Changes in blood pressure, heart rate, and electrocardiogram during dental treatment with use of local anesthesia

Cardiovascular complications caused by hypertension need to be anticipated during routine dental therapy. Changes in the cardiovascular system before, during, and after treatment were studied for 40 patients undergoing extraction

Validity of a risk-related patient-administered medical questionnaire for dental patients

In this study the validity of a patient-administered risk-related medical questionnaire for dental patients was tested. The answers given on the questionnaire were compared with the results of a verbal history taken by a physician. This verbal history was considered the "gold standard." The sensitivity and specificity of the medical questionnaire appeared to be sufficiently high, and the kappa values of the separate questions were satisfactory. The questionnaire was found to be valid in the registration of medical problems in dental patients, but combination of the two methods is recommende

Preoperative protein and energy intake and postoperative complications in well-nourished, non-hospitalized elderly cardiac surgery patients

Background & aims: Little is known about the impact of preoperative protein or energy intake in relation to the occurrence of postoperative complications in patients who are not undernourished but cannot keep up their daily protein or energy requirements prior to cardiac surgery. Therefore, a prospective study on intake in preoperatively well-nourished, non-hospitalized cardiac Surgery patients (>= 65 y) was carried out. Methods: Between December 2004 and November 2005 preoperative Protein and energy intake and postoperative outcome data were collected from 100 consecutive patients undergoing cardiac surgery. Results: Comparison of low protein intake ( <= 0.98 g/kg/d) with high protein intake (>0.98 g/kg/d) showed a low protein intake did not result in more complications or prolonged length of stay. In low-risk operation patients in particular, a high-energy intake (>22 kcal/kg/d) resulted in more postoperative complications than a low energy intake ( <= 22 kcal/kg/d) (33.3% and 13.2%, respectively; (OR 5.0 95% CI [1.5-16.9])). A preoperative protein intake <= 0.80g/kg/d was seen in 22.6%, and an energy intake <= 25 kcal/kg/d in 72.2% of the patients. Conclusion: The outcome of this study suggests that detecting and correcting a preoperative low protein or energy intake is of no clinical relevance in the well-nourished, non-hospitalized elderly cardiac surgery patients. Caloric overfeeding may be associated with an increased complication rate. (C) 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserve

Preoperative and postoperative agreement in fat free mass (FFM) between bioelectrical impedance spectroscopy (BIS) and dual-energy X-ray absorptiometry (DXA) in patients undergoing cardiac surgery.

Background & aims: To measure undernutrition in terms of fat free mass (FFM), there are several options. The aim of this study was to assess agreement in FFM between the portable, bedside bioelectrical impedance spectrometry (BIS) and relatively expensive, non-portable dual-energy X-ray absorptiometry (DXA) in patients undergoing cardiac surgery. Methods: In a prospective study, body composition measurements by BIS and DXA were performed two weeks prior and two months after cardiac surgery. Preoperative and postoperative agreement in FFM between BIS and DXA were analyzed with Bland and Altman plots. Results: Twenty-six patients were analyzed. BIS overestimated preoperative and postoperative FFM by 2 kg compared to DXA (2.3 kg (95%CI: -3.5-8.1 kg) and 2.1 kg (95%CI: -4.5-8.7 kg), respectively). BIS underestimated FFM change by -0.5% (95%CI: -8.4-7.5%). Conclusions: There is a large inter-individual variation between BIS and DXA. This hinders the interchange-ability of BIS and DXA in routine clinical practice and may lead to misclassifications and thereby inappropriate nutritional treatment and possible postoperative complications. To evaluate nutritional therapy in patients undergoing cardiac surgery, we advocate the use of DXA assessed FFM in parallel to BIS assessed extracellular and intracellular water and FFM. (C) 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserve