Correlations between multiple sclerosis functional composite, expanded disability status scale and health-related quality of life during and after treatment of relapses in patients with multiple sclerosis

The measurement of the clinical manifestations of multiple sclerosis (MS) is difficult. In the present study, we examined the changes in measurement of functions during and after pulse methylprednisolon (MP) treatment of MS exacerbations using the MSFC and EDSS. Correlation between multiple sclerosis quality of life (MSQoL)-54, EDSS and MSFC were studied. Thirty-six clinically definite MS patients were included in this study. Because of MSFC's repeating feature, we administered the tests to a control group to exclude practise effects. All patients received 1000-mg intravenous MP for 5 days, followed by tappering dose of 100-mg oral prednisolone. All three scales were assessed on day 0. EDSS and two components of MSFC (nine HPT and T25WT) were administered on the other days of pulse MP treatment. PASAT was not applied before the day 5 to exclude the practise effect. MSQoL-54 was assessed again on day 30. Mean EDSS values significantly decreased after the day 2. MSFC score improved from 0.03 +/- 1.71 on day 0 to 0.79 +/- 1.51 on day 5. Improvement continued on day 30. The mean physical health composite score increased from 66.50 +/- 9.3 on day 0 to 74.34 +/- 8.9 on day 30. Mental health composite had also a significant improvement on day 30. Correlation between the baseline overall MSFC and the EDSS was moderately strong. T25WT correlated most strongly with EDSS. Significant positive correlation was found between MSFC and both components of MSQoL-54. It is more prominent for the MSFC and physical health composite correlation. The same correlation was found for the EDSS and MSQoL-54 composites. Changes in EDSS and MSFC scores and MSQoL-54 were found significantly correlated for the overall score on day 30 compared with day 0. In conclusion, MSFC seems to be more sensitive in detecting changes in function than the EDSS. Hence, EDSS is still useful for daily routine practise. When these results combined with the significant correlation between MSFC and MSQoL-54 measures, which indicated the MSFC reflects the severity of MS as perceived by patients, MSFC seems to be the most useful scale for clinical trials. (C) 2003 Elsevier B.V. All rights reserved

Comparison of the effects of remifentanil and remifentanil plus lidocaine on intubation conditions in intellectually disabled patients [Comparação dos efeitos de remifentanil e remifentanil + lidocaína em intubação de pacientes intelectualmente deficientes]

Background and objectives: This is a prospective, randomized, single-blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents. Methods: Fifty intellectually disabled, American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2µg/kg remifentanil (Group 1, n=25) or a combination of 2µg/kg remifentanil and 1mg/kg lidocaine (Group 2, n=25). To evaluate intubation conditions, Helbo-Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO2) were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation. Results: Acceptable intubation parameters were achieved in 24 patients in Group 1 (96%) and in 23 patients in Group 2 (92%). In intra-group comparisons, the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values (p=0.000). Conclusion: By the addition of 2. µg/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1. mg/kg lidocaine to 2. µg/kg remifentanil does not provide any additional improvement in the intubation parameters. © 2013 Sociedade Brasileira de Anestesiologia

Comparison of oral Midazolam and Midazolam-Ketamineas sedative agents in paediatric dentistry

PubMed ID: 20359276Aim We compared the efficacy of sedation with oralMidazolam and a combination of oral Midazolam andKetamine, used as alternatives to general anaesthesia duringtooth extraction. Study Design: Retrospective study Materialsand methods A total of 30 patients aged between 3 and 9years, who had elective tooth extraction were included in thestudy. Subjects in Group A (n. 15) were given 0.75 mg/kgMidazolam orally while those in Group B (n. 15) were given0.75 mg/kg Midazolam orally + 5 mg/kg ketamine. Acceptanceof orally administered drugs, sedation and anxiety scores andreactions to local anaesthetic injection and tooth extractionwere assessed. Results Sedation and anxiety scores in Group Bwere better than in Group A (p<0.05). Reactions to localanaesthetic injection and tooth extraction were verysignificantly less common in Group B (p<0.0001). Requirementfor an additional medication was more common in Group A(p<0.05). Side effects were not observed in either group.Statistics: Patient demographics and time to discharge wereanalysed by Mann-Whitney U test, whereas Chi-square testwas used to analyse compliance to sedation, anxiety andsedation scores, reaction to tooth extraction, side effects andadditional drug requirement. Conclusion Compared to oralMidazolam only, a combination of oral Midazolam+Ketamineresulted in better sedation and surgical comfort in childrenduring a painful procedure such as tooth extraction