Comparative analysis of intravenous midazolam with nasal spray for conscious sedation in minor oral and maxillofacial surgeries

Aim: The aim of the current study was to evaluate the efficacy of nasal spray midazolam by collating it with conventional intravenous midazolam for conscious sedation in minor oral surgeries. Materials and Methods: Sixty patients were selected randomly and divided into two groups: group A for intranasal midazolam atomized spray (n = 30) and group B for intravenous midazolam (n = 30). Physiological parameters, anxiety score, sedation rating, patient’s cooperation score, and retrograde and anterograde amnesia were recorded for each patient during preoperative, intraoperative, and postoperative period. Final evaluation of safety and efficacy in the nasal and intravenous routes of midazolam drug during minor oral surgery was compared. Results: In this study, both intranasal and intravenous groups showed decrease in systolic blood pressure and diastolic blood pressure intraoperatively but within physiological limits and increase in the average pulse rates in both the groups. The average oxygen saturation levels were maintained to normal range in both the groups. The average respiratory rate decreased in both intranasal and intravenous groups during surgical procedure. The preoperative to postoperative anxiety scores were decreased significantly in the both groups and there was no significant difference in pre- to postoperative anxiety scores between the groups. Conclusion: Both intravenous and intranasal administration of midazolam showed better patient cooperation, satisfaction, and clinical effectiveness. Intranasal midazolam spray is effective in the reduction of subjective stress, reliable anxiolysis while preserving protective reflexes

Treatment of Stage I hard palate cancer with high-dose-rate brachytherapy using molds: Cost-based perspective

Introduction: Treatment of T1N0M0 (T1 = greatest tumor size < 2cm, N0 = regional lymph nodes not palpable by clinical examination, M0 = No evidence of distant metastasis) (Green FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M. AJCC Cancer Staging Manual. New York: Springer; 2002) lesions of hard palate carcinoma by radiotherapy carries equal results with the advantage of cosmesis and can avoid surgical complications. External beam radiotherapy (EBRT) will last for 6–8 weeks. Feasibility of high-dose-rate (HDR) intraoral mold brachytherapy is an alternative to EBRT, which is highly effective and reduces treatment time and is also cost-effective one, which can be practiced in a center without Linac facilities. Materials and Methods: Custom-made surface molds were prepared for each patient with dental wax, and HDR after loading tubes were placed as per tumor volume. After simulation, with the help of simulation check films, treatment was planned with PLATO Treatment Planning System (TPS) and optimization was carried out. Results: We treated six cases of T1N0M0 hard palate carcinoma by HDR intraoral mold brachytherapy. A total dose of 42–45 Gy in 14–15 fractions with 3 Gy per fraction, two fractions per day with a gap of minimum 6h was administered between two fractions. (Gray [Gy] is the unit of absorbed dose of radiation by tissues. A total radiation dose of 42–45 Gy will be delivered as per radiobiological principles, in divided number of fractions, thereby the given dose of radiation will kill the major portion of the tumor cells, which were in various sensitive phases of cell cycle and at the same time, less damage to the normal tissues. The time between two fractions of radiation is 6h, which is the experimentally proven optimal time for recovery of normal tissues from radiation damage and tumor tissues to enter into the sensitive phases of the cell cycle to radiation damage-late G2 and S phases). There was confluent mucositis and all the patients had a complete response and none of the patients had relapse. Conclusion: Early (T1N0M0) lesions of hard palate carcinoma with HDR intraoral mold brachytherapy will shorten overall duration of treatment time with excellent local control and toxicities as compared with EBRT