Till Sebastian Mutzbauer

Supraglottic airway adjuncts such as the laryngeal tube (LT) have been recommended to be used by cardiopulmonary resuscitation (CPR) first responders.Objective This study aims to evaluate the performance characteristics of dental students and dentists using the LT in comparison to a conventional bag valve mask device (BVM) within manikin CPR training. A group of eight dentists and 12 dental students performed randomised crossover CPR training using LT and BVM. Time intervals needed to perform five CPR cycles were recorded, as well as tidal and total gastric inflation volumes. Median tidal volumes 0-1025 ml (median 462.5 ml) were observed using BVM and 100-500 ml (median 237.5 ml) with LT (p = 0.02). Total gastric inflation of 0-2900 ml was measured using BVM, no gastric inflation using LT (p = 0.0005). Time intervals needed to perform five CPR cycles did not differ between BVM (range 87.5-354.5 s, median 112 s) and LT (range 84.7-322.3 s, median 114 s) (p = 0.55). A median delay of 37.6 s (range 0-82.1 s) before starting CPR was observed using LT. Lower tidal volumes but also lower or even no gastric inflation may be observed when dentists use a laryngeal tube during CPR. Respective training must focus on chest compressions. These must be started before inserting the LT or a different supraglottic airway adjunct and be delivered continuously during insertion. It is recommended to use a supraglottic airway such as an LT only after having been trained in its use.

The anterior tibia has been recommended as emergency vascular access site if the intravenous route cannot be used. This study aims to evaluate the peripheral venous and anterior tibial intraosseous puncture as alternatives for dentists, using a human and a cadaver model.Method One group of dental students performed a venipuncture by using a standard catheter device (n = 21) on other students. Another group (n = 24) used the Vidacare EZ-IO intraosseous kit on a cadaver tibia with india ink as a tracer. Success rates as well as the time needed for a successful puncture were recorded. 28.5% of venous and 83.3% of intraosseous punctures were successful. The relative risk of venous cannulation failure was 3.4 (95% CI 1.6-7.2; p = 0.0005). A successful venous access could be performed within 163 ± 23.2 seconds (mean ± SD), a tibial intraosseous access within 30 ± 27.8 seconds (p = 0.0003). Within the limitation of this study, it can be demonstrated that the chances to perform a successful vascular access for inexperienced dentists may be higher when using the tibial intraosseous route for emergency intravascular medication.

Several insertion sites have been described for intraosseous puncture in cases of emergencies when a conventional vascular access cannot be established. This pilot study has been designed to evaluate the feasibility of the mandibular bone for the use of an intraosseous vascular access in a cadaver model. 17 dentistry and 16 medical students participating in a voluntary course received a short introduction into the method and subsequently used the battery powered EZ-IO system with a 15 mm cannula for a puncture of the anterior mandible in 33 cadavers. The time needed to perform each procedure was evaluated. India ink was injected into the accesses and during the anatomy course cadavers were dissected to retrace the success or failure of the puncture. Dental students needed 25.5±18.9(mean±standard deviation)s and medical students 33±20.4 s for the procedure (p = 0.18). Floor of mouth extravasation occurred in both groups in 3 cases. Success rates were 82 and 75% (p = 0.93). Despite floor of mouth extravasation of injected fluid into a mandibular intraosseous access might severely complicate this procedure, the anterior mandible may be helpful as an alternative to other intraosseous and intravenous insertion sites when these are not available in medical emergencies.

Die Koniotomie hat die (Wieder-)Herstellung und Sicherung des Atemweges zum Ziel, wenn dieser verlegt oder anderweitig beeinträchtigt ist und konventionelle Methoden wie die endotracheale Intubation oder technisch damit verwandte Verfahren und auch Maskenbeatmung nicht verfügbar oder nicht durchführbar sind.

This retrospective review examined the influence of delay to recompression on mild/moderate neurological decompression sickness (DCS) in divers, as a pilot for an abandoned prospective study. The medical histories of 28 divers treated at a hyperbaric facility in the Maldive Islands in the Indian Ocean were evaluated. The term 'oxygen unit' (OU; 1 OU = 1 bar (ambient pressure) x 1 min x 1.0 (inspiratory oxygen fraction)) was used to enable a quantification of administered hyperbaric oxygen. Visual analog symptom scale (VASS) scores of the worst symptom at presentation (used routinely at the clinic to quantify treatment response) were analysed. Divers presenting later than 17 hours after surfacing (the median time to treatment after surfacing for the whole group) were likely to have more intense symptoms on VASS (median 100%) than those who presented earlier for treatment (median 30%, P = 0.02). Total OU needed to treat divers presenting within 17 hours did not differ from those treated later (P = 0.11). Divers with ≥ 70% symptom reduction with the first hyperbaric oxygen treatment (HBOT) needed between 260 and 1,463 OU in total, whereas those with less than 70% reduction in VASS needed between 263 and 2,126 OU (P = 0.04). Neither more HBOT nor a worse outcome of DCS could be related to delay to treatment longer than 17 hours. The amount of oxygen that had to be administered in total during the whole HBOT course was lower in cases that responded better to the initial HBOT.

Infrequent training of lay rescuers in cardiopulmonary resuscitation may lead to stomach inflation during ventilation of the unsecured airway. This is caused by a pressure loss of the lower oesophageal sphincter (LOSP) after onset of cardiac arrest. To minimise the risk of stomach inflation, the SMART BAG® (SB), a disposable flow-limited bag-valve-mask resuscitator, has been designed. Aim The aim of this study was to evaluate the occurrence of stomach inflation by use of SB in comparison to two other ventilation devices with respect to the ventilation capability. An Easy Grip® disposable bag-valve-mask resuscitator (EG), an SB and an EG with an interposed T-piece attached to a 0.5 l reservoir bag (EG/R) were compared in a manikin ventilation training setting. Fourteen dentists performed ventilations on a Mini Ventilation Training Analyzer using EG, SB and EG/R with lung compliance (LC) and LOSP being adjusted to 700 ml/kPa and 1.5 kPa (best case) and 500 ml/kPa and 0.5 kPa (worst case) in a randomised order. Sufficient tidal volumes were obtained by use of all the three test devices regardless of LC or LOSP. No statistical differences were detected between the use of SB and EG/R. Using EG led to statistically larger volumes. Stomach inflation could only be avoided using SB and EG/R at a high LOSP regardless of LC. Even in the worst case scenario, use of SB and EG/R administered sufficient tidal volumes with a significantly smaller stomach inflation compared to EG. Combination of standard bag-valve devices with a reservoir bag may provide similar protection from gastric inflation as the SMART BAG®.

Impairment of Eustachian tube function has been observed after hyperbaric oxygen treatment as well as after diving on oxygen used as breathing gas. The aim of the present study was to evaluate the influence of hyperbaric oxygen exposure on Eustachian tube ventilatory function and airflow characteristics of the nose. Six police task force divers performing two consecutive dives within a regular training schedule on oxygen were examined. Middle ear impedance, and nasal airflow velocities before and after diving as well as on the morning after the dive day were measured. Middle ear impedance decreased overnight in comparison to pre-dive values (P = 0.027) as well as compared to the value after the first dive (P = 0.032). Rhinoflowmetry did not reveal any changes of nasal airflow velocities related to the dives. Furthermore, no association between middle ear impedance and nasal airflow velocities was found. An impairment of Eustachian tube ventilatory function was obtained after hyperbaric oxygen exposure during dives employing oxygen as breathing gas. This impairment, however, was not associated with altered airflow characteristics of divers’ noses. Thus, it seems unlikely that hyperbaric oxygen exerts an effect on the nasal mucosa similar to that on the Eustachian tube mucosa.

Anxiolytic and possible side effects of clonidine 150 μg compared to midazolam 7.5 mg for premedication in surgical wisdom tooth extraction were evaluated. In a prospective, randomized, double-blind crossover trial, ten patients undergoing bilateral wisdom tooth surgery received clonidine or midazolam orally 1 h before the treatment. Patients receiving midazolam for the first surgery received clonidine at the second surgery and vice versa. The anxiolytic efficacy was evaluated with a visual analogue scale (VAS) upon admission and 30, 50 and 60 min after administration of the medication. Patient satisfaction was recorded on a VAS after surgery and 7 days postoperatively. As soon as 30 min after administration of midazolam (p < 0.03) and clonidine (p < 0.02), an anxiolytic effect was recorded. Both medications did not differ in patient satisfaction. Oral administration of clonidine 150 μg and midazolam 7.5 mg were rated as medications with equal anxiolytic effects before wisdom tooth surgery under local anesthesia.

The aim of this study is to compare the analgesic efficacy and tolerability of a pre-emptive/post-surgery 4-day regimen of oral ibuprofen 400 mg with that of lornoxicam 8 mg. Sixteen patients received ibuprofen or lornoxicam, respectively, before and after surgery of impacted third molars in two separate appointments, in a double-blind, randomized, and crossover design. The postoperative analgesic and rescue medication consumption was recorded and pain scores were evaluated with a visual analogue scale at 2, 6, 24, 48, and 72 h, postoperatively. No statistically significant differences were found between ibuprofen 400 mg and lornoxicam 8 mg with respect to study medication (p = 0.34) or rescue analgesic consumption (p = 0.5) (SUMstudy and SUMrescue). Ibuprofen: SUMstudy median 7.5 interquartile range IQR (4.25–8), 95% CI (4.6–7.7); SUMrescue median and IQR 0, 95% CI (−0.6–4.6). Lornoxicam: SUMstudy median 7 IQR (3.75–9), 95% CI (7.7–4.9); SUMrescue median and IQR 0, 95% CI (−0.7–2.7). The area under the pain intensity curve (AUC_2–72 PI) over the 4 days of investigation did not reveal significant differences between the two medications (p = 0.32). AUC_2–72 PI ibuprofen: median 1,509.7 IQR (712.36–2,444.65); 95% CI (1,078.7–2,156.5). AUC_2–72 PI lornoxicam: median 1,166.9 IQR (783.4–2,221.2), 95% CI (1,032–2,130.6). Moreover, patient satisfaction and incidence of adverse events did not reveal any significant differences between treatment groups. Ibuprofen 400 mg and lornoxicam 8 mg were rated as equal and effective pain treatment medication after wisdom tooth surgery. In comparison, neither of the drugs provided clinical advantages nor did side effects occur more frequently after one of the analgesics.