Comparison of Canine Overlap in Pediatric Patients Requiring Stainless Steel Crown Placement under General Anesthesia before and after the Procedure.

OBJECTIVES: Despite the increasing popularity of pediatric dental treatments under general anesthesia, information is scarce regarding occlusal changes in patients receiving stainless steel crowns (SSCs) under general anesthesia. This study sought to compare canine overlap before and after general anesthesia in children receiving SSCs. In case of a change, the possibility of returning to the preoperative state and the time required for this process were also evaluated. MATERIALS AND METHODS: This interventional, before-and-after study was performed on 60 children between 2 to 7 years of age requiring dental treatment under general anesthesia. The contact point of the most prominent area of the maxillary primary canine and mandibular primary canine was marked before and immediately after general anesthesia and at one and two weeks postoperatively. The change in canine overlap was analyzed using repeated measures analysis of variance (ANOVA) and linear regression test. RESULTS: Canine overlap significantly decreased immediately after general anesthesia (P<0.05). The mean bite opening was 0.51±0.22 mm at the site of the right canine and 0.50±0.185 mm at the site of the left canine. These values returned to their normal preoperative state after one week (P<0.05). Repeated measures ANOVA showed significant differences in this respect between the time points (P=0.002). CONCLUSION: The occlusion and vertical dimension of pediatric patients may change following dental treatment under general anesthesia; the magnitude of change in canine overlap may vary depending on the class of occlusion and number of SSCs placed. These changes are temporary and often resolve within a week.

Effect of Intravenous Acetaminophen on Postoperative Pain in Vitrectomy: A Randomized, Double-Blind, Clinical Trial.

BACKGROUND: Nowadays, pain, nausea, and vomiting are regarded as important complications of anesthesia and surgery. The current study aimed at assessing the effect of preemptive intravenous acetaminophen on control of pain, nausea, vomiting, shivering, and drowsiness following the general anesthesia for retina and/or vitrectomy surgeries. METHODS: In a randomized, double-blind, clinical trial, 83 candidates for retina or vitrectomy eye surgery under general anesthesia were distributed into 3 groups: A) 41 patients in the control group who received 100 mL of normal saline just before the surgery and 100 mL of normal saline 20 minutes before the end of surgery; B) 21 patients in the preemptive group who received acetaminophen 15 mg/kg in 100 mL normal saline just before the surgery and 100 mL normal saline 20 minutes before the end of surgery; C) 21 patients in the preventive group who received 100 mL normal saline just before the surgery and acetaminophen 15 mg/kg in 100 mL normal saline 20 minutes before the end of surgery. Pain, nausea, vomiting, and shivering were assessed at the recovery and 2, 4, and 24 hours after the operation. Anesthesia emergence situation was assessed after arrival in the recovery room by the Richmond agitation-sedation scale (RASS) questionnaire. Blood pressure and heart rate were recorded before anesthesia induction, just after intubation, before extubation, and on discharge from the recovery room. RESULTS: Total intraoperative fentanyl, duration of operation, and duration of anesthesia were not different among the studied groups. Vital signs were not statistically different among the groups at before anesthesia induction, just after intubation, before extubation, and on discharge from the recovery room. Thirty-three patients in the control group (87.8%), 11 in preemptive (52.4%), and 14 in preventive groups (66.7%) needed acetaminophen in the first 24 hours after the surgery (P value = 0.008). Pain scores measured by visual rating scale (VRS) was lower in the preemptive and preventive groups, compared with those of the control group, in the recovery (P value = 0.006), 2 hours after the surgery (P value = 0.008), and 4 hours after the surgery (P value = 0.012), but not in 24 hours after the operation (P value = 0.1). CONCLUSIONS: Intravenous acetaminophen administered as preemptive or preventive medication was effective and safe to control acute postoperative pain and analgesic request after the vitrectomy eye surgery.

Anesthetic Management in a Child With Niemann-Pick Disease.

Niemann-Pick is a lipid storage disease that results from a lysosomal enzyme deficiency (sphingomyelinase). It has different presentations, and it may affect various organs such as the central nervous system, kidney, liver, and spleen. Due to the complexity of the disease, careful perianesthetic management is necessary in order to reduce the risks and sequels. As there is little evidence available in the literature regarding the anesthetic implications of such patients, in this case report we describe the anesthetic management of a two-year-old female with Niemann-Pick disease.