فهرست مطالب naser kaviani

Delirium is a clinical syndrome characterizedby acute changes in awareness and consciousness, and disturbances and fluctuations in attention. This study evaluated the frequency of postoperative delirium in patients undergoing general anesthesia for dental procedures and the relevant risk factors. Materials &

In this cross-sectional study, 103 patients who were candidates for dental procedures under general anesthesia in Isfahan Dental School were randomly selected. General anesthesia was induced with thiopental sodium-fentanyl-atracurium in all the patients and maintained with propofol. Dental anxiety was evaluated in all the patients using the DAS-R (Dental Anxiety Score-Revised) questionnairebefore the procedure. In addition, the MMSE (Mini Mental State Examination) questionnaire was completed 48 hours after the procedure. Statistical analysis was performed with SPSS 25, using independent t-test and regression analysis (α = 0.05).

The results showed that the incidence of delirium in 103 patients undergoing general anesthesia was22 cases (21.4%). The results of linear regression analysis indicated that age was an important and influential factor in the mental status, and orientation to place (p value = 0.002) and time (p value = 0.001) after general anesthesia. The severity of anxiety before anesthesia significantly affected the duration of general anesthesia (p value = 0.01) and orientation to place after general anesthesia (p value = 0.005). Anxiety itself was affected by the age of the patient (p value = 0.01).

Delirium is highly prevalent in patients undergoing general anesthesia for dental procedures. It is critical to identify the risk factors associated with this disorder in order to reduce the incidence of delirium.

BIS (bispectralindex) indicates brain activity, and therefore, the depth of general anesthesia. Mentally challenged patients have different degrees of brain impairment and different levels of intelligence; as a result, it is expected that the BIS score of these patientswill be different from that of healthy patients during general anesthesia. This study aimed to determine the relationship between the BIS score and the severity of mental disability during general anesthesia for dental procedures.

Forty-four mentally challenged patients were selected and included in this cross-sectional descriptive/analytical study. After giving the Raven’s Standard Progressive Matrices test to the patients, they were classified into different groups in terms of theseverity of mental disability. After giving and maintaining the same general anesthesia level to the patients, BIS scores were calculated at 5-, 15-, 30-and 45-minute intervals after induction of anesthesia. BIS scores were compared at various degrees ofmental deficiency, and possible correlations were evaluated. Statistical analysis was performed using t-test and Spearman’s correlation test with SPSS 22 (α = 0.05).

There were no statistically significant differences in BIS scores between various degrees of mental deficiency except for the 30-minute interval after the induction of general anesthesia (p value = 0.025).

In this study, the severity of mental deficiency did not affect the depth of general anesthesia except for the 30-minute interval after its induction.

Ibuprofen – a non‑steroidal anti‑inflammatory drug (NSAID)‑ and glucosamine sulfate – a natural compound and a food supplement‑ are two therapeutic agents which have been widely used for treatment of patients with temporomandibular joint (TMJ) disorders. This study was aimed to compare the effectiveness and safety of these two medications in the treatment of patients suffering fromTMJ disorders.

After obtaining informed consent, 60 patients were randomly allocated to two groups. Patients with painful TMJ,TMJ crepitation or limitation of mouth opening entered the study. Exclusion criteria were history of depressive disorders, cardiovascular disease, musculoskeletal disorders, asthma, gastrointestinal problems, kidney or liver dysfunction or diabetes mellitus, dental diseases needing ongoing treatment; taking aspirin or warfarin, or concomitant treatment of TMJ disorder with other agents or methods.Thirty patients were treated with ibuprofen 400 mg twice a day, (mean age 27.12 ± 10.83 years) and 30 patients (mean age 26.60 ± 10) were treated with glucosamine sulfate 1500 mg daily. Patients were visited 30, 60 and 90 days after starting the treatment, pain and mandibular opening were checked and compared within and between two groups.

Comparing with baseline measures, both groups had significantly improved post‑treatment pain (P < 0.0001 for both groups) and mandibular opening (P value: 0.001 for glucosamine sulfate and 0.03 for ibuprofen).Post treatment pain and mandibular opening showed significantly more improvement in the glucosamine treated patients (P < 0.0001 and 0.01 respectively).Rate of adverse events was significantly lower in the P value glucosamine sulfate group (P < 0.0001).

This investigation demonstrated that comparing with a commonly prescribed NSAID – ibuprofen‑, glucosamine sulfate is a more effective and safer therapeutic agent for treatment of patients with TMJ degenerative join disorder

The aim of this prospective, randomized, double-blind study was to investigate the effect of articaine combined with ketamine on the success rate of inferior alveolar nerve block (IANB) in posterior mandible teeth with symptomatic irreversible pulpitis.
Methods and Materials: Forty two adult patients with diagnosis of symptomatic irreversible pulpitis of a mandibular posterior tooth were selected. The patients received two cartridges of either containing 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL 50 mg/mL ketamine hydrochloride (A-ketamine group) or 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL normal saline (A-saline group) using conventional IANB injections. Access cavity preparation started 15 min after injection. Lip numbness was required for all the patients. Success was considered as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed by independent student t, Mann-Whitney and Chi-square tests.
The success rates were 55% and 42.9% for A-ketamine and A-saline group, respectively, with no significant differences between the two groups (P=0.437).
Adding 0.4 mL 50 mg/mL ketamine hydrochloride to the articaine local anesthetic did not increase the efficacy of IANB for posterior mandibular teeth with symptomatic irreversible pulpitis.

This study was planned to determine the relationship between bispectoral index (BIS) during dental treatment and recovery conditions in children undergoing two regimes of anesthesia of propofol and isofl urane. In this single-blind clinical trial study, 57 4-7-year-old healthy children who had been referred for dental treatment under general anesthesia between 60 and 90 min were selected by convenience sampling and assigned to two groups, after obtaining their parents’ written consent. The anesthesia was induced by inhalation. For the fi rst group, the anesthesia was preserved by a mixture of oxygen (50%), nitrous oxide (50%), and isofl urane (1%). For the second group, the anesthesia was preserved by a mixture of oxygen (50%), nitrous oxide (50%), and propofol was administered intravenously at a dose of 100 Ng/kg/min. The patients’ vital signs, BIS, and agitation scores were recorded every 10 min. The data were analyzed by repeated measure ANOVA and t-tests at a signifi cance level of α = 0.05 using SPSS version 20. The results of independent t-test for anesthesia time showed no statistically signifi cant difference between isofl urane and propofol (P = 0.87). Controlling age, the BIS difference between the two anesthetic agents was not signifi cant (P > 0.05); however, it was negatively correlated with the duration of anesthesia and the discharge time (P = 0.001, r = –0.308) and (P < 0.001, r = –0.55). The same depth of anesthesia is produced by propofol and isofl urane, but lower recovery complications from anesthesia are observed with isofl urane.

Hyperactive gag reflex can make dental treatment procedures intolerable for some patients; so, it is highly important for the dentist to control it. Acupuncture is a technique used to control this phenomenon. In this study, the effects of two acupoints, anti-gagging and P6, on the gag r eflex control were analyzed. In this clinical trial study, a total number of 100 healthy people were classified into four groups. Acupuncture and psuedo-acupuncture procedures were performed on anti-gagging and P6 points based on the group. Before and after acupuncture or pseudo-acupuncture, gag reflex severity was measured via stimulation of the soft palate, tonsils, and root of the tongue. Obtained data was analyzed using statistical package of social sciences (SPSS) 22 statistical software. Acupuncture reduced gag reflex at both points, but psuedo-acupuncture did not reduce the gag reflex. Moreover, no significant difference was observed between acupuncture on P6 and anti-gagging points. Acupuncture on anti-gagging and P6 points can be effective in controlling the gag reflex during routine dental procedures.

Control of patient anxiety during dental procedure, makes better operating conditions and reduces medical complications in patients. Intravenous conscious sedation is a good method for patient control during dental surgery. This study aimed to compare the effects of two methods of low-dose intravenous sedation regimes for patient control in dental implant surgery. 30 patients candidate for dental implant surgery were randomly divided into two groups. Before the surgery, low intravenous doses of combinations of midazolam/fentanylin and midazolam/ketamine were administered for the two group. Sedation score and operation condition in both groups were evaluated and recorded. Data were analyzed using Mann-Whitney statistical test. In midazolam/ketamine group, 86.7% and in midazolam/fentanyl group, 80.0% of patients had appropriate sedation. Good operation condition was observed in 73.3% and 80.0% of the patients in midazolam/ketamine and midazolam/fentanyl groups, respectively. There were not any significant differences between the two groups in sedation score and operation conditions. Both evaluated drug regimens can provide good sedation score in over than 80% of patients and good operation condition in over than 70% of patients. So, both drug combinations are useful for patients in implant surgery.

Dental anxiety is caused by failure to provide quality services to patients. The oral medication is one way of controlling anxiety.Passion Flower is known as a sedative drug in traditional herbal medicine. This study aimed to determine the effect of passionflower extracts to reduce restlessness in children 3 to 6 years undergoing general anesthesia.Methods and materials: 50 healthy children aged 3 to 6 candidate for dental treatment under general anesthesia, after examination and consent from the parents were selected. Extract of Passion flower given to study group(25 children) and a similarvolume of oral sugar solution to control group.Separation from parents, cooperation for IV line and agitation score in recovery room was evaluated in two groups. Easy separation from their parents in the study group was 56% and 33% also had good cooperation for IV line, which was significantly more than control group. The agitation score of the study group in the minutes 10 and 20 and 30 of recovery room were significantly lower than controls. Extract of Passion flower makes easier separation from parent and higher cooperation for IV line and lower agitation score and need to analgesia in recovery room. So this drug was useful for premedication in children.

Based on data available, about 10% of people have severe dental anxiety. There are several methods to control dental anxiety, the use of which entails knowledge on behalf of the dental practitioners and appropriate equipment. This study evaluated knowledge of dental practitioners about dental anxiety control methods. In this study descriptive study, 249 dental practitioners in Isfahan were selected using simple sampling method and given a questionnaire consisting of 20 questions about pharmacological methods to control dental anxiety in patients. Data was analyzed with SPSS software using ANOVA at a significance level of 0.95. Knowledge scores were reported from 0 to 20. Knowledge scores for inhalation sedation, oral sedation and general anesthesia were 12.65 ± 3.31, 13 ± 2.84, and 17.91 ± 6.12, respectively. Mean of dental knowledge scores of dentists in relation to pharmacological sedation techniques was above 12, indicating proper knowledge level of dental practitioners. ANOVA did not reveal any significant differences in knowledge level means between different age groups in relation to general anesthesia (p value = 0.217). However, there were significant differences in the knowledge means between various age groups in relation to inhalation (p value = 0.036) and oral sedation (p value = 0.035) techniques. Under the limitations of this study the knowledge of dentists about pharmacological methods of controlling patient anxiety in dentistry was good but these methods are not widely used due to lack of background support. Given the importance of such measures, it is necessary to increase the knowledge of the community about these techniques.

During the past decade, attention to oral health-related quality of life has greatly increased. This study was designed to evaluate the effect of dental treatment under general anesthesia on the quality of life and dental fears in 2‒5 year-old children. The other aim of this study was to explore the effect of dental fears on oral health-related quality of life in children. This descriptive-analytical study was carried out on sixty-five 2‒5 year-old healthy children referring to the operating room of Isfahan Faculty of Dentistry for dental treatment under general anesthesia. ECOHIS (Early Childhood Oral Health Impact Scale) and CFSS-DS (Children’s Fear Survey Schedule– Dental Subscale) questionnaires were used to assess the oral health-related quality of life and dental fears. The questionnaires were completed by parents before and after the dental procedures. Paired-sample t-test and Spearman’s and Pearson’s tests were used for data analysis at a confidence interval of 0.95. Oral health-related quality of life significantly improved after dental treatment under general anesthesia (p value < 0.05). Mean scores before and after were 42.78 and 24.56, respectively, with statistically significant differences. In addition, the mean score of dental fear decreased from 46.29 to 42.20, which was statistically significant (p value < 0.001). Dental treatment under general anesthesia can significantly improve oral health-related quality of life and decrease dental fears in children.

Emergence agitation is a common clinical phenomenon in children undergoing general anesthesia. Possible predisposing factors are rapid regaining of consciousness in an unfamiliar environment, the type of general anesthesia technique used, the patient’s mood, duration of anesthesia and age. The aim of the present study was to compare the effects of two general anesthetic methods with and without local anesthetics on emergence agitation of children volunteering for general anesthesia in the recovery room. In this prospective single-blind clinical trial, 60 children under 6, who volunteered for general anesthesia, were randomly divided into two groups. All the subjects were anesthetized using the same protocol. During the dental procedure in the study groups, the teeth involved were anesthetized with one lidocaine+epinephrine cartridge using the infiltration technique. The children's emergence agitation was evaluated and compared between the two groups. Data was analyzed with t-test, ANOVA Mann-Whitney test and Spearman’s correlation coefficient (α = 0.05). There were no statistically significant differences in the means of age, in gender and in the number of treatment procedures between the two groups. Emergence agitation scores in the local anesthesia group at 15- and 30-minute intervals were 9.6±3.92 and 8±2.58, respectively, demonstrating a significantly higher rates compared to the other group (p value = 0.013 and p value = 0.014). However, there were no statistically significant differences at 45- and 60-minute intervals between the two groups (p value = 0.872 and p value = 0.048). Based on the results it was concluded injection of a local anesthetic reduces emergence agitation in children undergoing general anesthesia. Therefore, it is recommended to use this technique in children with no contraindications for local anesthetics.

Intravenous conscious sedation is widely used to control anxiety and increase patient tolerance during implant surgeries. Patients experience various sensations due to the use of different medications. In this study, patients’ sensations during conscious sedation were evaluated with the use of four IV sedation regimes to determine the best protocol. In this double-blind randomized clinical trial, 112 patients who were candidates for dental implants were evaluated in four groups: Midazolam, Midazolam/Fentanyl, Midazolam/Acetaminophen and Midazolam/Ketamine. At the end of recovery they were asked about their sensations during surgery. Data were analyzed with Pearson’s, chi-squared, Mann-Whitney and Kruskal-Wallis tests and ANOVA (α = 0.05). Pearson’s and chi-squared tests did not reveal any significant differences between the groups in relation to age, sex, and educational status; ANOVA did not show any differences between the groups in relation to duration of recovery and surgery and the dose of Midazolam used. Kruskal-Wallis test revealed significant differences in pleasant feelings between the four groups (p value < 0.001); Mann-Whitney test did not show any significant differences in pleasant sensations between the Midazolam and Midazolam/Ketamine groups (p value = 0.084). However, frequency of pleasant sensation was significantly higher in the Midazolam/Fentanyl group compared to that in the Midazolam group (p value = 0.008). Frequency of pleasant sensation was significantly higher in the Midazolam/Acetaminophen group compared to that in the Midazolam/Ketamine group (p value = 0.001). Kruskal-Wallis did not reveal any significant differences in pleasant sensations between the four groups (p value = 0.211). Based on the results of the present study, combined use of analgesics and sedatives gives rise to good sensations in patients during surgery and increases sedation efficacy and patient cooperation and satisfaction with the sedation procedure.

Dental fear is common in children. Many factors affect the severity of this kind of fear. Hospitalization increases children’s dental fears. The aim of this study was to evaluate the effect of the type of hospitalization on children’s dental fear. In this cross-sectional study, 153 children were placed in three equal groups, with a history of hospitalization, with a history of major surgery and a control group without any history of hospitalization and surgery. The children’s dental fear was evaluated with Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire. Data was analyzed with chi-squared and Kruskal-Wallis tests and one-way ANOVA (α = 0.05). The means of dental fear based on CFSS-DS score were higher in hospitalization and surgery groups in comparison with the control group (p value < 0.001). Dental fear score in hospitalization group was 37.4 and higher than the two other groups. Fear from injection and dyspnea and use of dental drills were the most common causes of fear, in descending order, in the groups under study. Hospitalization and surgery increase children’s fear of dental procedures. Dental fear in children with hospitalization in internal wards is more than the other groups, which might be attributed to frequent diagnostic and therapeutic procedures during the hospitalization period.

Emergence agitation is a common clinical phenomenon in children undergoing general anesthesia. A possible predisposing factor is the type of general anesthetic technique used. The aim of the present study was to evaluate the effect of two intravenous and inhalational general anesthetic methods on emergence agitation of children in the recovery room. In this prospective single-blind clinical trial, 56 children aged less than 6 years were randomly divided into two groups of 28. The first group received IV general anesthesia with propofol and alfentanyl and the second group received inhalation anesthesia with isoflorance and nitrous oxide. After awakening in the recovery room the children's emergence agitation was measured every ten minutes for 60 minutes by PAED scale. Data was analyzed with t-test, chi-squared test and ANOVA with SPSS software (α = 0.05). Emergence agitation in the intravenous and inhalational groups at 10-minute interval were 12.85 and 10.51 on PAED scale, respectively, demonstrating a significantly higher rate in the intravenous group. However, in general, there were no significant differences between the two groups (p value = 0.241). There was an inverse relationship between age and agitation, with higher rates in younger children. Based on the results it was concluded that decision-making on the type of anesthesia should not be based on emergence agitation. Other factors involved in emergence agitation should be considered.

Severe gagging in some patients during dental procedures can complicate the procedure. In this study, the effect of oral ondansetron and placebo, as antiemetic medications, on gag reflex was evaluated with the stimulation of soft palate and palatine tonsil areas to simulate the clinical situation during dental procedures. In this clinical trial, 88 healthy adult individuals were randomly divided into two equal groups of ondansetron and placebo, which were administered orally. Gag reflexes were checked using a tongue depressor and recorded before and 90 minutes after intervention in the soft palate and palatine tonsil areas. Data was analyzed and compared with SPSS software, using Mann-Whitney and Wilcoxon tests (α = 0.05). In the ondansetron group a statistically significant decrease in gag reflex was noted after intervention in both soft palate and tonsil areas (p value < 0.05); however, no significant decrease was observed in the placebo group in the two areas after intervention. The results of the present study showed the efficacy of ondansetron in reducing the severity of gag reflex in both the soft palate and tonsil areas; therefore, its administration can be considered in clinical procedures in those areas.

Intravenous sedation is one of methods to control anxiety in dentistry. However, due to intravenous use of potent drugs, the odds of hypoxia increases. In this study the prevalence of this complication between the two intravenous sedation methods was investigated. In this double-blind prospective clinical trial a total of 73 implant patients were evaluated in two groups. Conscious sedation was administered with a combination of midazolam/fentanyl in one group and with midazolam/ketamine in the other. SPO2 was measured in 6 stages and results were analyzed with t-test using SPSS software (α = 0.05). Mean of SPO2 five minutes after drug injection decreased in both groups. In midazolam/fentanyl group it decreased to 93.2% and in midazolam/ketamine group to 94.9% which indicates that the decrease in SPO2 in the first group (midazolam/fentanyl) was significantly more than other group. Use of intravenous sedation resulted in a decrease in SPO2 five minutes after sedation. In the midazolam/fentanyl group, it decreased to 93.2% and in the midazolam/ketamine group it decreased to 94.9%, with a significantly higher decrease in the former.

Sever dental fear and mental disorders are indications for dental treatment under general anesthesia, which usually is performed as outpatient anesthesia for dentistry; so decreased recovery time and complications are important. This study aimed to compare the recovery time and complications after Anesthesia with Propofol between mental retard and healthy patients. In this clinical trial study, 34 mental retarded and 34 healthy patients were prescribed for general anesthesia. In both groups, anesthesia was performed with propofol. After the end of anesthesia, recovery time and complications in both groups were recorded and the data were analyzed with independent samples t and Mann-Whitney tests. Recovery time in retarded group was significantly higher than the healthy group (P < 0.05); but the side effects had no significant difference between in the two groups (P > 0.05). There was direct relation between anesthesia time and recovery time (P < 0.05). Recovery time was prolonged in mental retard patients; it might be because of their need to prolonged treatment. Recovery side effects were similar in both groups. In both groups, increasing the anesthesia time made longer recovery time like the previous studies.