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be present. The movements can vary from fast to quite slow. They can be almost constantly present, or rarely seen. 3) Automatic chewing (lips typically closed) and swallowing are frequently present. 4) Blinking is a common finding (including blinking while the lids are closed). The patient who has an essentially preserved brain stem, intact cranial nerves and end organs, will have preserved pupillary, corneal, oculocephalic, vestibulo-ocular, gag and cough reflexes. With brain stem or cranial nerve (...) for the imagery tasks could have elicited some type of cortical response independent of awareness, some kind of a very sophisticated knee-jerk reflex. Ropper suggested that instead of cuing the patients with “playing tennis” versus “relax”, Monti’s team should have asked patients “imagine playing tennis” and compared with “imagine not playing tennis”. Perhaps nothing in clinical medicine is as complex as the assessment of consciousness, thus Allan Ropper, Andrew Billings, and others(3)(13)(14)(15) all hold
Design, development and validation of a new laryngo-pharyngeal endoscopic esthesiometer and range-finder based on the assessment of air-pulse variability determinants Laryngo-pharyngeal mechano-sensitivity (LPMS) is involved in dysphagia, sleep apnea, stroke, irritable larynx syndrome and cough hypersensitivity syndrome among other disorders. These conditions are associated with a wide range of airway reflex abnormalities. However, the current device for exploring LPMS is limited because (...) it assesses only the laryngeal adductor reflex during fiber-optic endoscopic evaluations of swallowing and requires a high degree of expertise to obtain reliable results, introducing intrinsic expert variability and subjectivity.We designed, developed and validated a new air-pulse laryngo-pharyngeal endoscopic esthesiometer with a built-in laser range-finder (LPEER) based on the evaluation and control of air-pulse variability determinants and on intrinsic observer variability and subjectivity determinants
design, 85 target patients were fulfilling the criteria: being Thai national at the age of at least 20-year-old, being performed TEE by the study participant's cardiologists, being able to communicate verbally. Seven outcomes were recorded, including gagreflex, insertion attempt, insertion time, vital signs (heart rate, oxygen saturation and mean arterial blood pressure), visible blood on TEE probe tip, and oropharyngeal pain at 1 h and 24-h.There were 85 eligible patients during June 2013 to June (...) 2014 [corrected]. The major participants were male (46, 54 %) and the mean age was 51.2 ± 12.5 years. The MMC class III was mostly found (33, 38.80 %). TEE probe insertion time and gagreflex were indicated statistical significance (P < 0.05). Linear regression revealed that MMC class III (b 3.718; SD ± 1.077; P = 0.001) and class IV (b 5.15; SD ± 1.286; P = 0.000) were statistically associated with TEE probe insertion time, whereas MMC class II was no statistically significant (b 2.348; SD ± 1.405
for Study: 18 Years to 65 Years (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Sufficient teeth to allow wearing of the device Mild to severe OSAS Ability to answer the questionnaires No concomitant CPAP treatment BMI inferior to 32 kg/m2 Exclusion Criteria: Important dental or parodontal disease Central sleep apnea Jaw opening limitations Temporo-mandibular joint dysfunction Major gagreflex precluding the long-term use of the device Major
/congestive heart failure (New York Heart Association Functional Classification grade III or IV), ascites Received any investigational therapy within 60 days of randomization Blood donation within 56 days prior to randomization Plasma donation within 7 days prior to randomization Received luminal contrast agents such as barium or water-soluble oral contrast agent within 21 days prior to randomization Known to have an impaired gagreflex, or prone to regurgitation or aspiration Serious underlying disease
(SpO2 ≥ 90% with FiO2 ≤ 40% and PEEP 10 ≤ cm H20, patients who are hemodynamically stable (off vasopressors or on low levels of vasopressors: phenylephrine < 50 ug/min; norepinephrine < 5 ug/min; dobutamine < 5 ug/kg/min; milrinone< 0.4 ug/kg/min), patients whose neurological status is stable (no deterioration in the last 24 hrs, intact respiratory drive and ICP <20), patients who have intact airway reflexes (adequate cough with suctioning and a gagreflex), and patient who are in normal sinus
Inclusion Criteria: Adults and legally responsible/ valid medical insurance patients : ALS diagnostic already announced healthy subjects : EAT-10 score<2 Exclusion Criteria: Non pregnant and non baby feeding Presence of risk factor or suspicion of Creutzfeld Jacob Disease Allergy/intolerance to the glueing paste Antecedent of pathology of the aerodigestive tract Other neurologic disease Morphologic anomaly of the aerodigestive tract Excessive gagreflex Contacts and Locations Go to Information from
for Study: up to 10 Days (Child) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion: less than 32 weeks gestational age at birth admitted to the neonatal intensive care unit (NICU) expected to have heel lances for routine blood tests yet to reach 10 days of life at the time of study enrollment. Exclusion: known hypersensitivity to sucrose, corn, corn products or any component of the formulation short-bowel syndrome carbohydrate intolerance unable to swallow/absent gagreflex
medication which disqualifies for OSA-treatment Extensive gag-reflex or claustrophobia Inadequate dental support (< 10 teeth in lower jaw) Inadequate periodontal support (no tooth mobility > Miller grade I) Anatomical abnormalities in the nasal cavity or oro-pharynx that disqualifies the use of CPAP and/or MAS Anatomical abnormalities which should be surgically corrected before treatment with CPAP and/or MAS Severely compromised general health condition Pregnancy General health issues that disqualifies
is type I or type II diabetic. Subject is allergic to Gentamicin. Acute use of any medication or other product, prescription or over-the-counter, for symptoms of rhinitis or nasal congestion within seven (7) days prior to challenge. This includes any corticosteroid or beta agonist containing nasal spray. An Abnormal ECG deemed clinically relevant by the Investigator(s). Any anatomic or neurologic abnormality impairing the gagreflex or conducive to aspiration, or history suggestive of such a problem
for Study: All Accepts Healthy Volunteers: Yes Criteria Inclusion Criteria: lack of keratinized tissue in the mandibular central incisor region Exclusion Criteria: smoking uncontrolled systemic disease that might contraindicate periodontal surgery severe gagreflex preventing maxillary surgical procedure inability or unwillingness to provide informed consent Contacts and Locations Go to No Contacts or Locations Provided More Information Go to Layout table for additonal information Responsible Party
, pulse oximeter and non-invasive blood pressure. After preoxygenation for three minutes, anesthesia would be induced with 8% sevoflurane inhalation in 50% oxygen and % 50 air ; 1ug/kg fentanyl and 3 mg/kg propofol is administered intravenously. Then laryngeal mask is inserted when conditions are satisfactory (jaw relaxed, lash reflex disappeared, no coughing, gagging, swallowing).After ethical committee approval, informed written consent will be obtained from all patients. Consenting patients
" or "good" pain relief condition was 73.2%, 63.0%, 53.2%, and 43.0% at 1, 3, 5, and 10 years. Postprocedure complication included dysesthesias, dysphagia, and diminished gagreflex. No mortality was observed during or after PRT procedures.This study indicates that CT-guided PRT is a safe and effective method for patients with GPN and should be considered as an alternative treatment for these patients.
success. Assessment of multiparametric hemodynamic, respiratory, and neurologic functions was performed just before extubation. Extubation failure was defined as the need for ventilatory support during intensive care unit stay. Extubation failure within 48 h was also analyzed. Neurologic outcomes were recorded at 6 months.Extubation failure occurred in 43 (31%) patients with 31 (24%) within 48 h. Predictors of extubation failure consisted of upper-airway functions (cough, gagreflex, and deglutition (...) % probability of success providing the presence of at least two operating airway functions.A simplified clinical pragmatic score assessing cough, deglutition, gagreflex, and neurologic status was developed in a preliminary prospective cohort of brain-injured patients and was internally validated (bootstrapping). Extubation appears possible, providing functioning upper airways and irrespective of neurologic status. Clinical practice generalizability urgently needs external validation.
Propofol-Based Sedation Versus General Anesthesia for Endoscopic Submucosal Dissection. The main objective of this study is to evaluate general anesthesia or propofol-based sedation methods at gastric endoscopic submucosal dissection (ESD) procedures.The anesthetic method administered to cases undergoing upper gastrointestinal ESD between 2013 and 2015 was retrospectively investigated. Procedure time, lesion size, dissection speed, anesthesia time, adverse effects such as gagreflex, nausea
Administration 4 Apparent Life-Threatening Events In Children Apparent Life-Threatening Events In Children Aka: Apparent Life-Threatening Events In Children , Apparent Life Threatening Event In Infant , ALTE , BRUE , Brief Resolved Unexplained Event From Related Chapters II. Definition Apparent Life-Threatening Event (ALTE) Sudden, brief episode with serious findings in an infant under age 1 year Presents with apnea, or pallor, limp, or gagging Brief Resolved Unexplained Event (BRUE) Replaces Apparent Life (...) . Causes ral ALTE after age 2 months predicts serious cause Idiopathic in 50% of cases No longer thought to be near-miss (older hypothesis) Gastrointestinal (50% of diagnosed cases) disorder (Gastric , ) Neurologic (30% of diagnosed causes) Disorder (e.g. s) Vasovagal reflex Structural Disease (Budd-Chiari Syndrome) Brain Mass (or other ) (e.g. ) or (e.g. ) Respiratory (20% of diagnosed causes) Infection (RSV, , ) Obstruction ( , vocal cord, foreign body) Laryngotracheomalacia Facial anomaly Cardiac (5
must have no solid food for 4 hours prior to the procedure, and only clear liquids for 2 hours prior to the procedure. Exclusion Criteria: Subjects over 70 years of age Subjects with the inability to swallow pills and capsules. Subjects with a strong gagreflex Esophageal fistula and/or esophageal strictures with a stricture diameter that is smaller than the diameter of the capsule. Pregnancy. If the subject is unsure, she will be asked to take a pregnancy test. Contacts and Locations Go
Comparison of Spraying and Nebulized Lidocaine in Patients Undergoing Esophago-Gastro-Duodenoscopy: A Randomized Trial. Esophago-gastro-duodenoscopy (EGD) was performed under the topical anesthesia of the pharynx. However spraying lidocaine was found to be an annoying maneuver to patients, while nebulized lidocaine appeared to efficiently suppress gags and cough reflexes in airway anesthesia. This study aimed to compare the effectiveness of spraying and nebulized lidocaine for patients (...) to start the procedure, ease for instrumentation, less gagreflex during the procedure, less presence of hypersecretion, and smooth operation. However participants favored nebulized lidocaine administration.
breathing, marked change in tone, or altered level of responsiveness An event doesn’t count as a BRUE if there is a likely explanation (probably the biggest change from ALTE) Choking and gagging are specifically not considered BRUEs because they usually have an explanation such as GERD or URI A low risk BRUE is defined as all of: age >60 days, born ≥ 32 weeks and gestational age ≥ 45 weeks, no CPR by a trained medical provider, event < 1 min, and first event. For these children, they specifically say (...) ) and were given ketamine. 44 of the 49 were adequately sedated with ketamine, and 4 of the 5 not sedated were given less than 200mg ketamine IM. There were only 3 adverse events: 2 patients vomited, and 1 had his oxygen saturation drop to 90%. This obviously isn’t practice changing in itself, but ketamine is a very interesting option for sedating agitated patients because of its ability to keep respiratory drive and airway reflexes in tact. Bottom line: Ketamine is an interesting option for managing
January 2011 and May 2016. The analysis examined the patient's sex, age, primary reason for IV sedation, duration of anesthesia and dental treatment, type of dental treatment performed, number of clinical departments involved in the dental treatment and level of multidisciplinary cooperation, and annual trends.Most dental treatments using intravenous sedation were performed on medically disabled patients or dentally disabled patients with an extreme gagreflex or dental phobia. The mean duration of IV