Amnesia after Midazolam and Ketamine Sedation in Children: A Secondary Analysis of a Randomized Controlled Trial.

The incidence of peri-procedural amnesia following procedural sedation in children is unclear and difficult to determine. This study aimed to apply quantitative and qualitative approaches to better understand amnesia following dental sedation of children. After Institutional Review Board Approval, children scheduled for sedation for dental procedures with oral midazolam (OM), oral midazolam and ketamine (OMK), or intranasal midazolam and ketamine (IMK) were recruited for examination of peri-procedural amnesia. Amnesia during the dental session was assessed using a three-stage method, using identification of pictures and an animal toy. On the day following the sedation, primary caregivers answered two questions about their children's memory. One week later, the children received a semi-structured interview. Behavior and level of sedation during the dental session were recorded. Quantitative data were analyzed using descriptive statistics and comparison tests. Qualitative data were analyzed using content analysis. Triangulation was used. Thirty-five children (age: 36 to 76 months) participated in the quantitative analysis. Most children showed amnesia for the dental procedure (82.9%, n = 29/35) and remembered receiving the sedation (82.1%, n = 23/28 for oral administration; 59.3%, n = 16/27 for intranasal administration). The occurrence of amnesia for the dental procedure was slightly higher in the oral midazolam group compared with the other groups (44.8%, n = 13/29 for OM, 13.8%, n = 4/29 for OMK, and 41.4%, n = 12/29 for IMK). Twenty-eight children participated in the qualitative approach. The major theme identified was that some children could remember their procedures in detail. We conclude that peri-procedural amnesia of the dental procedure was common following sedation.

Intranasal Dexmedetomidine Compared to a Combination of Intranasal Dexmedetomidine with Ketamine for Sedation of Children Requiring Dental Treatment: A Randomized Clinical Trial.

Outpatient pediatric sedation is challenging. This study aimed to test intranasal dexmedetomidine efficacy as a single drug or combined with ketamine (DK) to sedate children undergoing dental treatment. Children < 7 years were randomized into dexmedetomidine 2 mcg/kg and ketamine 1 mg/kg (DK) or dexmedetomidine 2.5 mcg/kg (D) groups. Videos from the dental sedation allowed the systematic assessment of children's behavior (primary outcome) according to the Ohio State University Behavioral Rating Scale (OSUBRS). Secondary outcomes were parental and dentist satisfaction, adverse events, and recovery time. The data were analyzed descriptively and through regression models. Participants were 88 children (44 per group; 50 boys). The duration of quiet behavior (OSUBRS) was higher than 50% (DK mean 58.4 [standard deviation 38.1]; D 55.2 [39.1]; p = 0.225). Parents (DK 78.0 [32.2]; D 72.7 [35.1]; p = 0.203) and dentists (KD 62.7 [41.0]; D 62.8 [40.1]; p = 0.339) were overall satisfied. Adverse events occurred in 16 cases (DK n = 10, 62.5%; D n= 6, 37.5%; p = 0.104) and were minor. The median recovery time in the DK group was 1.3 times greater than in group D (p < 0.05). Intranasal sedation with dexmedetomidine alone is equally efficacious and satisfactory for pediatric sedation with fewer adverse events and faster recovery than the DK combination.

The use of probiotics for improving lipid profiles in dyslipidemic individuals: an overview protocol.

BACKGROUND: Dyslipidemia is a major risk factor in triggering cardiovascular events, which can lead to the death of millions of people around the world. Thus, several pharmacological and non-pharmacological therapeutic strategies have been developed in recent decades with the objective of improving lipid profiles, including the use of probiotics. Therefore, the purpose of this protocol is to describe the steps that will guide the construction of an overview to demonstrate the scientific evidence of the efficacy of probiotics in improving the lipid profile of dyslipidemic individuals and to propose specific recommendations regarding their use. METHODS: The search will be conducted in the following databases: MEDLINE/PubMed, EMBASE, PROSPERO, Cochrane Library, CINAHL, JBI Database of Systematic Reviews and Implementation Reports, Google Scholar, and CADTH. Reviewers will select systematic evaluations and data analyses from randomized clinical trials that evaluated the effects of probiotics on lipid profiles. The studies will be analyzed for methodology quality by the AMSTAR 2 tool and risk of bias by ROBIS. The data will be extracted by three independent reviewers based on a data extraction sheet, which will include the most relevant variables for the analysis and interpretation of the results. The variables will be categorized and described in narrative form or in tables. DISCUSSION: There are some systematic reviews about the use of probiotics to prevent and/or treat dyslipidemia; however, their outcomes related to the ability of probiotics to improve lipid profiles are conflicting. So, an overview on this topic is needed to clarify this important issue. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017080328.

Memory effects of sedative drugs in children and adolescents--protocol for a systematic review.

BACKGROUND: Some sedatives used in children and adolescents can affect memory function. Memory impairment of traumatic experience can minimize the chance of future psychological trauma. Knowledge about the potential of different sedatives to produce amnesia can help in the decision-making process of choosing a sedative regimen. The aim of this systematic review is to evaluate the effect of different sedatives on memory of perioperative events in children and adolescents. METHODS/DESIGN: Electronic databases and other sources, such as trial registers, gray literature, and conference abstracts will be searched. Randomized controlled trials will be included that assess memory of perioperative events in children and adolescents 2-19 years old receiving sedative drugs as premedication or as agents for procedural sedation in a medical or dental settings. The outcomes will be loss of memory after and before sedative administration (anterograde and retrograde amnesia). Two independent reviewers will perform screening, study selection, and data extraction. Disagreement at all levels will be resolved by consensus or by involving a third reviewer. Assessment of the risk of bias of included studies will be performed according to "Cochrane Collaboration's Tool for Assessing Risk of Bias in Randomized Trials." Clinical and methodological heterogeneity across studies will be evaluated to determine if it is possible to combine or not combine study results in a meta-analysis. DISCUSSION: To the best of our knowledge, there is no systematic review that specifically addresses this question. Findings from the review will be useful in the decision-making process about the best sedative for minimizing recall of the medical/dental event and possible psychological trauma. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015017559.

Atuação do residente cirurgião-dentista em equipe multiprofissional de atenção hospitalar à saúde materno-Infantil / Activities of a dental resident in a multiprofessional team focused on mother and child health care

A atuação do cirurgião-dentista no ambiente hospitalar é uma perspectiva recente no contexto brasileiro, sendo pouco investigada e sistematicamente relatada. Este estudo descritivo retrospectivo objetivou descrever as atividades desenvolvidas por cirurgiões-dentistas residentes, inseridos em uma equipe multiprofissional de um hospital universitário de referência. Buscou-se os registros e fichas clínicas dos pacientes atendidos pelos residentes em Odontologia da área de Atenção à Saúde Materno-Infantil do Hospital das Clínicas, da Universidade Federal de Goiás, na cidade de Goiânia-GO, entre fevereiro de 2011 e julho de 2012, para caracterizar os pacientes e descrever os procedimentos odontológicos executados. Os dados foram analisados por meio de estatística descritiva. Foram atendidos 740 pacientes no período analisado e 1290 consultas odontológicas foram realizadas. Uma diversidade de alterações sistêmicas foi verificada em 29% da amostra atendida (n=207 pacientes). As atividades educativo-preventivas (n=706) foram mais frequentes do que as atividades curativas (n=66). No período analisado, as atividades multiprofissionais foram realizadas foram estudos de casos (n=18), grupos de educação em saúde (n=49) e reuniões de planejamento multiprofissional (n=17). Concluiu-se que: o cirurgião-dentista pode atuar de forma abrangente no contexto hospitalar; considerando a área materno-infantil, as atividades educativo-preventivas ocorreram em maior número do que as curativas; o cirurgião-dentista deve ser estimulado, desde a graduação, a compreender os aspectos diferencias do contexto hospitalar no planejamento do tratamento odontológico e no trabalho multiprofissional.

The responsibility of the dentist in the hospital environment is a recent perspective in the Brazilian context, and this subject is rarely systematically investigated and reported. This retrospective descriptive study aimed to describe the activities performed by dental residents, entered into a multidisciplinary team of a university hospital. We selected records of patients seen by dental residents in the area Maternal and Child Health, in the Clinical Hospital, Federal University of Goiás, Goiânia-GO, between February 2011 and July 2012, to characterize them and describe dental procedures performed. Data were analyzed using descriptive statistics. A total of 740 patients were seen in that specific period and 1,290 dental consultations were held. A variety of systemic disorders were observed in 29% of the sample (n = 207 patients). Educative-preventive activities (n = 706) were more frequent than curative activities (n = 66). Over that period, the multidisciplinary activities were case studies (n = 18), heal the education for particular groups (n = 49), and planning meetings (n = 17). We concluded that: dentists have a broad spectrum of activities in hospitals; regarding the maternal and child health, educational and preventive activities were more frequent than therapeutic ones; dentists should be encouraged since undergraduation to understand the aspects of the hospital context that influence in treatment planning and multidisciplinary work.