Gag Reflex Research Articles

INFLUENCE OF THE NAUSEA AND VOMITING REFLEX IN PROSTHETIC TREATMENT OF PATIENTS WITH HOMEOPATHIC MEDICINES - A CASE REPORT

Prosthetic treatment of a patient with manifested nausea reflex could be a dramatic experience. There is a risk of aspiration or ingestion of foreign objects, and the dentist may have great difficulties during the procedures. Purpose: The purpose is to report the efficiency of homeopathic medicines in the case of prosthetic treatment with removable dentures of a patient with a gag reflex and several medical conditions. There is a risk of aspiration of foreign bodies. This leads to compromises in the final treatment quality and difficulty wearing a denture because of gagging. Homeopathy is a safe and natural alternative that finds application in dentistry. Material/Methods: A case of a female patient is reported. Age of 63 with accompanying diseases. The patient has an exaggerated gag reflex during intraoral examination and needs prosthetic treatment with removable dentures. The gag reflex was assessed by the Classification of Gagging Problem Index (CGP), and examination of reflex reaction with a sterile swab and monofilaments were done before and after the reception of homeopathic medicines. Results: During the first and second visits, the results of the CGP index were recorded in the patient's clinical record. The results of the tests with the monofilaments and the sterile swab before and after taking homeopathic medicines were filled in tables and were compared. Conclusions: A satisfactory, harmless and long-lasting result in the reduction of the nausea reflex is achieved in the reported case by homeopathic medicines. All clinical stages of removable dentures' fabrication were possible, and the patient tolerated the new prostheses pretty well.

Comparison of Bispectral index-guided propofol and etomidate infusion for Supraglottic airway insertion

IntroductionSupraglottic airway devices have become extremely popular for minor therapeutic and surgical procedures. Their insertion requires an adequate depth of anesthesia with suppression of pharyngeal reflexes. Propofol is the most commonly used agent, but has hemodynamic side-effects. Etomidate, although hemodynamically stable, does not suppress pharyngeal reflexes adequately. Moreover, the use of clinical signs to assess the depth of anesthesia has questionable accuracy. Using bispectral index (BIS) monitoring, the hypnotic component of the anesthetic can be measured, with values of 40–60 implying adequate depth of anesthesia. MethodsThis randomized controlled trial included 80 ASA I patients, divided into two groups of 40 patients. Each group received either propofol or etomidate infusion, with BIS monitoring. At BIS 50, infusions were stopped and SGA was inserted. Changes in hemodynamic parameters, time for SGA insertion, number of attempts, and SGA insertion scores were recorded. ResultsWhen BIS reached 50, a statistically significant fall in mean arterial pressure was observed in the propofol group. Time for SGA insertion was less in the propofol group (30.7 ± 8.0 s), with successful SGA insertion observed in 92.5% of patients on the first attempt, compared with 47.9 ± 9.1 s and 32.3% in the etomidate group. ConclusionIn comparison with etomidate, the use of propofol is associated with better conditions for SGA insertion but has the side-effect of hypotension, even with BIS-guided titration of dose for maintaining an adequate depth of anesthesia.

Oral care in patients with ALS: an exploratory study

For this exploratory study, ALS patients and their partners/caregivers were interviewed to find out what problems they encounter when performing oral care. In addition, the tooth brushing procedure was recorded on video. Most mentioned by the six patients was that the performance of oral care is hampered by the loss of motor skills and by the gag reflex. They also mentioned various adjustments that would ease dental visits. Three of the four partners indicated that an instructional video would have additional value, and two partners said they sometimes felt insecure whether they were performing oral care properly. The five videos showed that there are major differences regarding tooth brushing duration, which surfaces are being brushed, and the brushing technique. This study shows that there are several ways in which oral care is performed in ALS patients. Furthermore, not all caregivers are aware of how oral care should be performed.

Surgical management of complete esophageal obstruction in graded Murrah buffalo (Bubalus bubalis) - A case report

A seven-year-old, advance pregnant graded Murrah buffalo was presented with sudden onset of profuse salivation, anorexia, severe tympany and generalized discomfort. Palpation revealed enlarged cervical esophageal mass with pain and gagging reflex. Plain lateral radiography of neck showed presence obstructed mass in cervical esophageal lumen. The obstructed mass was removed via esophagotomy under deep sedation and local infiltration anaesthesia with uneventful recovery.

IMPROVING BITEWING RADIOGRAPHY: EVALUATING THE EFFECT OF A DENTAL X-RAY POSITIONER ON IMAGE QUALITY IN DENTAL EXAMINATIONS

Bitewing radiography is a valuable tool in detecting and monitoring dental decay and other oral health problems and is typically performed as part of a routine dental examination. It has certain limitations that should be considered. Some of these limitations may cause discomfort or pain to the patient if not positioned correctly. Some patients may find biting down on the film holder difficult or have a strong gag reflex, making the procedure uncomfortable or even impossible. Bitewing radiography can be costly, especially if it needs to be performed regularly, which may limit access to this diagnostic tool for some patients. This study aimed to evaluate the effect of a dental X-ray positioner with a silicone layer on the quality of radiographic images in posterior bitewing dental examinations. Using this positioner was expected to improve the precision of radiographic interpretation and subsequent patient treatment. The study used a multivariate general linear model to analyze the data obtained from radiographic images using the X-ray positioner with the silicone layer and the conventional X-ray positioner. The results showed no significant difference in image quality between the two positioners, indicating that adding the silicone layer did not significantly improve image quality. However, using any X-ray positioner is still beneficial in ensuring accurate radiographic interpretation and subsequent patient treatment.

Local Anesthetics, Clinical Uses, and Toxicity: Recognition and Management.

Local anesthetic (LA) compounds decrease the permeability of the ion channels to sodium, which in turn, diminishes the rate of depolarization. These agents (a.k.a. -caines) are also used to depress mucosal sensations, e.g., gag reflex in the form of topical anesthetics. Overdose of LA can lead to local anesthetic systemic toxicity (LAST), which is the precursor of potentially lethal consequences on clinical grounds. There is a wide array of possible presentations of LAST, from mild findings, such as temporary hypertensive events, to serious conditions, including refractory cardiac dysfunction, dysrhythmias and prearrest situations. Lidocaine, prilocaine, mepivacaine, ropivacaine, and bupivacaine are among the most commonly used members of the family. The agents' dosages should be adjusted in children, elderly and fragile individuals and those with organ failures, as the metabolism of the compounds will be impaired. The ideal body weight, along with hepatic and renal functional reserves, will have an impact on elimination kinetics. Systemic absorption is an untoward consequence of LA administration which deserves every means of prevention. Intravenous lipid emulsion is an important life-saving treatment in severe, life-threatening cases. This narrative review article is designed to cover the clinical uses of LA in children, recognition, and management of untoward effects of the agents, with special emphasis on the LAST.

Superior Laryngeal Nerve Block in Transcutaneous Vocal Fold Injection: A Pilot Study

Topical lidocaine remains the mainstay for anesthesia in transcutaneous vocal fold injection (VFI). While using topical lidocaine, laryngologists sometimes encounter uncontrolled reflexes or poor compliance. Superior laryngeal nerve block (SLNB) provides deep and rapid anesthesia on the larynx above the vocal folds and abolishes the glottic closure reflex. Herein, we present a pilot study to evaluate the feasibility and safety of SLNB for transcutaneous VFI and explored its usefulness. Fifty-nine patients were prospectively anesthetized with SLNB during transcutaneous VFI for unilateral vocal fold paralysis. In the SLNB group, 0.5 to 1 mL of 2% lidocaine was infiltrated on bilateral SLNs through the thyrohyoid membrane. As the control group, we included previous 47 patients who underwent VFI with topical lidocaine. In the control group, 10% lidocaine spray was applied to the laryngopharyngeal mucosa. Demographic data, laryngeal exposure, patient compliance, procedural interruption, and complications were investigated. Patient compliance was evaluated based on the frequency of cough and swallowing during VFI procedures. SLNB enabled endoscopic contact on the epiglottis and pharyngeal wall without gag reflex and provided good exposure of the procedure field on the vocal folds. In the SLNB group, the laryngeal exposure is significantly better than in the control (P=0.005). The frequency of cough and swallowing was significantly lower in the SLNB group than in the control (P < 0.001). The number of procedural interruptions was lower in the SLNB group than in the control (P < 0.001). There was no acute or delayed complication related to SLNB such as bleeding, hematoma, delayed sensory/swallowing problems, or unscheduled hospital visits. SLNB might be safe and effective for anesthesia in transcutaneous VFI. SLNB could be a good anesthetic option for patients with poor compliance despite the sufficient application of topical lidocaine.

Guillain-Barré Syndrome Mimicking Brainstem Death Following Traumatic Intracerebral Hemorrhage (P12-7.006)

<h3>Objective:</h3> NA <h3>Background:</h3> NA <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 73-year-old man attended the ED following an assault where he sustained multiple traumatic blows to the head. He was alert, complained of headache but provided a detailed account. There were facial injuries but no clinical signs of cranial or skull base fractures. There was injury to the right eye, in which he had pre-existing visual impairment from previous injury. Vision was normal in the left. Right pupillary light reflex was absent but left was normal. The remainder of the neurological examination was unremarkable. CT-Head identified a small traumatic subarachnoid hemorrhage over the left cerebral convexity and a small contusion in the left temporo-parietal region. Vitreous hemorrhage was evident in the right eye. Clinically stable, follow-up CT on day 3 showed small intra-cerebral haemorrhage within the contusion, with minimal mass effect. However, on day 8, his GCS dropped and he was admitted to the ITU for airway management. Both pupils were non-responsive to light. Expansion of haemorrhage was suspected, however repeat CT was stable. EEG showed slowing over the left hemisphere without epileptiform activity. MRI excluded alternative causes for his neurological status such as brainstem ischaemia. With no clinical improvement, formal brainstem death testing was initiated. No potential confounders were recognised. The pupillary, corneal, oculocephalic, cough and gag reflexes were absent. Unexpectedly, deep tendon reflexes were absent in all limbs. A peripheral nerve stimulator using a train-of-four test protocol found no response. Post-traumatic Guillain-Barré syndrome (GBS) was suspected. Intravenous immunoglobulin was commenced. Nerve conduction studies found absent motor and sensory responses in all limbs. EMG showed fibrillation potentials and sharp waves. These findings were consistent with acute motor-sensory axonal neuropathy (AMSAN) variant of GBS. Serum Anti-GM1 antibodies were identified. After multiple rounds of plasmapheresis the patient was weaned from the ventilator. Nevertheless, severe neurological disability remained. <h3>Conclusions:</h3> NA <b>Disclosure:</b> Dr. Finegan has nothing to disclose. Dr. Ryan has nothing to disclose. Michael J. Hennessy has nothing to disclose. Kevin Murphy has nothing to disclose. Dr. Crowley has nothing to disclose. Dr. Elamin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche .

Resting State fMRI for Neuroprognostication in Traumatic Brain Injury: Clinical Experience of Evaluation for Covert Consciousness and Epileptogenic Networks in Acute Coma (P14-7.005)

<h3>Objective:</h3> To report the <b><i>clinical</i></b> experience of resting state fMRI (rs-fMRI) for neuroprognostication, consciousness recovery, and epileptogenic networks in acute coma. <h3>Background:</h3> Diagnosis and prognosis in acute disorders of consciousness (DoC) remains a challenge. Early withdrawal of care for traumatic brain injury (TBI) patients with recovery potential and continuation of care for patients with devastating prognosis due to misdiagnosis of DoC have both been reported. The rs-fMRI is an innovative tool that has shown promise in diagnosis and prognosis of DoC but has yet to see widespread clinical use. <h3>Design/Methods:</h3> Case Report. <h3>Results:</h3> We present a case of a previously healthy 38-year-old man who received clinical rs-fMRI in acute coma due to TBI. Initial exam: nonreactive pupils, intact corneal reflexes, absent cough and gag reflexes and no motor response. His Glasgow Coma Scale (GCS) was 3 and Coma Recovery Scale-Revised (CSR-R) score was 0. CT head showed acute left subdural hematoma, rightward midline shift, and uncal herniation. After undergoing emergent hemicraniectomy, MRI brain showed evolving Grade III diffuse axonal injury, severe ventriculomegaly, and protrusion of cortex through the hemicraniectomy. EEG demonstrated bilateral slowing but no seizures. Rs-fMRI (hospital day 36) demonstrated no epileptogenic networks, preserved default mode network, language and subcortical motor networks with moderate impairment. These findings supported return of consciousness, lower-level language comprehension, and motor impairment. Despite the patient’s poor initial examination, the rs-fMRI was useful in supporting the family’s decision to continue care. At three months, the patient’s CSR-R improved to 9, including regained localization to sound, visual fixation, flexion withdrawal, oral reflexive movements, no communication, and eye opening without stimulation, which is consistent with minimally conscious state minus. <h3>Conclusions:</h3> Clinical utilization of rs-fMRI has limitations but can aid in clinical decision-making when evaluating for epileptogenic networks, potential for consciousness recovery, and overall functional outcome in patients with DoC and severe TBI. <b>Disclosure:</b> Dr. Aseem has nothing to disclose. Dr. Strohm has nothing to disclose. Dr. Carlson has nothing to disclose. Dr. Karazanashvili has nothing to disclose. Dr. Gilbert has nothing to disclose. Ms. Gillette has nothing to disclose. Dr. Boerwinkle has nothing to disclose.

Acute Fulminant Encephalitis in the Setting of Acute COVID-19 Infection (P12-3.008)

<h3>Objective:</h3> NA <h3>Background:</h3> Encephalitis in the setting of COVID-19 has been reported, however the mechanism by which SARS-CoV-2 causes encephalitis remains unclear. We aimed to describe a case of fulminant limbic encephalitis associated with acute COVID-19 infection. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 33-year-old COVID-19 positive female presented after being found unresponsive with seizure-like activity. On arrival, patient was comatose with intermittent left gaze deviation, weak gag and cough reflexes, and no movement to pain. She was intubated for airway protection (without hypoxia). Continuous EEG demonstrated generalized and bilaterally independent epileptiform discharges, with no electrographic or clinical seizures. Patient was prophylactically started on levetiracetam. Brain MRI revealed scattered DWI and T2 hyperintensities involving supratentorial and infratentorial areas more prominent in temporal lobes. CSF analysis showed mild neutrophilic pleocytosis; protein and glucose were normal. Infectious, autoimmune, and paraneoplastic encephalopathy in CSF/serum panels were negative. CSF COVID-19 PCR was negative. ESR, CRP and ferritin were mildly elevated. High-dose steroids and intravenous immunoglobulin were initiated. After 7 days repeated brain MRI demonstrated progression of T2 hyperintensities including midbrain, cerebral peduncles, and right hemispheric cortical ribboning. Patient continued to decline with gradual loss of brainstem reflexes and downward gaze deviation with ocular bobbing movements. Due to clinical deterioration the patient was transitioned to comfort care and deceased after extubating. <h3>Conclusions:</h3> There have been increasing reports of severe encephalitis subtypes among younger COVID-19 patients commonly associated with poor outcomes compared to other subtypes of encephalitis. To our knowledge this is the first case of encephalitis associated with COVID-19 infection with no response to immunomodulatory therapies. Other possible etiologies in this case include hypoxic injury, hypoglycemia, or toxic insults, which were considered less likely given clinical scenario. In our case, PCR of CSF was negative for COVID-19 which raises possibility of secondary hyperinflammation or molecular mimicry as potential causes. <b>Disclosure:</b> Dr. Kherallah has nothing to disclose. Dr. Manrique has nothing to disclose. Dr. Vennavaram has nothing to disclose. Dr. Samaha has nothing to disclose.

Acute Loss Of Brain Stem Reflexes Following Intracranial Hemorrhage (P5-7.004)

<h3>Objective:</h3> The objective of this case report is to present a case of acute immune mediate demyelinating polyneuropathy (AIDP) triggered by an intracranial hemorrhage (ICH), which was identified by early loss of brainstem reflexes. <h3>Background:</h3> AIDP is a phagocytic attack on Schwann cells and/or myelin in the peripheral nervous system, resulting in decreased nerve conduction and acute denervation. AIDP has rarely been observed with intracranial hemorrhage or ischemic stroke. Moreover, a diagnosis of fulminant AIDP with a clinical picture of brain death has only been previously described in few case reports, and never in the setting of intracranial hemorrhage. <h3>Design/Methods:</h3> This is a case report, where we describe a patient who underwent ICH evacuation which progressed to fulminant AIDP with loss of brainstem reflexes. <h3>Results:</h3> A 79-year-old female who presented with acute onset left hemiparesis was admitted to the ICU after evacuation of a right frontal-parietal ICH. Two weeks after, the patient’s neurological exam showed an acute loss of corneal, gag and cough reflexes, bilateral mydriasis and flaccid quadriplegia with areflexia. Repeat imaging did not reveal injury that would explain the change in clinical status. A lumbar puncture revealed albumino-cytologic dissociation. Serum studies returned positive for anti-GM1 and TPO antibodies. EMG revealed multiple absent motor and sensory conduction responses and decreased amplitude and conduction velocity. She was treated with intravenous immunoglobulin and plasma exchange therapy. Over the course of one week, she gradually recovered her reflexes, motor strength and became responsive to medical care. <h3>Conclusions:</h3> While the patient’s apparent comatose state and absent brainstem reflexes was suspicious for brain death, the severity of her hemorrhage was not consistent with it. Our diagnosis of fulminant AIDP was based on a combination of neurological examination, lumbar puncture and EMG studies and allowed for effective treatment and recovery of a patient showing signs of apparent brain death. <b>Disclosure:</b> Dr. Malerba has nothing to disclose. Dr. Davitz has nothing to disclose. Dr. Patterson has nothing to disclose. Dr. Nelson has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Spark Healthcare. Dr. Nelson has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Healthcare. Dr. Nelson has received publishing royalties from a publication relating to health care. Dr. Tsetsou has nothing to disclose.

Partially reversible bilateral Lenticular fork sign and acute Parkinsonism in diabetic uremic syndrome (P5-11.005)

<h3>Objective:</h3> Not applicable <h3>Background:</h3> Diabetic uremic syndrome is a concept that has been increasingly recognized since it was proposed in 2003. It differs from uremic encephalopathy. Hereby, we describe the first case of North African Arab descent with end-stage renal disease and diabetes who developed acute Parkinsonism with bilateral lenticular fork sign and uremia that partially resolved after extensive dialysis therapy. <h3>Design/Methods:</h3> Not applicable <h3>Results:</h3> <h3>Case Description:</h3> 65 years old man with end-stage renal disease on peritoneal dialysis and newly diagnosed diabetes millets presented with a 3-day history of unsteady gait, generalized weakness, mild dysarthria, mild dysphagia, drowsiness, and changes in concentration. Examination revealed a mask face, dysphagia, absent gag reflex, dysphonia, generalized motor weakness more prominent in lower limbs, bradykinesia, absent knee reflexes, and myoclonic jerks. Laboratory studies showed urea 25 mmol/L, Creatinin 922 umol/L, arterial pH 7.25, and normal lactate. The lumbar puncture study was unremarkable. CT head showed swollen hypodense bilateral lentiform nuclei with a hypodense rim delineating the basal ganglia and giving the appearance of a lentiform fork sign. MRI showed bilateral T2 and FLAIR putamen and globus pallidus hyperintensity and significant lactate peak in the bilateral basal ganglia on MR spectroscopy. EMG study was evident of axonal polyneuropathy. IVIG course was commenced, and motor weakness improved. The peritoneal dialysis was intensified, and later treatment was switched to hemodialysis. Acidemia resolved, and uremia significantly improved. Two weeks post-admission, the fork sign on MRI significantly regressed, and the patient’s Parkinsonian symptoms partially improved. <h3>Conclusions:</h3> Development of acute or subacute extrapyramidal movement disorder in end-stage renal disease associated with diabetes should promote the possibility of diabetic uremic syndrome with bilateral basal ganglia lesions forming fork sign appearance that occurs early on brain imaging. Usually, extensive dialysis, preferable hemodialysis, leads to a total resolution of brain imaging and partial resolution of clinical findings. <b>Disclosure:</b> Dr. Nofal has nothing to disclose. Dr. Noorain has nothing to disclose. Dr. Safan has nothing to disclose. Dr. Adeli has nothing to disclose. Dr. Sokrab has nothing to disclose.

Comparison of Mean Insertion Time of Supraglottic Airway Device in Children Followed by Trapezius Squeeze Test Versus Jaw Thrust

Objective: To compare the assessment of the timing of insertion of supraglottic airway device in children by trapezius squeeze test versus jaw thrust as an indicator of the depth of anaesthesia. Study Design: Prospective comparative study. Place and Duration of Study: Combined Military Hospital, Quetta Pakistan, from Jan to Dec 2021. Methodology: Eighty children undergoing surgical interventions under Sevoflurane anaesthesia with supraglottic airway device having ASA physical status I or II were divided into two sets of 40 children. Both groups were labelled Group-A (trapezius squeeze test) and Group-B (jaw thrust). Supraglottic airway device iGel was inserted immediately after the negative trapezius squeeze test or jaw thrust. A negative test was defined as the absence of cough, reflex movements, breath-holding, gag reflex and laryngospasm. Insertion time and the number of attempts were carefully recorded. Results: The mean age of patients in the study was 4.8±2.028years, and the mean weight was 17.05±5.34. 47% of patients were in ASA-I, 52% in ASA-II in Group-A, 40 % were ASA-I and 60% in ASAII in Group-B. The mean insertion time was 143.42±5.56 seconds in Group-A and 117.525±7.15 seconds in Group-B with a p-value of 0.002. Conclusion: We concluded that the trapezius squeeze test provides better insertion conditions for supraglottic airway devices than jaw thrust during Sevoflurane anaesthesia in pediatric patients.

Airway nerve blocks for awake tracheal intubation: A meta-analysis of randomized control trials and trial sequential analysis

Study objectiveThis systematic review and meta-analysis aimed to assess the superiority of airway nerve blocks versus airway anesthesia without nerve blocks for awake tracheal intubation (ATI). DesignSystematic review and meta-analysis of randomized controlled trials (RCTs). SettingAll studies that assessed the superiority of airway anesthesia technique for awake tracheal intubation were searched in PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase and Chinese databases (including China National Knowledge Infrastructure, Wanfang database, and VIP databases) and trial registry databases from their inception to December 2022. PatientsAdult patients included in randomized controlled trials comparing airway anesthesia with or without airway nerve blocks for ATI. InterventionsAirway nerve (including superior laryngeal nerve, glossopharyngeal nerve, or recurrent laryngeal nerve) blocks for ATI. MeasurementsThe primary outcome was the intubation time. Secondary outcomes were quality of intubating conditions (including patient reaction to placement of the flexible scope and tracheal tube, coughing and gagging, and patient satisfaction) and overall complications during ATI. Main resultsFourteen articles with 658 patients were identified for analysis. When compared with airway anesthesia without nerve blocks, airway nerve blocks significantly reduced intubation time (standardized mean difference [SMD] -2.57, 95% CI -3.59- -1.56, p < 0.00001), improved anesthesia quality of ATI with higher no reaction to placement of the flexible scope and tracheal tube (relative risk [RR] 9.87; 95% CI 4.10–23.75, p < 0.00001), lower cough or gag reflex during intubation (RR 0.35, 95% CI 0.27–0.46, p < 0.00001), higher excellent patient satisfaction rate (RR 1.88, 95% CI 1.05–3.34, p = 0.03), and lower overall complications (RR 0.29, 95% CI 0.19–0.45, p < 0.00001). The overall quality of evidence was moderate. ConclusionsBased on current published evidence, airway nerve blocks provide better airway anesthesia quality for ATI with a shorter intubation time, better intubation conditions including higher no reaction to placement of the flexible scope and tracheal tube, lower cough or gag reflex during intubation, higher excellent patient satisfaction, and lower overall complications.

Comparison of I-Gel insertion conditions with two different induction methods in children: a prospective observational study

Aim: Insufficient depth of anesthesia is one of the important causes of laryngospasm in pediatric patients undergoing surgery. Propofol is a widely used anesthetic agent for induction of anesthesia in children. Its use alone in induction may be insufficient to suppress laryngeal reflexes during laryngeal mask insertion and may lead to complications such as cough, hiccups, and laryngospasm. In this study, the effects of fentanyl-ketamine mixture and remifentanil used as co-induction in anesthesia induction in children on I-gel insertion conditions and hemodynamic stability were compared. In addition, the evaluation of propofol injection pain after the use of coinduction agent was made.&#x0D; Material and Method: The study included 60 patients aged 2-10 years, of ASA I-III class, who underwent ambulatory surgery. For anesthesia induction, the KF group (n:30) were administered intravenous (iv) 1 mcg/kg fentanyl + 0.5 mg/kg ketamine followed by 3 mg/kg propofol, and the R group (n:30) were administered iv 0.5 mcg/kg remifentanil followed by 3 mg propofol. The I-gel insertion conditions were evaluated by scoring the six variables of mouth opening, ease of insertion, swallowing, coughing, movement, and laryngospasm. Pain during propofol injection was graded using a four-point scale. &#x0D; Results: No statistically significant difference was determined between the groups in terms of I-gel insertion conditions total score values (p&gt;0.05). The pain of the propofol injection was determined at a significantly higher level in Group R (p

Association Between Oral Health and Swallowing Function in the Elderly.

Although the oral environment significantly affects the risk of pneumonia, there have been few studies regarding its relation with swallowing. There is no doubt that there is a significant link between the oral environment and the development of pneumonia; however, there have been few comparative studies of swallowing using video endoscopy (VE) and video fluorography (VF) as indicators to determine the actual availability of oral intake and the choice of food form. This study was performed to examine whether the oral environment or swallowing function contributes more to the development of pneumonia in the elderly. The study population consisted of 24 patients (7 men and 17 women; age range: 64-97 years; average age: 86 years) assessed using the Oral Health Assessment Tool (OHAT), VE and VF at Fukuoka Dental College Hospital. The most common disease was pneumonia (17 patients), followed by cerebral infarction (5 patients), pyelonephritis (4 patients), bronchitis (2 patients), Parkinson's disease (2 patients), scleroderma (1 patient), diabetes (1 patient), eosophageal cancer (1 patient) and Parkinson's syndrome> (1 patient). Some patients had multiple diseases. Oral intake was possible in 20 patients (80%), whereas tube feeding and gastric banding were required in 4 patients. The OHAT score was not correlated with either the VE or VF score. Furthermore, the OHAT score was not significantly different between the multiple- and no/single-pneumonia episode groups. The group with multiple episodes of pneumonia had lower VE and VF scores than those with no or only a single episode of pneumonia. Oral assessment, VE and VF are necessary to evaluate swallowing in patients with suspected dysphagia. Swallowing function, especially as assessed by VE and VF, is more important than examination of the oral environment for evaluating risk of recurrent aspiration pneumonia in the elderly. In addition, multiple factors contribute to recurrent pneumonia in patients with a good oral environment, including subclinical aspiration, pharyngeal clearance and delayed activation of the gag reflex.

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

A Simple Technique to Manage Gag Reflex.

Gagging poses a clinical difficulty to the dentist in all facets of therapy, from diagnostic techniques to active treatment. Various treatment methods to manage the gagging include behavioral techniques, acupressure, acupuncture, hypnosis, systemic desensitization, and pharmacological techniques. This article presents a straightforward method for getting rid of the gag reflex using an eye massager. Eye massagers can help reduce the stress and anxiety associated with dental procedures by providing an effective alternative to traditional methods. This technique can be a valuable aid in making short dental procedures more comfortable and successful.

The prevalence and influencing factors of gag reflex in children aged 7-14 years in the dental setting.

Gag reflex may occur in patients of all ages and often considered having a multifactorial aetiology. The aim of the study was to evaluate the prevalence and influencing factors of gag reflex in Turkish children aged 7-14 years in the dental setting. This cross-sectional study was carried out among 320 children aged between 7 and 14 years. First, an anamnesis form which include sosyodemographic status, monthly level of income, children past medical and dental experiences was filled by mothers. Children's fear levels were evaluated using the Dental Subscale of Children's Fear Survey Schedule(CFSS-DS) while mother's anxiety levels using the Modified Dental Anxiety Scale(MDAS). The revised dentist section of gagging problem assessment questionnaire (GPA-R-de) was used for both children and mothers. Statistical analysis was done with SPSS program. The prevalence of gag reflex among children was 34.1%, among mothers was 20.3%. The association between child and mother gagging was found statistically significant (χ2 =53.121, p < 0.001). When the mother of the child gagged, the risk of child gagging increases 6.83 times (p < 0.001). Higher CFSS-DS scores of children increase risk of gagging (OR=1.052, p=0.023). Children who were previously treated mostly in public hospitals significantly more likely to gag compared with private dental clinics (OR=10.990, p < 0.001). It was concluded that negative past dental experiences, previous dental treatments with local anaesthesia, history of hospital admission, number and place of previous dental visits, dental fear level of children, and low education level and gagging of mother have an influence on the gagging of children.

Photobiomodulation on “PC6” acupoint in controlling the gag reflex of children during intraoral mandibular radiography—a randomized clinical trial

Photobiomodulation on “PC6” acupoint in controlling the gag reflex of children during intraoral mandibular radiography—a randomized clinical trial