ABSTRACT
Myotonic dystrophy (dystrophia myotonica; DM) is an uncommon progressive hereditary muscle disorder that can present with variable severity at birth, in early childhood, or most commonly as an adult. Patients with DM, especially type 1 (DM1), are extremely sensitive to the respiratory depressant effects of sedative-hypnotics, anxiolytics, and opioid agonists. This case report describes a 37-year-old male patient with previously undiagnosed DM1 who received dental care under minimal sedation using intravenous midazolam. During the case, the patient experienced 2 brief episodes of hypoxemia, the second of which required emergency intubation after propofol and succinylcholine and resulted in extended hospital admission. A lipid emulsion (Liposyn II 20%) infusion was given approximately 2 hours after the last local anesthetic injection due to slight ST elevation and suspicion of local anesthetic toxicity (LAST). Months after treatment, the patient suffered a fall resulting in a fatal traumatic brain injury. Complications noted in this case report were primarily attributed to the unknown diagnosis of DM1, although additional precipitating factors were likely present. This report also provides a basic review of the literature and clinical guidelines for managing myotonic dystrophy patients for dental care with local anesthesia, sedation, or general anesthesia.
Subject(s)
Myotonic Dystrophy , Propofol , Adult , Male , Infant, Newborn , Humans , Child, Preschool , Myotonic Dystrophy/complications , Myotonic Dystrophy/diagnosis , Myotonic Dystrophy/therapy , Anesthetics, Local , Hypnotics and Sedatives , Anesthesia, LocalABSTRACT
Asymmetric transfer hydrogenation (ATH) of prochiral aromatic ketones was carried out with a water-soluble complex of Rh(III)Cp* and mononitrobenzenesulfonamide bidentate ligand (1R,2R)-N-(2-aminocyclohexyl)-4-nitrobenzenesulfonamide 1 derived from chiral cyclohexane-1,2-diamine. Aqueous sodium formate was used as the hydride source. The reaction afforded the chiral alcohols in good enantioselectivities (79-93%) and yields (>99%). The modified monosulfonamide ligand was also covalently immobilized on solid phase such as silica, resin, and mesoporous SBA-15 silica and then explored as a catalyst with Rh(III)Cp* in the ATH of acetophenone.
Subject(s)
Acetophenones/chemistry , Alcohols/chemical synthesis , Cyclohexanes/chemistry , Rhodium/chemistry , Sulfonamides/chemistry , Catalysis , Cyclohexanes/chemical synthesis , Hydrogenation , Ligands , Molecular Structure , Organometallic Compounds/chemistry , Oxidation-Reduction , Silicon Dioxide/chemistry , Stereoisomerism , Sulfonamides/chemical synthesis , Water/chemistryABSTRACT
Basados en la metodología empleada y frente a lo expuesto se puede concluir establecido que realizar la TECNICA DE DOBLEINLAY METAL CERAMICA. Se garantiza la adaptación, de las restauraciones produciendo un adecuado asentamiento de la restauración al diente. La preparación del bisel, mimétiza esa linea, dando una armonia entre el diente y la restauración aún cuando el color de la restauración es diferente al color del diente
