Complications associated with intravenous midazolam and fentanyl sedation in patients undergoing minor oral surgery

BACKGROUND: Anxiety control remains an important concern in dental practice. We evaluated the incidence, nature, and sequelae of complications during and after minor oral surgeries performed under intravenous midazolam and fentanyl sedation using the titration technique. METHODS: The medical records of patients who had undergone minor oral surgeries under moderate intravenous midazolam and fentanyl sedation at our institution between January 1, 2015 and December 31, 2015 were retrospectively evaluated. Age, sex, body mass index, medical history, American Society of Anesthesiologists (ASA) classification, indications for sedation, amount of sedative used, surgical duration, and recovery time were evaluated for all patients. RESULTS: In total, 107 patients aged 9–84 years were included. ASA class I and class II were observed for 56.1% and 43.9% patients, respectively. Complications associated with sedation occurred in 11 (10.2%) patients. There were no serious adverse events. Oxygen saturation reached 95% during the procedure in six patients; this was successfully managed by stimulating the patients to take a deep breath. Two patients exhibited deep sedation and one exhibited paradoxical excitement. After the procedure, one patient experienced nausea without vomiting and one exhibited a prolonged recovery time. The surgical procedures were completed in all patients. Obesity was found to be significantly associated with sedation-related complications. CONCLUSIONS: Our results suggest that complications associated with intravenous midazolam and fentanyl sedation using the titration technique for minor oral surgeries are mostly minor and can be successfully managed with no prolonged sequelae.

Comparison of bacterial eradication between standard and double-painted antiseptic application method in minor hand surgery.

Background: Bacteria need to be eliminated for skin preparation in minor hand surgery. The standard method of skin preparation uses an antiseptic scrub and antiseptic solution, which is expensive and time-consuming. Objective: Design a “double-painted antiseptic application method”, and compare the effectiveness of eliminating bacteria at the area around the hand and wrist between the standard method and the double-painted antiseptic application method. Methods: This cross-over designed experimental study was performed on seven volunteers. The standard and the double-painted antiseptic application method were alternately used for skin preparation around the hand, wrist, and half of the forearm. The bacterial colony counts were collected before, immediately after, and at 45 minutes after skin preparation by using the modified glove-juice technique. The primary outcomes were the eradication rate and the number of bacterial colonies. Results: There was no statistical difference in bacterial colonies between either method before skin preparation. The median of bacterial colony counts immediately after and at 45 minutes after skin preparation were zero colony forming units per milliliter in both methods. The eradication rate was 61.5% and 76.9% in the standard and doublepainted antiseptic application method, respectively, for a risk difference of -15.4. There was no statistically significant difference (p=0.67). Conclusion: The number of bacterial colonies and eradication rate were not significantly different between either method. The double-painted antiseptic application method can be used instead of the standard method for the skin preparation in minor hand surgery, which has an expected duration of about 45 minutes or less.

Exéresis quirúrgica radical como único tratamiento del condiloma acuminado gigante: a propósito de un caso / Surgical radical excision alone as a treatment for the giant condyloma acuminatum: a case report

Los condilomas o verrugas genitales son producidos por el virus del papiloma humano del que existen más de 100 genotipos distintos. De ellos, cerca de 40 son transmitidos sexualmente. Se presenta el caso de una mujer con condiloma acuminado gigante de localización vulvo perineal y perianal, de cinco años de evolución que le dificultaba la micción, las relaciones sexuales, e incluso la marcha; además había fetidez, prurito y en ocasiones dolor. El examen histopatológico fue compatible con condiloma acuminado. Se realizó extirpación quirúrgica radical del tumor con excelentes resultados funcionales y cosméticos, sin complicaciones postoperatorias y sin recurrencias ni cicatrices hipertróficas al año de evolución. Es de interés la publicación por tratarse del primer caso que se informa en el Estado de Eritrea, país en desarrollo del cuerno africano.

Condylomas or genital warts are caused by the human papilloma virus, from which exist more than 100 different genotypes. About 40 of them are sexually transmitted. We report a case of a female patient with a giant condyloma acuminatum in the vulvar perineal and perianal regions, of around five years of course, which disturbs her urination, sexual intercourse, and even walk; accompanied by pruritus, foul-smelling, and occasionally pain. The histopathological study was compatible with condyloma acuminatum. She was treated conservatively with radical local surgical excision of the tumor with excellent functional and cosmetic results. No postoperative complications were observed. A year later there were neither recurrences nor hypertrophic scars. We consider interesting to publish it due to it’s the first case published in the state of Eritrea, developing country of the horn of Africa.

Comparison of Pain Control Method and Assessment on Postoperative Pain in Pediatric Urological Surgery of Penoscrotal and Inguinal Regions / 대한비뇨기과학회지

PURPOSE: This study was designed to evaluate the effects of caudal block or/and local infiltration on postoperative pain control in pediatric patients, and whether the faces pain rating scale (FPS), visual analogue scale (VAS) or sleep disturbance scale (SDS) values were estimator dependent (parents, doctors and nurses). MATERIALS AND METHODS: Thirty four children (average age 2.8+/-2.4 years), undergoing inguinal and scrotal surgery, were randomly allocated to one of three groups; combined caudal block with local infiltration (group I), caudal block only (group II) and neither of the above two (group III). Parents, doctors and nurses assessed the FPS, VAS and SDS before and after surgery, and the side effects were assessed after surgery. RESULTS: The mean SDS, FPS and VAS values in Group III were significantly higher than those in groups I and II at 1 and 3 hours postoperatively. All patients slept with a discontented look 1 hour postoperatively, but gradually improved and normalized 12 hours postoperatively. The mean FPS and VAS values were highest 1 hour postoperatively, and decreased with time in all groups. The mean pain value, as assessed by parents, tended to be higher than those assessed by healthcare professionals - doctors and nurses, but the correlation between the parents and healthcare professionals for the SDS, FPS and VAS assessments was statistically significant (intraclass correlation coefficients; 0.64, p<0.05). There were no side effects in any patient. CONCLISIONS: This study suggests that caudal block with local infiltration may be more useful for postoperative pain control, and all three pain scales are useful for assessing the postoperative pain associated with pediatric urological surgery of the penoscrotal and inguinal regions.