patients undergone third molar extraction. Outpatients who needed removal of partially impacted, bilateral lower third molars, during the period of one year, were included. Each patient underwent conscious sedation with either oral diazepam or inhalatory N2O/O2 on a randomized controlled trial, split-mouth design. Systolic and diastolic blood pressure, heart rate and oxygen blood saturation were the changes measured before, at the beginning and the end of the procedure. Also, surgical procedure duration was recorded. Data from vital signs were submitted to analysis of variance and the duration of the surgery to paired Student's t-test. Twenty-five healthy outpatients (13 women and 12 men) with a mean age of 21.6 years were studied. There was an increase in systolic and diastolic pressure and in heart rate in the beginning; these values decreased and stabilized at the end of the surgical procedure in both treatments (p < 0.001) being lower in N2O/O2 but without difference between treatments. The surgical procedure duration was lower and occurred an expected increase of oximetry under N2O/O2 sedation (p < 0.001). Both treatments were effective for the conscious sedation but N2O/O2 showed better outcomes, mainly in duration of the surgery.

RESUMEN: La ansiedad en la cirugía dentoalveolar puede conducir a alteraciones fisiológicas y de comportamiento en el paciente, constituyendo así un desafío frecuente para el cirujano maxilofacial. El objetivo de este estudio fue comparar el efecto del óxido nitroso inhalatorio con oxígeno (N2O/O2) y la sedación consciente oral con diazepam por médio de los signos vitales de pacientes sometidos a la extracción del tercer molar. Fueron incluídos pacientes ambulatoriales com necesidad de exodoncia de terceros molares inferiores bilaterales, parcialmente impactados, durante el período de un año. Cada paciente fue sometido a sedación consciente con diazepam oral o N2O/O2 por inhalación en un ensayo controlado aleatorio, diseño de boca dividida. La presión arterial sistólica y diastólica, la frecuencia cardíaca y la saturación de oxígeno en la sangre fueron medidos antes, al inicio y al final del procedimiento. Además, se registró la duración del procedimiento quirúrgico. Los datos de los signos vitales fueron enviados para análisis de varianza y la duración de la cirugía para la prueba t de Student pareada. Se estudiaron 25 pacientes ambulatorios sanos (13 mujeres y 12 hombres) con una edad media de 21,6 años. Al início hubo un aumento en la presión sistólica y diastólica y en la frecuencia cardíaca; estos valores disminuyeron y se estabilizaron al final del procedimiento quirúrgico en ambos tratamientos (p <0,001), siendo más bajos en N2O/ O2 pero sin diferencia entre los tratamientos. La duración del procedimiento quirúrgico fue menor y se produjo un aumento esperado de la oximetría bajo sedación con N2O/O2 (p <0,001). Ambos tratamientos fueron efectivos para la sedación consciente, pero el N2O/O2 mostró mejores resultados, principalmente en la duración de la cirugía.

Comparison between chloral hydrate and propofol-ketamine as sedation regimens for pediatric auditory brainstem response testing / Comparação entre o uso de hidrato de cloral e propofol-quetamina como formas de sedação para exames de potenciais evocados auditivos de tronco encefálico

Abstract Introduction: The use of diagnostic auditory brainstem response testing under sedation is currently the "gold standard" in infants and young children who are not developmentally capable of completing the test. Objective: The aim of the study is to compare a propofol-ketamine regimen to an oral chloral hydrate regimen for sedating children undergoing auditory brainstem response testing. Methods: Patients between 4 months and 6 years who required sedation for auditory brainstem response testing were included in this retrospective study. Drugs doses, adverse effects, sedation times, and the effectiveness of the sedative regimens were reviewed. Results: 73 patients underwent oral chloral hydrate sedation, while 117 received propofol-ketamine sedation. 12% of the patients in the chloral hydrate group failed to achieve desired sedation level. The average procedure, recovery and total nursing times were significantly lower in the propofol-ketamine group. Propofol-ketamine group experienced higher incidence of transient hypoxemia. Conclusion: Both sedation regimens can be successfully used for sedating children undergoing auditory brainstem response testing. While deep sedation using propofol-ketamine regimen offers more efficiency than moderate sedation using chloral hydrate, it does carry a higher incidence of transient hypoxemia, which warrants the use of a highly skilled team trained in pediatric cardio-respiratory monitoring and airway management.

Resumo Introdução: O uso de testes diagnósticos de potencial evocado auditivo de tronco encefálico sob sedação é atualmente o padrão-ouro em lactentes e crianças pequenas que não têm desenvolvimento suficiente para realizar o exame. Objetivo: O objetivo do estudo foi comparar a sedação de crianças submetidas a testes de potencial evocado auditivo de tronco encefálico com propofol-quetamina e com hidrato de cloral por via oral. Método: Pacientes entre 4 meses e 6 anos de idade que necessitaram de sedação para a realização do potencial evocado auditivo de tronco encefálico foram incluídos nesse estudo retrospectivo. Foram revisadas as doses dos medicamentos, os efeitos adversos, os tempos de sedação e a eficácia das formas de sedação. Resultados: 73 pacientes foram submetidos à sedação oral com hidrato de cloral, enquanto 117 receberam sedação com propofol-quetamina; 12% dos pacientes do grupo hidrato de cloral não alcançaram o nível desejado de sedação. Os tempos médios de procedimento, recuperação e o tempo total de cuidados de enfermagem foram significativamente menores no grupo propofol-quetamina, entretanto este grupo experimentou maior incidência de hipoxemia transitória. Conclusão: Ambos os regimes de sedação podem ser utilizados com sucesso para sedar crianças para realização do exame de potencial evocado de tronco encefálico. Embora a sedação profunda com propofol e quetamina ofereça mais eficiência do que a sedação moderada com hidrato de cloral, ela apresenta maior incidência de hipoxemia transitória, o que requer uma equipe altamente qualificada, treinada em monitoramento cardiorrespiratório pediátrico e manejo de vias aéreas.

Experiencia clínica del manejo anestésico en craneotomía vigil / Clinical experience of anesthetic management of Awake Craniotomy

OBJECTIVES: Describe the demographic characteristics of patients undergoing awake craniotomy, which are the anesthetic techniques and most commonly used drugs, as well as to identify the type and frequency of anesthetic and surgical complications. MATERIAL AND METHODS: Perioperative awake craniotomy records were reviewed in the operating room. All cases of patients with gliomas in which the need for cortical mapping was determined between november 2015 and august 2018 were included. Of a total of 27 operated patients, data were collected for 18 surgeries. RESULTS: Two thirds of the patients were men and one third were women. The average age was 42 years. 39% of the patients presented overweight, being obese by 28%. The most used anesthetic technique was asleep-awake-asleep in 56% of the cases, the rest was under conscious sedation. In all cases, remifentanil and propofol were used, in addition to the scalp block. Intraoperative complications are described in two patients and new-onset neurological deficit in seven patients. There was no conversion to general anesthesia in any case. CONCLUSIONS: Awake craniotomy remains the gold standard for the surgical management of brain tumors in eloquent areas. It is a challenge that requires clear communication with the patient and between the team. We share the experience of our center, with favorable results for patients.

OBJETIVOS: Describir las características demográficas de los pacientes sometidos a craneotomía vigil, cuáles son las técnicas anestésicas y fármacos más utilizados, además de identificar el tipo y frecuencia de complicaciones anestésicas y quirúrgicas. MATERIAL Y MÉTODOS: Se revisaron los registros perioperatorios de craneotomía vigil en pabellón. Fueron incluidos todos los casos de pacientes con gliomas en que se determinó la necesidad de mapeo cortical entre noviembre de 2015 y agosto de 2018. De un total de 27 pacientes operados se recolectaron datos para 18 cirugías. RESULTADOS: Dos tercios de los pacientes fueron hombres y un tercio mujeres. El promedio de edad fue de 42 años. Un 39% de los pacientes presentaron exceso de peso, siendo obesos en un 28%. La técnica anestésica más usada fue dormido-despierto-dormido en 56% de los casos, el resto fue bajo sedación consciente. En todos los casos se usó remifentanilo y propofol, además, del bloqueo pericráneo. Se describen complicaciones intraoperatorias en dos pacientes y déficit neurológico de nueva aparición en siete pacientes. No hubo conversión a anestesia general en ningún caso. CONCLUSIONES: La craneotomía vigil permanece como el estándar de oro del manejo quirúrgico de los tumores cerebrales en áreas elocuentes. Es un desafío que requiere de comunicación clara con el paciente y entre el equipo. Compartimos la experiencia de nuestro centro, con resultados favorables a los pacientes.

La simulación puede mejorar la seguridad de los pacientes sometidos a procedimientos endoscópicos gastrointestinales bajo sedación / Simulation can improve patients’ security in gastrointestinal endoscopic procedures under sedation

background: Appropriate sedation is crucial for a successful gastrointestinal endoscopy procedure (GEP); however, this is associated with adverse events, therefore adequate capacitation in this subject is mandatory. Simulation is an excellent teaching tool but its use in the setting of sedation teaching for GEP has not bee explored. The aim of this study was to assess the impact of a simulation course on sedation for GEP procedures done by endoscopist. Methods: A checklist to assess the endoscopists’ sedation performance for GEP was developed. This checklist was used to assess the sedations’ quality before and after a high fidelity sedation simulation course for GEP. Differences before/after the intervention was calculated using the McNemar’s test. A p ≤ 0,05 was considered significant. Results: All participants were assessed 15 times pre and post intervention. After the simulation, there was a significant improvement in patients’ airway assessment, in the level of awareness about patients’ condition during the procedure and in the monitoring after the procedure. All participants considered simulation should be compulsory before obtaining a license to sedate patients. Conclusions: The implementation of a sedation course based on simulation cases directed to endoscopists improved patient safety and sedations’ quality during the procedure. Simulation should be considered as a valid teaching tool, which is an enormous challenge to the anaesthesiologists.

Introducción: Una adecuada sedación contribuye al éxito de un procedimiento endoscópico gastrointestinal (PEG); sin embargo, esto puede estar asociado a eventos adversos, siendo importante la capacitación al respecto. La simulación es una excelente herramienta docente, pero su uso en la enseñanza de sedación para PEG no ha sido explorada. El objetivo de este estudio fue evaluar el impacto de un curso de sedación para PEG dirigido a endoscopistas basado en simulación. Materiales y Métodos: Se diseño una lista de cotejo para evaluar la calidad de la sedación impartida por endoscopistas durante PEG. Con dicho instrumento se determinó la calidad de la sedación antes y después de un curso de simulación de alta fidelidad sobre sedación para PEG. La magnitud de las diferencias secundario a la intervención se calcularon utilizando el test de McNemar. Una p ≤ 0,05 se consideró significativa. Resultados: Todos los participantes fueron evaluados 15 veces antes y después de la intervención. Después de la intervención, mejoró significativamente la evaluación de vía aérea, el nivel de alerta por las condiciones del paciente durante el procedimiento y el seguimiento posterior. Todos los participantes consideraron que la simulación debería ser obligatoria antes de obtener privilegios clínicos. Conclusiones: La implementación de un curso de sedación basados en simulación dirigidos a endoscopistas mejora la calidad de esta y la seguridad del paciente durante el procedimiento. La simulación debe ser considerada como una estrategia de enseñanza válida en este contexto lo que plantea un gran desafío a todos los anestesiólogos.

Conhecimento de pacientes sobre o uso de benzodiazepínicos no controle da ansiedade em Odontologia / Knowledge of patients about the use of benzodiazepines for anxiety control in Dentistry

Objetivo: O objetivo desta pesquisa foi avaliar o conhecimento de pacientes sobre técnica de sedação consciente com benzodiazepínicos e sua aceitação no controle de medo e ansiedade para o tratamento odontológico. Método: Esta pesquisa baseou-se em um estudo quantitativo com abordagem descritiva através da coleta de dados realizada pelo próprio pesquisador com a finalidade de assegurar uniformidade de interpretação dos resultados através de questionários. Os pacientes antes do atendimento receberam orientação do questionário e então foram convidados a responder. Nesse momento foram prestados os devidos esclarecimentos aos responsáveis quanto à finalidade dos questionários e orientados no sentido de que os dados seriam mantidos em sigilo. Os dados foram analisados por meio de tabelas cruzando a classe socioeconômica de 150 pacientes, selecionados igualitariamente entre as classes A/B, C e D/E. A associação entre a classe social e as respostas às questões foram avaliados pelo teste exato de Fisher. Resultados: A questão 1, primeira consulta ao Cirurgião-Dentista, destaca que todos os pacientes da Classe A/B já haviam comparecido ao Cirurgião-Dentista antes, contra 86% da classe C e 94% da Classe D/E. A questão 2 aborda se o Cirurgião-Dentista afere sinais vitais na anamnese,40% dos Cirurgiões-Dentistas classe A/B afere sinais vitais e apenas 20% dos odontólogos que trabalham com uma população de classe C, D e E. As questões 3, 4 e 5 (sobre medo do cirurgião, doenças e vícios) se mostraram semelhantemente distribuída entre as classes. E as questões 6 e 7 sobre o uso de ansiolítico destaca a maior frequência na Classe A/B, o dobro da Classe C, que por sua vez também é o dobro da Classe D/E. Das sete questões avaliadas, quatro se mostraram significativamente associadas à classe social. Conclusão: Classes sociais A/B têm mais aceitação e conhecimento sobre o uso de benzodiazepínicos no controle de medo e ansiedade na Odontologia.

Objective: The aim of this search was to avaluate the knowledge of patients on technique of conscious sedation with benzodiazepines and their acceptance in the controlo the fear, pain and anxiety during dental treatment. Method: this research was based on quantitative study with descriptive approach through data gathering, conducted by the own researcher, in order to ensure uniformity in the interpretation of the results of the questionnaires. Patients were instructed about the questionnaire before treatment and then, invited to answer it. At this moment, was provided the appropriate explanations to the responsables about the purpose of the questionnaires and orientedin the sense that the data will be kept confidential. Data were analyzed by means of tables crossing the socio-economic class of 150 patients, selected equally between classes A/B, C and D/E. The association between social class and the answers to the questions were evaluated by Fisher’s exact test (Agresti, 2002; Bussab e Morettin, 2006). Results: Question 1, first visit to the dentist, highlights thatall patients Class A/B were attended by dentist before, against 86% of the class C and 94% of ClassD/E. Question 2 addresses if the dentist assesses vital signs at the anamnesis. 40% of dental surgeons class A/B assesses vital signs, against only 20% of dentists who Works with a population of class C, Dand E. Questions 3, 4 and 5 (about fear surgeon, diseases and addictions) show then selves similar lydistributed between classes. And finally, questions 6 and 7, about the use of anxiolytic highlights the most frequently in Class A/B, class C twice, which in turn is also twice the Class D/E. From 7 questions avaluated, 4 of them show thenselves significantly associated to social classes. Conclusion: Social classes A/B have more acceptence and knowledge about the use of benzodiazepines in the control of the fear and anxiety in dentistry.

Análisis de costo-efectividad del clorhidrato de dexmedetomidina comparada con propofol y midazolam para la sedación ligera a moderada de adultos con ventilación mecánica invasiva en unidades de cuidado intensivo de Colombia / Cost-effectiveness analysis of dexmedetomidine hydrochloride compared to propofol and midazolam for mild to moderate sedation of adults with invasive mechanical ventilation in intensive care units in Colombia

Problema de investigación: Analizar los costos y la efectividad del clorhidrato de dexmedetomidina, propofol y midazolam para pacientes que requieren ventilación mecánica y sedación ligera a moderada en la Unidad de Cuidados Intensivos en Colombia. Tipo de evaluación económica: Análisis de costo-efectividad. Población objetivo: Pacientes adultos (hombres y mujeres) que requieren ventilación mecánica y sedación ligera-moderada en la Unidad de Cuidados Intensivos en Colombia. Se delimitó la población a aquellos pacientes que requieren ventilación mecánica invasiva, debido a que la ventilación mecánica no invasiva por lo general no requiere sedación. Se excluyeron pacientes con enfermedad cardíaca, trastornos neurológicos agudos y graves, y pacientes que requieren procedimientos colon-rectales. Intervención y comparadores: I: clorhidrato de dexmedetomidina, C: propofol y midazolam. Horizonte temporal: Se empleó un horizonte temporal de 15 días, tomando en cuenta la disponibilidad de evidencia de efectividad y seguridad y las recomendaciones de los expertos clave durante la socialización y discusión. Perspectiva: La del Sistema General de Seguridad Social en Salud (SGSSS). Tasa de descuento: No se requiere. Estructura del modelo: Se estructuró un árbol de decisión, que incluye los eventos generadores de costos basados en el curso clínico de la condición de salud objeto de la evaluación. Fuentes de datos de efectividad y seguridad: Ensayos clínicos y meta-análisis. Desenlaces y valoración: Días de estancia en la Unidad de Cuidados Intensivos. Costos incluidos: Costo de medicamentos para el tratamiento, Costo relacionados al manejo de eventos adversos, Costo de procedimientos e insumos. Fuentes de datos de costos: SISMED, Manual tarifario ISS 2001 y SOAT 2015. Resultados del caso base: El clorhidrato de dexmedetomidina resulta ser una estrategia dominante, es decir que resulta menos costosa y más efectiva, con una estancia en UCI menor frente a la de propofol y idazolam con un costo esperado por estancia en UCI durante 15 días de $10.972872 frente a $11.032.746 y 11.116.602 respectivamente por cada paciente que requiere VM invasiva y sedación ligera a moderada. Análisis de sensibilidad: El análisis de sensibilidad univariado muestra que los resultados son robustos (cuando se pusieron a variar los parámetros entre sus valores mínimos y máximos) y que el clorhidrato de dexmedetomidina es una estrategia que siempre es dominante sobre los otros medicamentos incluidos en este estudio. Conclusiones y discusión: Desde la perspectiva del sistema general de seguridad social en \r\nsalud en Colombia, el clorhidrato de dexmedetomidina comparada con propofol y midazolam, para la sedación ligera a moderada de pacientes mayores de 18 años de edad con ventilación mecánica invasiva en unidades de cuidado intensivo, es una tecnología dominante, al asociarse con una estancia más corta en dicho servicio, indicando que sería una alternativa ahorradora para el país.(AU)

Moderate sedation helps improve future behavior in pediatric dental patients - a prospective study

Abstract There is little evidence on the long-term effects of pharmacological management in children undergoing dental treatment. This study aimed to assess children's behavior in consecutive dental sessions following oral rehabilitation using different pharmacological regimens for behavioral control. Participants were preschoolers who were previously treated for caries under one of the following: no sedative, oral sedation with midazolam, oral sedation with midazolam/ketamine, or general anesthesia. The children's behavior in the follow-up sessions was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS); higher scores represented less cooperative behavior (range 5-20). Follow-up assessments were conducted on 50 children under four years old for up to 29 months. Data were analyzed by the Friedman/Wilcoxon tests and Cox regression model. OSUBRS mean (standard deviation) scores for the whole sample decreased from 11.9 (5.4) before treatment to 6.8 (3.2) at the final recall session (p < 0.001). Moderate sedation with midazolam (OR 2.9, 95%CI 1.2-6.9) or midazolam/ketamine (OR 4.3, 95%CI 1.6-11.4) improved children's future behavior. The general anesthesia group (n = 4) had a small sample size and the results should be considered with caution. Although invasive dental treatment negatively affected the child's behavior in the dental chair, they became more cooperative over time. Moderately sedated children showed better prospective behavior than those in the non-sedation group.

Room for Quality Improvement in Endoscopist-Directed Sedation: Results from the First Nationwide Survey in Korea

BACKGROUND/AIMS: This study sought to characterize the current sedation practices of Korean endoscopists in real-world settings. METHODS: All active members of the Korean Society of Gastrointestinal Endoscopy were invited to complete an anonymous 35-item questionnaire. RESULTS: The overall response rate was 22.7% (1,332/5,860). Propofol-based sedation was the dominant method used in both elective esophagogastroduodenoscopy (55.6%) and colonoscopy (52.6%). The mean satisfaction score for propofol-based sedation was significantly higher than that for standard sedation in both examinations (all p<0.001). The use of propofol was supervised exclusively by endoscopists (98.6%). Endoscopists practicing in nonacademic settings, gastroenterologists, or endoscopists with <10 years of endoscopic practice were more likely to use propofol than were their counterparts (all p<0.001). In total, 27.3% of all respondents performed sedation practices without having undergone sedation training, and 27.4% did so without any formal sedation protocols. The choice of propofol as the dominant sedation method was the only significant predictor of endoscopist experience with serious sedation-related adverse events (odds ratio, 1.854; 95% confidence interval, 1.414 to 2.432). CONCLUSIONS: Endoscopist-directed propofol administration is the predominant sedation method used in Korea. This survey strongly suggests that there is much room for quality improvement regarding sedation training and patient vigilance in endoscopist-directed sedation.

Estratégia minimamente invasiva para o implante percutâneo de bioprótese aórtica de segunda geração Lotus™ / Minimally-invasive strategy for transcatheter implantation of second-generation Lotus™ aortic valve system

O implante percutâneo de bioprótese aórtica é a terapia estabelecida em pacientes com estenose aórtica grave. Houve um progressivo aperfeiçoamento na tecnologia dos dispositivos que, associada a maior experiência dos operadores, resultou em procedimentos mais seguros e com melhores resultados. O primeiro dispositivo de segunda geração aprovado no Brasil, o sistema de válvula Lotus™ (Boston Scientific Corporation, Natick, EUA), incorpora várias dessas novas características. Descrevemos aqui os dois primeiros casos realizados no país, conduzidos sob anestesia local e sedação consciente, ambos com sucesso

Transcatheter aortic valve implantation is a well-established therapy in patients with severe aortic stenosis. There has been a progressive improvement in device technology associated with increased experience of the interventionists, resulting in safer procedures with better outcomes. The first secondgeneration device approved in Brazil, Lotus™ Valve System (Boston Scientific Corporation, Natick, USA), incorporates several of these new characteristics. This report describes the first two cases, both successfully performed in the country, carried out under local anesthesia and conscious sedation

Chronic pain relief after the exposure of nitrous oxide during dental treatment: longitudinal retrospective study / Alívio da dor crônica após exposição ao óxido nitroso durante tratamento odontológico: estudo retrospectivo longitudinal

The objective was to investigate the effect of nitrous/oxygen in chronic pain. Seventy-seven chronic pain patients referred to dental treatment with conscious sedation with nitrous oxide/oxygen had their records included in this research. Data were collected regarding the location and intensity of pain by the visual analogue scale before and after the treatment. Statistical analysis was performed comparing pre- and post-treatment findings. It was observed a remarkable decrease in the prevalence of pain in this sample (only 18 patients still had chronic pain, p < 0.001) and in its intensity (p < 0.001). Patients that needed fewer sessions received higher proportions of nitrous oxide/oxygen. Nitrous oxide may be a tool to be used in the treatment of chronic pain, and future prospective studies are necessary to understand the underlying mechanisms and the effect of nitrous oxide/oxygen in patients according to the pain diagnosis and other characteristics.

O objetivo deste estudo foi investigar o efeito do óxido nitroso na dor crônica. Os prontuários de 77 pacientes com dor crônica submetidos a tratamento odontológico com sedação consciente (óxido nitroso/oxigênio) foram incluídos. Os dados sobre localização e intensidade de dor pela escala visual analógica foram considerados, e foi realizada comparação e análise estatística entre os momentos pré- e pós-tratamento. Foi observada redução marcante na prevalência de dor nesta amostra (apenas 18 doentes ainda tinham dor, p < 0,001) e na intensidade de dor (p < 0,001). Os doentes que precisaram de menor quantidade de sessões receberam maiores proporções de óxido nitroso/oxigênio. Em conclusão, pode-se considerar o oxido nitroso como uma ferramenta a ser investigada no tratamento da dor crônica em estudos futuros prospectivos, que poderão identificar os mecanismos associados de acordo com o diagnóstico de dor e outras características.

The Elderly Also Deserves to Undergo Therapeutic Endoscopy Safely under Sedation with Propofol by Gastroenterologists

No abstract available.