This systematic review aimed to investigate the drugs used and their potential effect on noninvasive ventilation (NIV). NIV is used increasingly in acute respiratory failure (ARF). Sedation and analgesia are potentially beneficial in NIV, but they can have a deleterious impact. Proper guidelines to specifically address this issue and the recommendations for or against it are scarce in the literature. In the most recent guidelines published in 2017 by the European Respiratory Society/American Thoracic Society (ERS/ATS) relating to NIV use in patients having ARF, the well-defined recommendation on the selective use of sedation and analgesia is missing. Nevertheless, some national guidelines suggested using sedation for agitation. Electronic databases (PubMed/Medline, Google Scholar, and Cochrane library) from January 1999 to December 2019 were searched systematically for research articles related to sedation and analgosedation in NIV. A brief review of the existing literature related to sedation and analgesia was also done. Sixteen articles (five randomized trials) were analyzed. Other trials, guidelines, and reviews published over the last two decades were also discussed. The present review analysis suggests dexmedetomidine as the emerging sedative agent of choice based on the most recent trials because of better efficacy with an improved and predictable cardiorespiratory profile. Current evidence suggests that sedation has a potentially beneficial role in patients at risk of NIV failure due to interface intolerance, anxiety, and pain. However, more randomized controlled trials are needed to comment on this issue and formulate strong evidence-based recommendations. Karim HMR, Šarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD, et al. Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations. Indian J Crit Care Med 2022;26(8):938–948.

This study aimed to evaluate the clinical effects, complications (peri- and postoperative), depth of sedation, recovery times, and changes in anxiety levels in paediatric dental patients receiving intravenous sedation with propofol and ketamine–propofol mixtures. This prospective clinical study included 69 healthy children (ASA 1) aged 3–7 years. The patients were assigned randomly to propofol group (n = 23), which received propofol; 1:3 ketofol group (n = 23), which received 1:3 ketofol; or 1:4 ketofol group (n = 23), which received 1:4 ketofol. The bispectral index (BIS) and Ramsay Sedation Scale (RSS) score were recorded at intervals of 5 min to measure the depth of sedation, and vital signs were evaluated. Peri- and postoperative complications and recovery times were recorded. Anxiety levels were also evaluated using the Facial Image Scale (FIS) and changes in saliva cortisol levels (SCLs) before and after the intravenous sedation procedure. The Kruskal‒Wallis test and Wilcoxon signed-rank test were used to determine pre- and posttreatment parameters. Dunn’s test for post hoc analysis was used to determine the differences among groups. Children’s pre- and posttreatment anxiety levels did not differ significantly according to FIS scores, and increases in SCLs were detected in 1:3 ketofol and 1:4 ketofol groups after dental treatment was completed. Compared with those in the other groups, the BIS values of the patients in 1:4 ketofol indicated a slightly lower depth of sedation. The recovery time of the patients in 1:3 ketofol was longer than that of patients in propofol and 1:4 ketofol. The incidence of postoperative complications (agitation, hypersalivation, nausea/vomiting, and diplopia) did not differ among the groups. Ketamine–propofol combinations provided effective sedation similar to that of propofol infusion without any serious complications during dental treatment performed under intravenous sedation. The ketofol infusion increased the anxiety level of paediatric dental patients to a greater extent than the propofol infusion.

Respiratory failure,nasal cannula,high-flow oxygen,methodology

Epidermolysis bullosa (EB) is a rare hereditary disorder characterized by an abnormal increase in the fragility of the skin and mucosal surface and recurrent blistering. Blisters and scar formation can be seen in tissues even after a minor trauma. Due to the healing of this disease by leaving a contracted scar tissue, the findings, especially on the airway, may cause important anesthetic problems. In addition, the protection of the skin and the mucosa during the procedures to be performed, prevention of new bulla formation and prevention of infection constitute the main difficulty in anesthesia management. This case report describes the anesthesia management for the dental treatment of a patient diagnosed with dystrophic epidermolysis bullosa (DEB) and aims to review the current information.

In this study, amoxicillin and potassium clavulanate were loaded as antibiotic additives to hydroxyapatite coating (L-HAP) and were used to enhance biocompatibility and corrosion resistance of titanium (Ti) in- vitro conditions. Coating was achieved using the Successive Ionic Layer Adsorption and Reaction (SILAR) process. Scanning electron microscopy (SEM) images, energy dispersive X-ray (EDX) analysis, atomic force microscopy (AFM) images, X-ray diffraction (XRD) analysis, and attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) were used to determine the surface morphology. The corrosion test was performed using electrochemical impedance spectroscopy (EIS) and polarization curves in artificial saliva at 310 K. Furthermore the quantum chemical parameters of amoxicillin and potassium clavulanate were investigated and associated with the adsorption ability of these molecules. Results revealed that the corrosion performance of Ti was improved by L-HAP, which had a lower anodic current density and better corrosion resistance. This situation dealt with the more durable, compact film that had been produced on the surface.