Melatonin premedication versus placebo in wisdom teeth extraction: a randomised controlled trial

<p><b>INTRODUCTION</b>Pain after wisdom teeth surgery can be moderate in severity and is compounded by preoperative anxiety in young patients. We studied the effect of melatonin premedication on postoperative pain and preoperative anxiety in patients undergoing wisdom teeth extractions.</p><p><b>METHODS</b>This randomised controlled trial recruited 76 patients at Khoo Teck Puat Hospital who were American Society of Anesthesiologists physical status I and II, aged 21 to 65 and scheduled to undergo elective extraction of all four wisdom teeth under general anaesthesia. Patients with a history of long-term use or allergy to melatonin were excluded. The patients received either 6 mg melatonin or a placebo 90 minutes before surgery. Visual analogue scale (VAS) scores at multiple time intervals for postoperative pain and preoperative anxiety, patient satisfaction and first-night sleep quality scores were obtained. Mixed-effects regression models were used for longitudinal analysis of VAS pain, anxiety and satisfaction scores.</p><p><b>RESULTS</b>Maximum VAS scores for pain and anxiety were 18.6 ± 19.1 mm at 60 minutes postoperatively and 26.2 ± 23.4 mm at 90 minutes preoperatively, respectively. After adjusting for gender, female patients who received melatonin had a faster rate of reduction of VAS pain (p = 0.020) and anxiety scores (p = 0.003) over time compared to the placebo group. No such effect was demonstrated in male patients. There was no significant difference in sleep quality or satisfaction scores.</p><p><b>CONCLUSION</b>Melatonin use did not consistently contribute to pain and anxiety amelioration in all patients. Our study demonstrated a positive effect in female patients, suggestive of sexual dimorphism.</p>

High STOP-BANG questionnaire scores predict intraoperative and early postoperative adverse events

<p><b>INTRODUCTION</b>Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder associated with multisystemic organ involvement. The STOP-BANG questionnaire is a concise, validated questionnaire that is used to screen for OSA. This study aimed to establish the use of the STOP-BANG questionnaire for perioperative patient risk stratification.</p><p><b>METHODS</b>In this retrospective cohort study, we extracted the demographic, medical and perioperative outcome data of all patients who underwent elective surgery, excluding ophthalmic surgeries, from January to December 2011. Multivariate regression analysis was used to predict independent risk factors for intraoperative and early postoperative adverse events.</p><p><b>RESULTS</b>Of the 5,432 patients analysed, 7.4% had unexpected intraoperative and early postoperative adverse events. We found that the risk of unexpected intraoperative and early postoperative adverse events was greater in patients with STOP-BANG scores ≥ 3 compared to those with a STOP-BANG score of 0 (score 3: odds ratio [OR] 3.6, 95% confidence interval [CI] 2.1-6.3, p < 0.001; score 4: OR 3.4, 95% CI 1.8-6.5, p < 0.001; score 5: OR 6.4, 95% CI 2.7-15.0, p < 0.001; score ≥ 6: OR 5.6, 95% CI 2.1-15.4, p < 0.001). Patients with STOP-BANG scores ≥ 5 had a fivefold increased risk of unexpected intraoperative and early postoperative adverse events, while patients with STOP-BANG scores ≥ 3 had a 'one in four' chance of having an adverse event. Other independent predictors included older age (p < 0.001), American Society of Anesthesiologists class ≥ 2 (p < 0.003) and uncontrolled hypertension (p = 0.028).</p><p><b>CONCLUSION</b>STOP-BANG score may be used as a preoperative risk stratification tool to predict the risk of intraoperative and early postoperative adverse events.</p>

Comparison of results from novice and trained personnel using the Macintosh laryngoscope, Pentax AWS®, C-MAC™ and Bonfils intubation fibrescope: a manikin study

<p><b>INTRODUCTION</b>Indirect laryngoscopes offer improved laryngeal view and higher success rates of intubation, particularly for difficult airways. We hypothesised that: (a) the time required for intubation, overall success rates and ease of intubation with indirect laryngoscopes would be better than with the Macintosh laryngoscope; and (b) novices may achieve higher success rates and intubate faster using indirect laryngoscopes.</p><p><b>METHODS</b>In a cross-sectional observational study, 13 novices and 13 skilled anaesthetists were recruited. Participants were compared when intubating a manikin simulating normal and difficult airway scenarios using the Macintosh laryngoscope, Pentax Airway Scope® (AWS), C-MAC[TM] and Bonfils intubation fibrescope.</p><p><b>RESULTS</b>There was no significant difference in intubation success rates between the groups. Skilled anaesthetists intubated faster than novices with Pentax AWS in the difficult airway scenario (22 s vs. 33 s, p = 0.047). The mean intubation times for C-MAC and Pentax AWS were shorter than for the Macintosh laryngoscope and Bonfils intubation fibrescope in both difficult (C-MAC: 24 s, Pentax AWS: 28 s, Macintosh: 80 s, Bonfils: 61 s; p < 0.001) and normal (C-MAC: 17 s, Pentax AWS: 19 s, Macintosh: 39 s, Bonfils: 38 s; p = 0.002) airway scenarios.</p><p><b>CONCLUSION</b>We found that intubation success was more than 85% with all indirect laryngoscopes compared to 69% for the Macintosh laryngoscope. Both C-MAC and Pentax AWS achieved faster intubation times compared to the Macintosh laryngoscope and Bonfils intubation fibroscope for both airway scenarios. Skilled anaesthetists were 33% faster than novices when intubating a difficult airway using Pentax AWS.</p>