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Gag Reflex

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181. Cocaine-Induced Acute Fatal Basilar Artery Thrombosis: Report of a Case and Review of the Literature (PubMed)

and preserved oculocephalic and gag reflexes. The patient was noted to have semi-rhythmic jerking movement of the right arm and extensor posturing in response to noxious stimuli. Non-contrast computed tomography (CT) of the brain showed hyperdense basilar sign consistent with acute thrombosis. On brain magnetic resonance imaging (MRI), he was found to have bilateral pons acute ischemic stroke with early petechial hemorrhagic conversion. His laboratory work-up was unremarkable except for positive cocaine

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2015 The American journal of case reports

182. Predicted EC50 and EC95 of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia (PubMed)

assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintained at a predetermined Ce during the emergence period. The modified Dixon's up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regarded as absence of coughing/gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm (...) , or other airway reflexes.

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2015 Yonsei medical journal

183. Clinical impact of gastroenterologist-administered propofol during esophagogastroduodenoscopy: a randomized comparison at a single medical clinic. (PubMed)

and four levels of the gag reflex, respectively. For safety purposes, endoscopists and nurses were trained in administering propofol and an anesthesiologist was on call at all times.No statistically significant differences were found between the two groups in sedation level and patient tolerability. Full recovery time in the propofol group (4.7 min) was significantly shorter than that in the midazolam group (24 min, P < 0.01).Regarding post-procedure management of patients in a medical clinic, propofol

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2014 Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association

184. The effect of chewing lidocaine soaked gauze on intubation conditions during awake videolaryngoscopy: a randomised controlled trial in the morbidly obese. (PubMed)

The effect of chewing lidocaine soaked gauze on intubation conditions during awake videolaryngoscopy: a randomised controlled trial in the morbidly obese. The increasing utilisation of the videolaryngoscope for awake tracheal intubation requires development and assessment of methods to decrease the gag reflex. We hypothesised that chewing gauze soaked with lidocaine would decrease the gag reflex during awake videolaryngoscope tracheal intubation. Twenty four morbidly obese patients assessed (...) as having a potential difficult tracheal intubation were randomised to chew gauze soaked with 20 ml of 2% lidocaine or saline for 3 minutes. All patients then received 20 ml of aerosolised 2% lidocaine and underwent awake videolaryngoscope assisted tracheal intubation. Gagging scores, heart rate and blood pressure were assessed when best laryngeal view was obtained, when the tracheal tube was positioned at the cords, and when the tube was advanced into the trachea. In addition, serum lidocaine levels

2014 Acta anaesthesiologica Belgica

185. Risk factors for unsuccessful prehospital laryngeal tube placement. (PubMed)

in 15.1% of first attempts and 9.9% of cases overall. The majority (79.2%) of first attempts occurred as a rescue airway after unsuccessful endotracheal intubation attempt(s), in patients with non-traumatic complaints (70.9%) and in cardiac arrest (60.8%). Gag reflex (OR 4.08, 95% CI 1.72-9.67), ground (versus air) EMS agency (OR 2.49, 95% CI 1.07-5.79), and male gender (OR 1.90, 95% CI 1.04-3.46) were associated with unsuccessful LT placement in our multivariable model.The laryngeal tube (...) is an effective airway management tool for both advanced life support and critical care prehospital providers. Gag reflex, ground (versus air) EMS agency, and male gender were associated with unsuccessful laryngeal tube placement by prehospital personnel.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

2014 Resuscitation

186. An analysis of moderate sedation protocols used in dental specialty programs: a retrospective observational study. (PubMed)

, and other information that was recorded.The reasons for the use of moderate sedation were anxiety (54%), local anesthesia failures (15%), fear of needles (15%), severe gag reflex (8%), and claustrophobia with the rubber dam (8%). The most common medical conditions were hypertension (17%), asthma (15%), and bipolar disorder (8%). Most patients were classified as American Society of Anesthesiologists class II. More women (63.1%) were treated than men (36.9%). The mean age was 45 years. Monitoring

2014 Journal of Endodontics

187. Incident and Extent of Pulse Alteration During Local Anesthesia in Children

aberrant event which may occur during alteration of the pulse rate such as gag reflex, coughing, or pain related disruptive behavior will be documented on the computer in real time by another person that is not the treating dentist. All types of local anesthesia delivery will be performed by the computerized-controlled local anesthesia delivery system - Single-Tooth-Anesthesia which connected to a computer and documents continuously the amount and velocity of the local anesthetic delivered

2014 Clinical Trials

188. Safety and Efficacy of CDFR0612 and CDFR0613 for Bowel Cleansing Before Colonoscopy

) disturbance Severe dehydration risk (e.g., rhabdomyolysis, ascites) Dialysis or renal disorder (creatinine clearance <15ml/min) Suspected pulmonary aspiration or gag reflex disorder History of hypersensitivity of drug or others Alcohol or drug abuse within 6 months Clinically significant underlying disease or medical history at investigator's discretion Inability in written/verbal communication Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study

2014 Clinical Trials

189. Predictors of extubation failure in neurocritical patients identified by a systematic review and meta-analysis. (PubMed)

to close the eyes, thick secretion, and no intact gag reflex. Meanwhile, the following were not predictive for extubation failure: sex, secretion volume, coughing upon suctioning, and the inability to follow one command among showing two fingers, wiggling the toes, or coughing on command. Additionally, some traditional weaning parameters were shown to poorly predict extubation failure in neurocritical patients.Besides pneumonia, atelectasis, and the duration of mechanical ventilation, other factors (...) that should be taken into consideration in the prediction of extubation failure when neurocritical patients are weaned from tracheal intubation include neurologic abilities (Glasgow Coma Scale score and following commands), the secretion texture, and the presence of a gag reflex.

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2014 PloS one

190. Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy: A Randomized, Controlled Trial. (PubMed)

Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy: A Randomized, Controlled Trial. Unsedated upper gastrointestinal endoscopy (UGE) can induce patient discomfort, mainly due to a strong gag reflex. The aim was to assess the effect of a bupivacaine lozenge as topical pharyngeal anesthetic compared with standard treatment with a lidocaine spray before UGE. Ninety-nine adult outpatients undergoing unsedated (...) diagnostic UGE were randomized to receive either a bupivacaine lozenge (L-group, n = 51) or lidocaine spray (S-group, n = 42). Primary objective was assessment of patient discomfort including acceptance of the gag reflex during UGE. The L-group assessed the discomfort significantly lower on a visual analog scale compared with the S-group (P = 0.02). There was also a significant difference in the four-point scale assessment of the gag reflex (P = 0.03). It was evaluated as acceptable by 49% in the L-group

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2014 Clinical medicine insights. Gastroenterology

191. Cardiopulmonary Syndromes

and obtund the gag reflex, and anaphylactic reactions to preservatives in these solutions have been documented. Opioid and nonopioid antitussives, such as dextromethorphan, may act synergistically, but further studies are required to confirm this hypothesis.[ ] Gabapentin was found to be efficacious compared with placebo for chronic refractory cough, although this study did not specifically include cancer patients.[ ] In cases of increased sputum production, expectorants and mucolytics have been employed

2012 PDQ - NCI's Comprehensive Cancer Database

193. Neurological History and Physical Examination (Overview)

of the transverse colon. The vagus provides secretomotor fibers to the glands in the same region and inhibits the sphincters of the upper GI tract. Along with visceral sensation from the same region, the nerve participates in vasomotor regulation of blood pressure by carrying the fibers of the stretch receptors and chemoreceptors (ie, aortic bodies) of the aorta and providing parasympathetic innervation to the heart. The pharyngeal gag reflex (ie, tongue retraction and elevation and constriction (...) the following: Higher functions Cranial nerves (CNs) Sensory system Motor system Reflexes Cerebellum Meninges System survey Tools required In addition to the stethoscope and the usual office supplies (eg, gloves, tongue depressors), the neurologist should have an ophthalmoscope, a reflex hammer, and a tuning fork. A pin (Wartenberg) wheel was once a favorite tool of many neurologists because it was easy to use for sensory (pinprick) testing. Unless it is disposable (commercially available), this wheel

2014 eMedicine.com

194. Nutritional Management in the Rehabilitation Setting (Overview)

Access Indication Advantages Disadvantages Nasogastric Requires intact gag reflex, normal gastric motility/gastric outlet Low cost, easy placement, easy removal Increased risk of aspiration/tube dislodgement Nasoduodenal/ nasojejunal High aspiration risk, delayed gastric emptying, gastroparesis, gastric dysfunction resulting from trauma or surgery Beneficial for lower incidence of nosocomial pneumonia Requires endoscopy or fluoroscopy for placement, increased risk of tube migration/dislodgement

2014 eMedicine.com

195. Nursing Home Acquired Pneumonia (Overview)

to acquiring pneumonia. Prevention of NHAP Keep patients who are predisposed to aspiration pneumonia in a semiupright position at night. Additionally, take care when feeding patients who have an empiric gag reflex or neurologic disorder that depresses consciousness or interferes with swallowing. Dysphagia has been identified as a risk factor, so nurses and other healthcare workers should be vigilant for signs of dysphagia to help prevent NHAP. [ ] Previous Next: History and Physical Examination Patient (...) history Patients may report fever, cough, chest pain, or rapid respiration. Patients with are particularly prone to developing pneumonia Patients with aspiration NHAP often have a history of central nervous system (CNS) or esophageal disease, or they have a decreased gag reflex that predisposes them to recurrent aspiration. Physical examination Most, but not all, patients are febrile. Fever, when present, may be low grade. Physical examination findings in the chest include rales over the involved lung

2014 eMedicine.com

196. Oral Examination (Overview)

the posterior tongue with a tongue blade and instructing the patient to say "Ahhh." Deviation of the soft palate to one side or the other may indicate a neurologic problem or an occult neoplasm. Once the posterior tongue has been depressed and the patient has elevated the soft palate, examining the oral pharynx is possible. This can occasionally be complicated in patients who have a hyperactive gag reflex; however, in such cases, the gag reflex can be suppressed through the use of topical anesthetics (...) be confirmed with its signs and symptoms, a biopsy of the oral soft tissues with an histopathological examination is warranted. [ ] Intraoral photography with digital camera should be used to document mucosal lesions and evaluate the progression of the disease and responses to therapy. This typically requires 35-mm single lens reflex cameras with macro lens and ring flash attachment. Several models are available for intraoral photos. For patient education resources, see the patient education articles

2014 eMedicine.com

197. Assessment of Neuromuscular Transmission (Follow-up)

weakness, which is exacerbated by exertion. Frequently, the pupillary light reflex is slowed (or even absent), and ophthalmoparesis may be present. Scoliosis or lordosis may also be present. The severity of the different symptoms varies considerably from patient to patient. The disease is caused by an autosomal recessive gene ( COLQ ; 603033) that codes for the collagen-like tail of endplate acetylcholinesterase. Histochemical stains show that acetylcholinesterase is absent from the nerve terminals

2014 eMedicine.com

198. Basilar Artery Thrombosis (Follow-up)

involvement of lower cranial nerves and impairment of consciousness in patients with brainstem ischemia. Other important aspects include assessment of the respiratory drive, the gag reflex, and the ability to handle secretions by a forceful cough. Ventilation Generally, endotracheal intubation should be considered in patients with a decreased level of consciousness and Glasgow Coma Scale score of less than 8. Endotracheal intubation is recommended in most patients to keep their airway clear while (...) therapy should address the concerns of aspiration in patients with profound dysarthria and depressed cough reflex. Diet The patient should be restricted to taking nothing by mouth until his or her swallowing mechanism has been assessed and cleared and the airway has been protected. If the patient has a high risk of aspiration, a nasogastric or nasoduodenal tube should be placed. If the swallowing abnormalities are so severe that recovery is expected to take weeks or months, a gastrostomy tube should

2014 eMedicine.com

199. Brain Death in Children (Follow-up)

brainstem function - Fixed and dilated or midposition pupils; absent spontaneous and oculocaloric/oculovestibular eye movements; absent movement of facial and oropharyngeal muscles; and bsent corneal, gag, cough, sucking, and rooting reflexes Spinal cord reflex withdrawal not included Consistent examination throughout the observation period (see Table 1, below) Table 1. Age-Dependent Observation Period Age Hours Between 2 Examinations Recommended Number of EEGs 7 days-2 months 48 2 2 months-1 year 24 2 (...) of the remaining patients; therefore, generalizations concerning age could not be made. The report concluded that ECS together with complete unresponsiveness, apnea, absent cephalic reflexes, and the inability to maintain circulation without artificial means is strongly presumptive of irreversible coma (ie, cerebral death). [ , ] The term electrocerebral inactivity (ECI) is often used instead of ECS. Previous Next: Harvard Medical School Ad Hoc Committee In 1968, a consensus report of the Ad Hoc Committee

2014 eMedicine.com

200. Snoring and Obstructive Sleep Apnea, Upper Airway Evaluation

pressure (see Flexible Nasopharyngoscopy). Micrognathia can be a life-threatening pathology in some patients, such as those who have Pierre-Robin syndrome. In certain circumstances, temporary glossopexy may need to be performed to avoid asphyxia until a secure airway is obtained. Hypopharynx Examination of the hypopharynx requires the use of a laryngeal mirror, flexible endoscope, or a magnifying laryngoscope. A gag reflex that is very intense is a common problem in some patients and can make

2014 eMedicine Surgery

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