Efficacy of dexmedetomidine on perioperative morbidity during nasal surgery: A meta-analysis

Objectives

The goal of this meta-analysis was to perform a systematic review of the literature on the effect of dexmedetomidine on perioperative morbidity following nasal surgery and on the adverse effects of dexmedetomidine.

Data Sources

MEDLINE, Scopus, and Cochrane Database of Systematic Reviews.

Review Methods

Two authors independently searched scientific and medical databases from their inception of article collection to March 2017. Studies that compared perioperative dexmedetomidine administration (dexmedetomidine group) with another agent under monitored anesthesia care (MAC) or general anesthesia (control group) with outcomes of interest that were perioperative pain intensity; rescue analgesic consumption; or adverse effects such as hemodynamic instability, nausea, and vomiting (PONV), and operative bleeding were included in the analysis.

Results

Perioperative pain scores and postoperative need for analgesics were significantly decreased in the dexmedetomidine group versus control group (other agent or general anesthesia). In subgroup analysis according to anesthesia type (general anesthesia and other sedatives in MAC), dexmedetomidine showed a similar effect on bradycardia, hypotension, and desaturation with general anesthesia, but it reduced PONV effectively compared with general anesthesia. Additionally, dexmedetomidine satisfied patient significantly. By contrast, compared with other sedative under MAC, it provoked bradycardia significantly.

Conclusion

This meta-analysis showed that systemic administration of dexmedetomidine efficiently can decrease intraoperative and postoperative pain without adverse effects such as nausea, vomiting, and respiratory depression. Dexmedetomidine also can decrease analgesic consumption. However, clinicians should be aware of the potential for intraoperative bradycardia; patients also should be educated regarding these possibilities.

Level of Evidence

NA. Laryngoscope, 122, 2017

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Long-term impact of endoscopic orbital decompression on sinonasal-specific quality of life

Objective

Endoscopic orbital decompression (EOD) is the workhorse surgical intervention for severe thyroid eye disease in Graves disease. Although EOD is a safe and effective procedure. The objective of this study is to determine the impact of orbital decompression on long-term sinonasal-specific quality of life.

Methods

Retrospective study of 27 patients who underwent EOD by a single surgeon. The primary endpoint was change in preoperative 22-item Sinonasal Outcomes Test (SNOT-22) score at a minimum of 1 year. The secondary endpoint was to determine whether the performance of septoplasty for surgical access in patients without nasal obstruction impacted domain 1 (i.e., rhinologic domain) and total SNOT-22 scores.

Results

The mean follow-up was 25.7 ± 11.4 months. Domain 1 scores significantly increased at the first postoperative visit (P ≤ 0.01) and returned to baseline values between 1 and 3 months. At 1 year, significant improvements in both total score and domain 4 and 5 (psychological and sleep dysfunction, respectively) scores were seen (P < 0.01 for all scores). Septoplasty was not associated with a significant change in SNOT-22 score at 1 year (P = 0.48).

Conclusion

Endoscopic orbital decompression is associated at 1 year with a significant improvement in sinonasal-specific quality of life, which is driven by the psychological and sleep dysfunction domains. Adjunctive septoplasty has no significant impact on SNOT-22 scores.

Level of Evidence

4. Laryngoscope, 2017

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Morbidity and mortality associated with preclinical tracheostomy models

Objectives/Hypothesis

A secure airway is critical to study obstructive disorders of the larynx and trachea in preclinical models. Tracheostomy has been described in rabbits, swine, canines, and other mammals using tracheostomy tubes or permanent stomas. No studies specifically evaluated morbidity and mortality associated with these models, and existing studies using tracheostomy make little mention of tracheostomy-related complications. We assessed the management, complications, and mortality associated with tracheostomy in a rabbit model that has recently gained significant attention.

Study Design

In vivo.

Methods

Twenty-two female rabbits underwent tubeless tracheotomy. Rabbits were monitored hourly for the first 8 hours, with progressively increasing intervals between evaluations up to 7 days. A suctioning and tracheal moisture protocol was employed, and animals with signs of crusting or impending airway compromise underwent therapeutic bronchoscopy.

Results

Nine of 22 (41%) rabbits succumbed to tracheostomy-related complications, ranging from 1 to 7 days after tracheotomy. The experiment consisted of two study groups. The preliminary group of 10 rabbits studied over a 4-day period had 40% mortality. After implementing modified preventive therapy guidelines and a new humidification system, the second group of 12 rabbits studied over a 7-day period had 42% mortality. Average time to unrecoverable complication was 2.2 days (median = 2 days). Cause of death was airway obstruction in four animals and respiratory depression in three animals, and two animals were found unresponsive.

Conclusion

Tracheostomy in preclinical rabbit models should be temporally limited, and investigators should anticipate tracheostomy-related complications during study design.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2xDTBDk

Pharmacologic management of voice disorders by general medicine providers and otolaryngologists

Objectives

1) To compare laryngeal diagnoses from general medical providers (GMP) to otolaryngologists following GMP-based medication trial, and 2) to evaluate associations between GMP medication trials and pharmacologic treatment by otolaryngologists.

Methods

Retrospective cohort analysis using large, national administrative U.S. claims database. Patients with laryngeal/voice disorders as per the International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2010, to December 31, 2012, seen by a GMP and then an otolaryngologist between 2 weeks to 3 months after the GMP visit, were included. Patient demographics, comorbid conditions, medication use, and initial GMP and otolaryngology laryngeal diagnoses were collected. Logistic regression was performed to evaluate the association between GMP and otolaryngologist medication trials.

Results

A total of 12,475 unique laryngeal/voice-disordered patients met inclusion criteria. At the initial GMP visit, 15.3% received an antibiotic, 14.0% a proton pump inhibitor (PPI), and 7.7% an oral steroid. After the otolaryngology visit, increased diagnoses of vocal fold paralysis/paresis, benign vocal fold/laryngeal pathology, chronic laryngitis, and multiple diagnoses occurred. The adjusted odds for an otolaryngologist prescribing an antibiotic, PPI, or oral steroid, respectively, given that a GMP prescribed an antibiotic, PPI, or oral steroid, was roughly two to three times higher that of a GMP not prescribing the given medication.

Conclusion

Patients with structural and neuromuscular laryngeal disorders were treated with medications by GMPs, and similar mediations often were repeated after otolaryngology evaluation. These findings suggest potential areas of unnecessary pharmacologic treatment of laryngeal/voice-disordered patients.

Level of Evidence

2b. Laryngoscope, 2017

http://ift.tt/2fqGfmW

Phospholipase C zeta parameters in sperm from polymorphic teratozoospermic men

Publication date: Available online 24 September 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Nahid Azad, Hamid Nazarian, Marefat Ghaffari Novin, Reza Masteri Farahani, Abbas Piryaei, Mohammad Hassan Heidari
Teratozoospermia is a disorder associated with high abnormal sperm morphology which affects fertility in males. In recent years, it has been described that biomarker-based sperm quality evaluation can alleviate male infertility treatment. Phospholipase C zeta (PLCζ) is a sperm-specific factor which appears to be a predicting biomarker for fertilization potential of males. Following fertilization, PLCζ enters into oocyte cytoplasm and induces oocyte activation, a fundamental stage in initiation of embryo development. Currently, PLCζ parameters, including localization patterns, the proportion of PLCζ-expressing sperm and the expression level, are not defined in polymorphic teratozoospermic men. This study aimed to evaluate PLCζ parameters in polymorphic teratozoospermic men, and compare these parameters with fertile normozoospermic men. Semen samples from thirteen normozoospermic fertile men and twenty-three polymorphic teratozoospermic men were included in this study and evaluated using western blotting and immunofluorescence analyses. Our data indicated significantly lower expression of PLCζ in polymorphic teratozoospermic men, as compared with control men; however, there was no significant difference in localization patterns and the proportion of PLCζ-expressing sperm between polymorphic teratozoospermic patients and control men. Collectively, findings from the present study demonstrated that polymorphic teratozoospermic men did not show abnormal localization patterns or the absence of PLCζ, as compared to the control men; nonetheless, lower expression of PLCζ, considering its role in oocyte activation, might be one of the possible causes of infertility in these patients.



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Gonial Angle Growth Patterns According To Age And Gender

Publication date: Available online 24 September 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Carolina Larrazabal-Moron, Juan A. Sanchis-Gimeno
Currently there are controversial results about gender and age differences in human gonial angle values. In this context we aimed to ascertain the gender and age differences in the gonial angle values of young Caucasian Mediterranean subjects. We tested the hypothesis of a relation between the gonial angle values and the gender and age of the subjects by means of a prospective study involving 266 subjects. Panoramic radiographs (Cranex Novus^®, XMIND Novus^® Soredex, France) were carried out in order to measure the gonial angle values. We found significant differences between females and males in the subgroups aged≤10years old (128.6±3.4 vs 126.8±4.5, p=0.017), 16-20 years old (119.1±5.6 vs 122.3±7.7, p=0.011), 21-25 years old (117.6±5.2 vs 120.8±7.0, p=0.016) and 26-30 years old (117.5±5.4 vs 120.6±5.4, p=0.019) but not in the subgroup aged 11 to 15 years old (123.4±5.2 vs 123.5±5.4, p=0.927). A significant negative correlation was found between age and gonial angle values (r=−0.365, p <0.001). In sum, females under 10 years of age have significantly higher values than males. The angle values decreased until the age of 11-15 years of age when there were no significant gender differences. Thus, the males aged over 16 years old presented significantly higher values than the females. The decrease in gonial angle values seems to slow or stop from 21 years onwards. Knowledge of the pattern differences will serve for age and gender determination when analyzing human remains.



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MOLECULAR BASIS OF DENTAL SENSITIVITY: THE ODONTOBLASTS ARE MULTISENSORY CELLS AND EXPRESS MULTIFUNCTIONAL ION CHANNELS

Publication date: Available online 24 September 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): A. Solé-Magdalena, M. Martínez-Alonso, C.A. Coronado, L.M. Junquera, J. Cobo, J.A. Vega
Odontoblasts are the dental pulp cells responsible for the formation of dentin. In addition, accumulating data strongly suggest that they can also function as sensory cells that mediate the early steps of mechanical, thermic, and chemical dental sensitivity. This assumption is based on the expression of different families of ion channels involved in various modalities of sensitivity and the release of putative neurotransmitters in response to odontoblast stimulation which are able to act on pulp sensory nerve fibers. This review updates the current knowledge on the expression of transient-potential receptor ion channel and acid-sensing ion channels in odontoblasts, nerve fibers innervating them and trigeminal sensory neurons, as well as in pulp cells. Moreover, the innervation of the odontoblasts and the interrelationship been odontoblasts and nerve fibers mediated by neurotransmitters was also revisited. These data might provide the basis for novel therapeutic approaches for the treatment of dentine sensibility and/or dental pain.



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