1
|
Leira Y, Cho H, Marletta D, Orlandi M, Diz P, Kumar N, D'Aiuto F. Complications and treatment errors in periodontal therapy in medically compromised patients. Periodontol 2000 2023; 92:197-219. [PMID: 36166645 DOI: 10.1111/prd.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
Patients who are medically compromised may be at an increased risk of complications and treatment errors following periodontal therapy. A review of the evidence on the topic is presented, in relation to the type of complication reported, of periodontal treatment, and of patients' medical status. Further, a framework for risk assessment and appropriate treatment modifications is introduced, with the aim of facilitating the management of patients with existing comorbidities and reducing the incidence of treatment complications.
Collapse
Affiliation(s)
- Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Hana Cho
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | | | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
| | - Pedro Diz
- Special Care Dentistry Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Navdeep Kumar
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
| |
Collapse
|
2
|
Marti F, Lindner G, Ravioli S. Resistance to local anaesthetics: a literature review. Br J Anaesth 2022; 129:e43-e45. [PMID: 35718562 DOI: 10.1016/j.bja.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/22/2022] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Florian Marti
- Department of Anaesthesiology and Intensive Care Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
| | - Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland; Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Svenja Ravioli
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| |
Collapse
|
3
|
Loss L, Meier J, Phung T, Ordonez J, Huerta S. Feasibility of Umbilical Hernia Repair Under Local Anesthesia and Monitored Anesthesia Care at a Veteran Affairs Hospital. Am Surg 2021; 88:167-173. [PMID: 34846213 DOI: 10.1177/0003134820951452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Local anesthesia (LA) for open umbilical hernia tissue repair (OUHTR) is not widely utilized in academic centers in the United States. We hypothesize that LA for OUHTR is feasible in a veteran patient population. METHODS From 2015 to 2019, 449 umbilical hernias were repaired at our institution utilizing a standardized technique in veteran patients. OUHTR was included in this analysis (n = 283). Since 2017, 18.7% (n = 53) UH were repaired under LA. We compared outcomes and operative times between general anesthesia and LA in patients undergoing OUHTR. Univariable and multivariable analyses were performed to determine significance. RESULTS The entire cohort was composed of older (56.3 ± 12.1 years), White (75.5%), obese (body mass index [BMI] = 32.3 ± 4.6 kg/m2) men (98.0%). The average hernia size for the entire cohort was 2.42 ± 1.2 cm. The groups were similar in age and BMI. Patients with higher American Society of Anesthesiologists (ASA) (Odds ratio [OR] 3.1; 95% CI 1.5-6.8) and cardiovascular disease (OR 2.7; 95% CI 1.0-7.2) were more likely to receive LA. Recurrence (0.0% vs 6.0%; P = .9) and 30-day complications (6.0% vs 13%; P = .9) were similar between LA and GA after correcting for hernia size. Operating room times were reduced in the LA group (17.7 minutes; P < .05). None of the patients with LA required postanesthesia care unit for recovery. The patients who received LA reported being comfortable (78.9% of patients), with the worst reported pain being 2.4 ± 2.4 (out of a scale of 10), and 94.7% would elect to receive LA if they had another hernia repair. CONCLUSION Patients who received LA had more cardiac disease and a higher ASA. Complications were similar between both groups. LA reduced operating room times. Patients were satisfied with LA.
Collapse
Affiliation(s)
- Lindsey Loss
- Department of Surgery, University of Toledo, Toledo, OH, USA
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tri Phung
- 7067 Department of Anesthesiology, VA North Texas Health Care System, TX, USA
| | - Javier Ordonez
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sergio Huerta
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,7067 Department of Surgery, VA North Texas Health Care System, TX, USA
| |
Collapse
|
4
|
Derakhshan P, Imani F, Seyed-Siamdoust SA, Garousi S, Nouri N. Cerebrospinal Fluid and Spinal Anesthesia Parameters in Healthy Individuals versus Opium-addict Patients during Lower Limb Surgery. ADDICTION & HEALTH 2020; 12:11-17. [PMID: 32582410 PMCID: PMC7291896 DOI: 10.22122/ahj.v12i1.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Studies have reported lower pain threshold, spinal anesthesia duration, and level of sensory block in addicts compared to non-addict patients undergoing spinal anesthesia for surgery. Moreover, blood gas and cerebrospinal fluid (CSF) were likely to be affected as well. The aim in the present study is to evaluate CSF and spinal parameters in addict versus non-addict patients during lower limb surgery. Methods In this case-control study, 22 opium addicts and 22 sex- and age- matched non-addicts undergoing lower limb surgery under spinal anesthesia were included. The CSF parameters, venous blood gas (VBG), and sensory and motor block findings were compared between the groups. Findings The addict and non-addict patients were similar regarding CSF and blood gas parameters except higher pH in VBG (7.39 ± 0.06 vs. 7.33 ± 0.11, P = 0.030) and CSF (7.39 ± 0.06 vs. 7.33 ± 0.11, P = 0.030) for addict patients. The addict patients had significantly later onset of sensory block (5.72 ± 1.57 vs. 3.16 ± 0.93 minutes, P < 0.001) and shorter motor block duration (137.72 ± 11.51 vs. 149.09 ± 14.44 minutes, P = 0.006), with no significant difference in the sensory block duration and motor block onset. Conclusion Addict patients have delayed onset of sensory block with shorter duration of motor block and lower sensory block level. Among the blood gas and CSF markers, only pH was significantly higher in addict patients, needing further evaluations; however, it seems that addiction has no significant effect on these parameters.
Collapse
Affiliation(s)
- Pooya Derakhshan
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Sorour Garousi
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasrin Nouri
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Otterness K, J Singer A. Updates in emergency department laceration management. Clin Exp Emerg Med 2019; 6:97-105. [PMID: 30947489 PMCID: PMC6614056 DOI: 10.15441/ceem.18.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/23/2018] [Indexed: 01/06/2023] Open
Abstract
Lacerations are a common reason for patients to seek medical attention, and are often acutely managed in the emergency department. Recent studies pertaining to closure techniques, sedation and analgesia, advances in wound care, and various other topics have been published, which may enhance our understanding of this injury and improve our management practices. This article will review pertinent studies published in the past few years relevant to laceration management. Understanding the current literature and appreciating which areas warrant further investigation will help us optimize outcomes for patients who sustain laceration injuries.
Collapse
Affiliation(s)
- Karalynn Otterness
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| |
Collapse
|
6
|
Wright J, MacNeill AL, Mayich DJ. A prospective comparison of wide-awake local anesthesia and general anesthesia for forefoot surgery. Foot Ankle Surg 2019; 25:211-214. [PMID: 29409279 DOI: 10.1016/j.fas.2017.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND A recent case series suggested that surgery with wide-awake local anesthesia is tolerated well by most foot and ankle patients. However, patients were assessed retrospectively and there was no comparison group to show the relative efficacy of this approach. The present study was conducted to address these concerns. METHODS Perioperative pain and anxiety were assessed in 40 patients receiving forefoot surgery using either wide-awake local anesthesia or general anesthesia. Ratings were collected on the day of surgery using 11-point (0-10) numerical rating scales. RESULTS Patients in the two anesthesia groups reported no differences in preoperative pain (p=0.500) or anxiety (p=0.820). Patients who received wide-awake local anesthesia reported lower levels of postoperative pain (p<0.001) and anxiety (p<0.001) than patients who received general anesthesia. They also reported little pain (M=0.17, SD=0.32) or anxiety (M=1.33, SD=1.74) during the operation. CONCLUSIONS Results indicate that surgery with wide-awake local anesthesia is tolerated well by most patients, and that it may have some benefit compared to surgery with general anesthesia.
Collapse
Affiliation(s)
- John Wright
- Dalhousie University, 100 Tucker Park Road, P.O. Box 5050, Saint John, NB E2L 4L5, Canada.
| | - A Luke MacNeill
- University of New Brunswick, 100 Tucker Park Road, P.O. Box 5050, Saint John, NB E2L 4L5, Canada.
| | - D Joshua Mayich
- Horizon Health Network, 560 Main Street, Building A, Suite 325, Saint John, NB E2K 1J5, Canada.
| |
Collapse
|
7
|
Abstract
BACKGROUND Previous evidence suggests that opioid-tolerant patients are less responsive to local anesthetics (LAs) for postoperative pain management. METHODS To determine whether this apparent loss of LA potency is due to an intrinsic change in the peripheral nerve, the effect of systemic morphine was assessed on the potency of lidocaine-induced block of the compound action potential in isolated rat sciatic nerves. Analgesic efficacy was assessed with the heat withdrawal assay. RESULTS While acute administration of 10 mg/kg morphine had no detectable influence on lidocaine potency, seven daily subcutaneous injections of morphine produced a three-fold decrease in potency (EC50 for block A and C waves for naive rats were [mean ± SD] 186 ± 32 μM [n = 6] and 201 ± 31 μM [n = 6], respectively, vs. 608 ± 53 μM [n = 6] and 613 ± 42 μM [n = 6], respectively [P < 0.001], in nerves from rats that had received seven daily injections of morphine [10 mg/kg]). This loss in potency was both dose-dependent and injection number dependent, such that the magnitude of the loss of lidocaine potency was significantly (n = 6; P < 0.01) correlated (r = 0.93) with the development of morphine tolerance. Interestingly, despite the complete recovery of analgesic efficacy within days after cessation of morphine administration, the morphine-induced decrease in lidocaine potency was fully manifest even 35 days after the last morphine injection. Coadministration of naloxone (1 mg/kg, intraperitoneally), but not of naloxone methiodide (1 mg/kg, subcutaneously), with each of seven daily injections of morphine blocked the decrease in lidocaine potency. CONCLUSIONS These preclinical data suggest that the morphine-induced decrease in LA potency is due, at least in part, to the intrinsic changes in the peripheral nerve. Identification of the underlying mechanisms may suggest strategies for more effective postoperative pain management in the growing population of opioid-tolerant patients.
Collapse
|
8
|
Are Opioid-tolerant Patients Resistant to Local Anesthetic Nerve Blockade?: We Need More Information. Anesthesiology 2016; 125:625-6. [PMID: 27428824 DOI: 10.1097/aln.0000000000001240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
9
|
Kouzehgaran S, Saber-Tanha A. What Is the Main Reason for Reduction in Duration of Action of Local Anesthetics Used for Spinal Anesthesia in Opium Addicted Patients? ADDICTION & HEALTH 2015; 7:198. [PMID: 26885357 PMCID: PMC4741241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Samaneh Kouzehgaran
- Assistant Professor, Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Saber-Tanha
- Assistant Professor, Department of Anesthesiology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran,Correspondence to: Amir Saber-Tanha MD,
| |
Collapse
|