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Investigation of fluctuations in blood glucose level due to dietary restrictions during impacted mandibular third molar extraction under intravenous sedation: effect of perioperative glucose administration.

ABSTRACT: OBJECTIVE:We aimed to investigate the usefulness of glucose administration for maintaining perioperative glycemic control in patients with dietary restrictions during 4 h prior to impacted mandibular third molar extraction under intravenous sedation. METHODS:Fifty-four individuals scheduled to undergo extraction of impacted mandibular third molars under intravenous sedation, with preoperative blood glucose levels (GL) of 70-110 mg/dL, were evaluated and divided into 3 groups (n?=?18 each): control group receiving glucose-free sodium lactate Ringer's solution, perioperative GL group receiving 100 mL of 5% glucose solution immediately after local anesthesia, and postoperative GL group receiving 100 mL of 5% glucose solution immediately after surgery completion. Blood glucose levels, systolic blood pressure, diastolic blood pressure, and heart rate were measured. RESULTS:Glucose levels of those in the control and perioperative GL groups decreased within the standard range 90 min after surgery, compared with the preoperative blood glucose level. However, in the postoperative GL group, glucose levels were similar to the preoperative levels. Systolic and diastolic blood pressure and heart rate were not affected by glucose administration, and sedation could be maintained without an invasive procedure. CONCLUSIONS:Following a restriction on eating and drinking 4 h prior to surgery, the blood glucose level gradually decreased in the perioperative period but remained within the reference range until 90 min following surgery. The administration of 100 mL 5% glucose solution immediately after surgery was sufficient for the prevention of postoperative hypoglycemia. This approach may be useful for perioperative glycemic control during third molar extraction.

SUBMITTER: Sekine M

PROVIDER: S-EPMC7413897 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Investigation of fluctuations in blood glucose level due to dietary restrictions during impacted mandibular third molar extraction under intravenous sedation: effect of perioperative glucose administration.

Sekine Mio M Tomita Yuya Y Iguchi Asami A Fujii Kazuyuki K

Oral and maxillofacial surgery 20200427 3

<h4>Objective</h4>We aimed to investigate the usefulness of glucose administration for maintaining perioperative glycemic control in patients with dietary restrictions during 4 h prior to impacted mandibular third molar extraction under intravenous sedation.<h4>Methods</h4>Fifty-four individuals scheduled to undergo extraction of impacted mandibular third molars under intravenous sedation, with preoperative blood glucose levels (GL) of 70-110 mg/dL, were evaluated and divided into 3 groups (n = ...[more]

PMID: 32342247

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Project description:BackgroundSurgical extraction of the impacted mandibular third molar is commonly associated with postoperative pain, swelling, and trismus. Usually, rotatory instruments like burs have been used for osteotomy, while Piezosurgery is an innovative technique introduced to overcome the weaknesses related to the conventional technique. In addition, Dexamethasone administration before the extraction of impacted third molars is an efficient way to reduce postoperative pain due to robust anti-inflammatory activity. The purpose of the study is to evaluate the effect of piezo-surgery and dexamethasone injection on postoperative sequelae after the surgical extraction of impacted mandibular third molars, and ultimately to compare their effect on reducing postoperative pain.MethodsA randomized controlled clinical trial was conducted with a sample of 80 patients. Participants were divided into four groups: Group 1 (Conventional rotatory), Group 2 (Conventional rotatory with 8 mg dose of dexamethasone 30 min before surgery), Group 3 (Piezo-surgery), and Group 4 (Piezo-surgery with 8 mg dose of dexamethasone 30 min before surgery). The outcome variables were surgical working time calculated in minutes, maximal mouth opening measured in millimeters using Vernier Caliper at baseline and day 3 and postoperative pain assessed using a Visual Analog Scale (VAS) on days 1, 3, and 7.ResultsThe surgical working time was longer in piezo-surgery groups compared with the conventional rotatory instruments groups (15.82 ± 3.47 vs 23.33 ± 2.54; p value < 0.0001). The lowest reduction in mouth opening between baseline and 3rd-day post-op was found in the Piezo-surgery with Dexamethasone group (mean difference = 5.0, SD = 3.9, p value < 0.0001) followed by the Piezosurgery without Dexamethasone group (mean difference = 5.8, SD = 4.5, p value < 0.0001) and the highest average was reported by the Conventional rotatory without Dexamethasone (mean difference = 9.7, SD = 4.5, p value < 0.0001. In the four groups, the mean pain score was highest on the 1st day and gradually decreased over the following days. Comparison of the 1st and 3rd postoperative pain between groups revealed a lowest mean pain score in the Piezo-surgery with Dexamethasone group, followed by Conventional rotatory with Dexamethasone group and a highest mean score in the Conventional rotatory without Dexamethasone group (p value < 0.0001).ConclusionThe association of Piezosurgery osteotomy and Dexamethasone intramuscular injection could be an effective combination to reduce postoperative pain and trismus after impacted third molar surgery.Trial registrationNCT04889781 ( https://clinicaltrials.gov/ ), Date of Registration: 17/05/2021 (retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04889781?term=NCT04889781&draw=2&rank=1.

Project description:BackgroundVarious injection methods have been used to improve the success rate of inferior alveolar nerve (IAN) block and reduce the pain and complications. But these methods also have their advantages and disadvantages. A modified 3-distal site anesthesia injection method proposed in 2015 was used clinically with satisfactory results at some dental clinics in China. This study aimed to determine the feasibility of this modified 3-distal site anesthesia injection method for extraction of an impacted mandibular third molar from an anatomical point of view.MethodsThree-dimensional (3D) reconstruction and analysis of the mandibles was performed using cone-beam computed tomography (CBCT) scanning to measure the simulated needle insertion depth, infiltration distance, and other important parameters. These parameters were compared with an actual depth of 20 mm and a theoretic infiltration distance of 10 mm. The main parameters were compared between males and females.ResultsSixty-three CBCT datasets were imported into Simplant OMS software for 3D reconstruction. The left simulated insertion depth did not differ from 20 mm, while right insertion depth was >20 mm (P<0.05). The bilateral infiltration distances were <10 mm (P<0.05) and articaine blocked the IAN. The widths of the mandibular rami were greater than the syringe length (21 mm), thus it was not possible for the syringe to reach the distal edge of the mandible. There was no difference in the simulated needle insertion depth and infiltration distance between the left and right (P>0.05). The bilateral simulated insertion depths, infiltration distances, widths of the mandibular rami, and height of the left mandibular foramen in females were less than in males (P<0.05), while there was no difference in the height of the right mandibular foramen and bilateral insertion angles (P>0.05).ConclusionsThe modified 3-distal site anesthesia injection method was shown to block the IAN based on anatomic evidence derived from 3D analysis on the measurements by CBCT.

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Investigation of fluctuations in blood glucose level due to dietary restrictions during impacted mandibular third molar extraction under intravenous sedation: effect of perioperative glucose administration.

Publications

Investigation of fluctuations in blood glucose level due to dietary restrictions during impacted mandibular third molar extraction under intravenous sedation: effect of perioperative glucose administration.

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