ABSTRACT
The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post-1984 literature there are no published reports of aspiration-associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus-derived algorithm in which each patient is first risk-stratified during their pre-sedation assessment, using evidence-based factors relating to patient characteristics, comorbidities, the nature of the procedure and the nature of the anticipated sedation technique. Graded fasting precautions for liquids and solids are then recommended for elective procedures based upon this categorisation of negligible, mild or moderate aspiration risk. This consensus statement can serve as a resource to practitioners and policymakers who perform and oversee procedural sedation in patients of all ages, worldwide.
Subject(s)
Conscious Sedation/methods , Conscious Sedation/standards , Fasting , Adolescent , Adult , Algorithms , Child , Child, Preschool , Conscious Sedation/adverse effects , Consensus , Delphi Technique , Guideline Adherence , Humans , Infant , Infant, Newborn , Respiratory Aspiration of Gastric Contents/prevention & controlABSTRACT
For years paediatric dentists have searched for the ideal sedative, that is, a drug that allows the safe control of a child's behaviour, provides adequate time to complete a procedure, and also has a quick recovery so that the patient may be discharged. Many drugs have been tried either alone or in combination, and unfortunately none has yet produced reliable results. This paper will review current philosophies in the use of conscious sedation in children. Currently, much interest has been focused on the use of midazolam, a short acting benzodiazepine. The safety of midazolam will be addressed, either when given alone or in combination with nitrous oxide. Midazolam appears to be a safe and effective drug when given in the appropriate doses. Its use in combination with nitrous oxide also appears to be effective, but certain precautions should be kept in mind. Careful patient selection, adequate informed consent, and specific clinical criteria appear to be vital for success. In general, the use of sedation in paediatric dentistry should be carried out by experienced operators in a well controlled environment.
Subject(s)
Anesthesia, Dental , Conscious Sedation , Dental Care for Children , Anesthesia Recovery Period , Anesthesia, Dental/methods , Anesthetics, Inhalation/administration & dosage , Anti-Anxiety Agents/administration & dosage , Child , Child Behavior/drug effects , Conscious Sedation/methods , GABA Modulators/administration & dosage , Humans , Hypnotics and Sedatives/administration & dosage , Hypnotics and Sedatives/chemistry , Informed Consent , Midazolam/administration & dosage , Nitrous Oxide/administration & dosage , Patient Selection , Philosophy, Dental , Safety , Time FactorsABSTRACT
OBJECTIVES: To assess the demand for paediatric dental general anaesthetic services at a specialist paediatric dental unit in Australia and to evaluate the changing pattern of general anaesthetic use in children at this unit over the past decade. METHODS: A retrospective review of hospital records of a random sample of children receiving dental treatment under general anaesthesia during the years 1984 and 1996. Demographic and clinical data was collated and analysed using SPSS for Windows. RESULTS: The number of children managed under general anaesthesia increased from 189 in 1984 to 777 in 1996. This was accompanied by an increase in the time the patients waited for treatment. There was little difference in the mean age of the patients with over two-thirds of the children being under the age of 6 years. Whilst children of Anglo-Saxon origin accounted for the majority of patients across the 13-year period there was a significant increase in the number of children from Asian or Middle Eastern backgrounds. A disproportionate number of these children accessed the services as self-referrals. Caries remained the most common reason for referral, with trauma and dental anomalies accounting for less than 10%. CONCLUSIONS: Despite the general decline in dental caries there remain an important group of young children who have high treatment needs and for whom general anaesthesia provides a useful treatment option. Preventive strategies should be targeted towards these groups of children.
Subject(s)
Ambulatory Surgical Procedures/statistics & numerical data , Anesthesia, Dental/methods , Anesthesia, General/statistics & numerical data , Dental Care for Children/methods , Chi-Square Distribution , Child , Child, Preschool , Dental Caries/therapy , Ethnicity , Humans , Infant , New South Wales , Referral and Consultation/statistics & numerical dataABSTRACT
Antes de exponer su casuistica y resultados de 20 pacientes portadores de colobomas palpebrales, operados y controlados desde 1976, los autores efectuan una actualizada revision del tema, dando especial enfasis a los procedimientos correctores mas utiles. Los resultados por ellos obtenidos, tanto del punto de vista funcional como estetico, fueron muy satisfactorios, como lo demostraron las series fotograficas expuestas
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Coloboma , Eyelids , Eye/surgeryABSTRACT
Los autores antes de exponer su casuistica y resultados de 85 pacientes operados y controlados desde 1975 a la fecha, realizan una amplia y actualizada revision del tema de las ptosis palpebrales: evaluacion clinica y tratamiento quirurgico, sus indicaciones y contraindicaciones. Hacen notar en la exposicion que en terminos generales, las tecnicas operatorias mas utiles son la reseccion tarsotendinosa por via conjuntiva (operacion de Fasanella-Servat modificada) y la reseccion del musculo elevador por via cutanea. Los resultados obtenidos, tanto desde punto de vista funcional como estetico, fueron altamente satisfactorios como lo revelaron las series fotograficas expuestas
Subject(s)
Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Blepharoptosis , Surgery, PlasticABSTRACT
Se decribe un procedimiento quirurgico que utilizando estructuras anatomicas palpebrales corrige el lagoftalmo paralitico.Se analizan sus indicaciones y resultados obtenidos luego de seis anos de manejo por los autores: obtienen un 80,95% de exito
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Eyelids , Facial Paralysis , Surgery, PlasticABSTRACT
El trabajo muestra la experiencia de los autores desde el ano 1976 en la reparacion de las heridas palpebrales antiguas hasta de veinte dias de evolucion. Los resultados obtenidos en la normalizacion palpebral y en permeabilizacion de las vias lagrimales, han sido sorprendentemente exitosos, demostrando con ello el error de postergar el tratamiento quirurgico hasta la cesacion de los procesos cicatrizales, momento en que los resultados de ordinario no son tan brilhantes
Subject(s)
Adult , Middle Aged , Humans , Male , Eyelids , Surgery, Plastic , Wounds and InjuriesABSTRACT
En el trabajo se analiza la etiopatogenia y clasificacion de los entropiones, ectropiones y retracciones palpebrales, como tambien las tecnicas quirurgicas correctoras mais efectivas. Los resultados esteticos y funcionales obtenidos durante el lapso 1970-1980 en la correction de 220 anomalias de posicion del borde libre palpebral, utilizando las tecnicas descritas fueron muy buenos
