Could conscious sedation with midazolam for dental procedures be an alternative to general anesthesia?

Aim: The aim of our study was to evaluate the likelihood that conscious sedation (CS) with intravenous midazolam could become an alternative modality to general anesthesia (GA) for dental procedures.Materials and Methods: In our study, 58 and 47 American Society of Anesthesiologists (ASA).1 pediatric patients, aged 2.12 (mean 6) years, underwent dental procedures and minor oral surgical procedures under GA and CS with intravenous midazolam, respectively. The two groups were evaluated in terms of vital signs, duration of the treatment procedure, patient behavior, and the treatment comfort experienced by the physicians.Results: The oxygen saturation level was significantly lower (GA: 99.0 } 0.30, CS: 98.4 } 1.02; P < 0.001) and the duration of the treatment procedure was significantly shorter (P < 0.001) in the sedation group compared with the GA group. The physicians encountered various difficulties during implementation of the treatment strategy in cases wherethey used CS. Minor oral surgical procedures and tooth extraction  processes requiring no saline irrigation, however, could be performed successfully under CS.Conclusions: In cases requiring multiple dental management issues, the sedation method was not found to be a useful alternative to GA.Key words: Conscious sedation, general anesthesia, pediatric dentistr

The effects of propofol and propofol-alfentanil used in electroconvulsive therapy on duration of convulsion, hemodynamic responses and recovery characteristics [Elektrokonvülsif tedavide propofol ile propofol+alfentanil'in konvülsiyon süresi, hemodina?ik yanitlar ve derlenme üzerine etk?ileri]

The aim of this study was to investigate the effects of propofol and propofol-alfentanil combination used in Electroconvulsive therapy (ECT) on duration of convulsion, hemodynamic responses cardiovascular system and recovery characteristics. Arterial blood pressure, heart rate, peripheral oxygen saturation, and electrocardiogram were monitored during the ECT procedure. Patients were randomized into two groups (Group I: propofol, n:16, Group II: propofol+alfentanil, n:16). After premedication with atropine, the G I received propofol 0.75 mg kg-1 and the G II received propofol 0.50 mg kg-1 and alfentanil 20, µg kg-1 Additional propofol was given as needed in 0.1 mg kg-1 increments until loss of consciousness. Suxamethonium 1.0 mg kg-1 IV was given for muscular paralysis. The electrical stimulus was administered immediately after resolution of fasciculations. Mean motor convulsion duration were longer with propofol-alfentanil than with propofol. Hemodynamic responses and recovery characteristics were similar for the two groups. We concluded that the combination of propofol with alfentanil is a better combination for ECT

Is YouTube an accurate and/or comprehensive source of information for monosymptomatic enuresis nocturna?

[Abstract Not Available

Pathways to paediatric urology subspecialisation:a study of casemix, incumbent attitudes and opinions

Objective: To identify any self-reported differences or attitudes towards certification, publication, or practice patterns between adult urology and paediatric general surgery-trained paediatric urology providers. There are no known published differences in clinical/operative/research outcomes in either group. Methods: An 18-item cross-sectional survey was compiled through the EAU Young Academic Urologists (YAU) office and disseminated to a trans-Atlantic convenience sample of current practising paediatric urologists. This was created using a mini-Delphi method to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. Results: A total of 228 respondents completed the survey, with female respondents representing 37% and 34% for urology and paediatric general surgery, respectively. Nearly 90% overall respondents felt that a full 2-year paediatric fellowship program was very important and 94% endorsed a collaborative dedicated paediatric urology on call service, with 92% supporting the joint development of transitional care. Urology managed higher numbers of bedwetting (p = 0.04), bladder bowel dysfunction (p = 0.02), endourological procedures (p = 0.04), and robotics (p = 0.04). Paediatric general surgery managed higher numbers of laparoscopic reconstruction (p = 0.03), and posterior urethral valve ablation (p = 0.002). Conclusion: This study represents the first time that a cross-sectional cohort of paediatric urologists from different training backgrounds were compared to assess their productivity, practice patterns and attitudes. Paediatric urology is in a unique position to have two contributing specialities, with the ability to provide optimal transitional and lifelong care. We believe that there should be a strong emphasis on collaboration and to remove any historically-created barriers under policies of equity, diversity and inclusivity.</p

Neuropsychiatric Developmental Disorders in Children Are Associated With an Impaired Response to Treatment in Bladder Bowel Dysfunction:A Prospective Multi-Institutional European Observational Study

PURPOSE: Bladder and bowel dysfunction is a common but underdiagnosed pediatric entity which may represent up to 47% of pediatric urology consults. The objectives of this observational study were to determine functional 1-year outcomes following standard treatment of bladder and bowel dysfunction in both control and neuropsychiatric developmental disorder groups using validated questionnaires, and to perform an initial cost analysis. MATERIALS AND METHODS: This was a prospective observational study conducted across a number of academic European centers (July 2020-November 2022) for new bladder and bowel dysfunction patients. Parents completed a sociodemographic survey, information pertaining to prior neuropsychiatric developmental disorder diagnoses, as well as a number of validated functional scores. RESULTS: A total of 240 patients were recruited. In the control bladder and bowel dysfunction group, the baseline Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores were 20% and 17.% lower, respectively, after 1 year compared to the neuropsychiatric developmental disorder group. The change in improvement was diminished for the neuropsychiatric developmental disorder cohort in both Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores. The odds ratio of full symptom resolution was 5.7 in the control cohort compared to the neuropsychiatric developmental disorder cohort. A cost analysis on prescribed medications at referral led to a total cost of €32,603.76 (US $35,381.00) in the control group and €37,625.36 (US$40,830.00) in the neuropsychiatric developmental disorder group. CONCLUSIONS: This study demonstrates that pediatric patients with a neuropsychiatric developmental disorder exhibit more severe bladder and bowel dysfunction at baseline and throughout treatment with a lower overall quality of life, as well as 15.4% higher medication costs at referral. It is also important that parents' and caregivers' expectations are managed regarding higher levels of treatment resistance for functional bladder and bowel issues.</p

A cross-sectional analysis of paediatric urologists’ current practices, opinions and areas of perceived importance in the delivery of adolescent &amp; transitional care

Introduction: Complex urological anomalies often require continued care as patients reach adulthood. Adequate transition for adolescents with ongoing urological care needs is critical to allow for seamless care in adult hospitals. Studies have shown that this can lead to improved patient and parental satisfaction, and lower utilisation of unplanned inpatient beds and emergency department visits. There is currently no ESPU-EAU consensus on the adequate mechanism and very few individual papers examining the role of urological transition for these patients in a European setting. This study aimed to identify current practice patterns in paediatric urologists providing adolescent/transitional care, to assess their opinions towards formal transition and to look for variations in care. This has implications for long-term patient health and specialist care. Methods: An 18-item cross-sectional survey was compiled and pre-approved through the EAU-EWPU and ESPU board offices prior to dissemination to all registered ordinary members affiliated with the ESPU. This was created using a mini-Delphi method through the EWPU research meetings to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. Results: A total of 172 respondents (55% paediatric general surgery; 45% urology) across 28 countries completed the survey. The majority of respondents were in practice &gt;10 years and spent &gt;80% time in paediatric urology. There was no formal transition process according to 50% respondents and over half of those that did have less than 1/month, with &lt;10% using validated questionnaires. More than two-thirds respondents continued to provide care after transition, as &gt;70% units had no designated corresponding adult service. Furthermore, 93% paediatric believe a formal transition service to be very important, using a multidisciplinary framework. A pareto chart demonstrated 10 specific conditions to be of most interest in transition to adulthood. Conclusion: This is the first study to assess the requirements of paediatric urologists for adequate transitional care, however due to the nature of the survey's distribution, this was a non-scientific poll based on a convenience sample of respondents. It is critical that dual-trained or adult-trained urologists with a specific interest in paediatric urology work with current paediatric urologists in a multidisciplinary fashion to facilitate early transition based on the adolescent's developmental and biopsychosocial requirements. National urological and paediatric surgical societies need to make transitional urology a priority. The ESPU and EAU should collaboratively consider developing transitional urology guidelines to allow a framework by which this can occur.[Formula</p