Sensory integration dysfunction affects efficacy of speech therapy on children with functional articulation disorders.

BACKGROUND: Articulation disorders in young children are due to defects occurring at a certain stage in sensory and motor development. Some children with functional articulation disorders may also have sensory integration dysfunction (SID). We hypothesized that speech therapy would be less efficacious in children with SID than in those without SID. Hence, the purpose of this study was to compare the efficacy of speech therapy in two groups of children with functional articulation disorders: those without and those with SID. METHOD: A total of 30 young children with functional articulation disorders were divided into two groups, the no-SID group (15 children) and the SID group (15 children). The number of pronunciation mistakes was evaluated before and after speech therapy. RESULTS: There were no statistically significant differences in age, sex, sibling order, education of parents, and pretest number of mistakes in pronunciation between the two groups (P > 0.05). The mean and standard deviation in the pre- and post-test number of mistakes in pronunciation were 10.5 ± 3.2 and 3.3 ± 3.3 in the no-SID group, and 10.1 ± 2.9 and 6.9 ± 3.5 in the SID group, respectively. Results showed great changes after speech therapy treatment (F = 70.393; P < 0.001) and interaction between the pre/post speech therapy treatment and groups (F = 11.119; P = 0.002). CONCLUSIONS: Speech therapy can improve the articulation performance of children who have functional articulation disorders whether or not they have SID, but it results in significantly greater improvement in children without SID. SID may affect the treatment efficiency of speech therapy in young children with articulation disorders.

The effects of low-dose fentanyl on emergence agitation and quality of life in patients with moderate developmental disabilities.

STUDY OBJECTIVE: To analyze whether emergence agitation could be reduced by using a low dosage of fentanyl without causing an increase in postoperative adverse effects and/or affecting the patient's quality of life after discharge. DESIGN: Randomized, controlled crossover trial. SETTING: University medical center. PATIENTS: One hundred ten ASA physical status I and II ambulatory patients with moderate developmental disabilities who received anesthesia for dental care. INTERVENTIONS: During their first visit, patients were randomly treated either with a placebo or a 1- to 1.5-microg/kg dose of fentanyl before inserting a reinforced laryngeal mask airway and treated with the remaining method during their second visit 6 to 12 months later. MEASUREMENTS: Measured variables included anesthetic and emergence period, the occurrence of emergence agitation, and postanesthetic adverse effects such as nausea and vomiting. After discharge, the patient's quality of life was evaluated based on disturbances in daily activity, eating habit, and sleeping behavior. Results were analyzed by Student t test and McNemar test (P < 0.05). MAIN RESULTS: Between the two treatments, there was a significant difference in the frequency of emergence agitation (P = 0.04) but no postoperative adverse effects such as postoperative nausea and vomiting. We also found no significant disturbances in the patient's quality of life according to daily activity, eating habits, or sleeping behavior. CONCLUSION: Emergence agitation may be reduced by using 1 to 1.5 microg/kg of fentanyl during induction while maintaining anesthesia by sevoflurane in patients with moderate developmental disabilities undergoing dental care, without causing an increase in postoperative adverse effects and affecting the patient's life quality after discharge.

Effect of reinforced laryngeal mask airway or endotracheal intubation anesthesia on adverse events: quality of life issues for dental patients requiring general sedation.

This study tested whether the use of a reinforced laryngeal mask airway (LMA) compared to endotracheal intubation (El) anesthesia diminished adverse events and improved the post-operative quality of life for 146 dental patients who required general anesthesia due to developmental disabilities. In this randomized, crossover trial, patients received either reinforced LMA or El anesthesia during an initial dental treatment visit; the other anesthetic method was used during a second visit scheduled after six months or more. Data were assessed with Student's t-test, chi-square test and McNemar's test to evaluate the affect on quality of life by analyzing disturbances in daily activity, such as eating patterns and sleeping behaviors after the procedure. Although the reinforced LMA anesthesia was associated with a significantly lowered incidence of adverse events (p = .04), neither method significantly disturbed quality of life activities.

Improving the success rate of laryngeal mask airway insertion during etomidate induction by using fentanyl or succinylcholine.

BACKGROUND: Smooth and successful insertion of a laryngeal mask airway (LMA) during etomidate induction requires a proper mouth opening and efforts to minimize airway reflexes such as gagging, coughing, or laryngospasm. We hypothesized that the concurrent use of fentanyl or succinylcholine with etomidate, the induction agent, could reduce the occurrence of airway reflexes and increase the success rate of LMA. METHODS: Sixty adult patients, ASA class I-II, scheduled for surgery under general anesthesia, were randomly allocated into three groups: group I in which patients were given etomidate 0.3 mg/kg alone; group 2 in which patients were given fentanyl 2 microg/kg and etomidate 0.3 mg/kg; groups 3 in which patients were give etomidate 0.3 mg/kg and succinylcholine 1 mg/kg. All patients were premedicated with atropine 0.01 mg/kg. When induction of anesthesia began we recorded the time from administering the designated regiminal agent or agents to the time of relaxation of jaw (the ease of mouth opening) and checked the patient for any excitatory movement after administering the induction agents. After inserting the LMA, we checked for signs of airway reflexes. Student's t test, Chi-square and Fisher's exact test were used to analyze the data. A value of P < 0.05 was considered significant. RESULTS: There were no significant differences in demographic data among the the three groups. The concurrent use of fentanyl or succinylcholine with etomidate during induction could significantly reduce the occurrence of excitatory movements and airway reflexes after LMA insertion, and increase the success rate of LMA insertion in comparison with using etomidate alone. Comparing the two adjutant agents, the concurrent use of succinylcholine could provide a significantly better jaw relaxation, shorten the time to insert the LMA and increase the success rate of LMA insertion. CONCLUSIONS: As an induction agent to facilitate insertion of LMA, etomidate alone was far from perfect. The concurrent use of 2 microg/kg of fentanyl with etomidate might significantly reduce the occurrence of airway reflexes in response to LMA insertion and increase the success rate of insertion. However, concurrent use of 1 mg/kg succinylcholine with etomidate might provide better results in terms of shortened time for the LMA insertion, jaw relaxation, and the success rate of LMA insertion than that of fentanyl.

Evaluation of airway leakage using reinforced laryngeal mask during dental anesthesia with spontaneous breathing.

BACKGROUND: The purpose of this study was to evaluate whether manipulation or position change of the head during dental procedures for handicapped patients (mentally retarded) using a reinforced laryngeal mask airway for ventilation would lead to air leak. METHODS: All patients had a reinforced laryngeal mask airway inserted after induction of anesthesia; anesthesia was maintained with sevoflurane. Normal saline stained with methylene blue was instilled into the oral cavity of the patient. Then, the patient's laryngeal region was checked for blue staining with a fiberoptic bronchoscope. After dental treatment, the laryngeal region was checked again under fiberoptic bronchoscopy. The staining results were recorded and analyzed. RESULTS: In one of 51 patients (1.96%), the laryngeal region was stained blue after the flexible laryngeal mask airway was inserted. In ten of 51 (19.6%) patients, the laryngeal area was stained blue after the dental procedure. One of the ten patients who had a leak because the laryngeal mask was pulled out during the dental procedure. And in another one patient endotracheal tube was placed in lieu of laryngeal mask due to severe leakage. No oxygen desaturation below 90% occurred in all patients. No major complications such as fever or aspiration pneumonia were reported. CONCLUSIONS: The use of a reinforced laryngeal mask airway eliminates the complications due to endotracheal intubation and enhances the progress of the dental procedure. Although leakage may happen during dental manipulation, it usually does not raise serious problem. No serious complications such as aspiration were found in our cases. So a reinforced laryngeal mask airway may be considered to be another safe choice for maintenance of a patent airway in handicapped patients during dental procedures.