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Heart rate (HR) and arterial blood pressure (BP) changes have been reported during conscious sedation with propofol and midazolam. One potential mechanism to explain these changes is that propofol and midazolam affect HR and BP via changes in the cardiac autonomic nervous system. Two specific hypotheses were tested by HR variability analysis: 1) propofol induces predominance of parasympathetic activity, leading to decreased HR and BP, and 2) midazolam induces predominance of sympathetic activity, leading to increased HR and decreased BP. Thirty dental patients were included in a prospective, randomized study. HR, BP, low frequency (LF), high frequency (HF), and entropy were monitored during the awake, sedation, and recovery periods and depth of sedation was assessed using the Observer's Assessment of Alertness/Sedation score. Propofol induced a significant decrease in total power (503 +/- 209 ms(2)/Hz versus 162 +/- 92 ms(2)/Hz) and LF/HF ratio (2.5 +/- 1.2 versus 1.0 +/- 0.4), despite the absence of any change in HR during the sedation period compared with baseline. Midazolam decreased normalized HF (34 +/- 10% versus 10 +/- 4%) but did not significantly change LF/HF ratio (2.3 +/- 1.1 versus 2.2 +/- 1.4) and increased HR in the sedation period. Compared with baseline, propofol was associated with a significant increase in normalized HF in the recovery period (34 +/- 11% versus 44 +/- 12%) and a significant decrease in HR, whereas midazolam was associated with an increase in LF/HF ratio (2.3 +/- 1.1 versus 3.7 +/- 1.8) with no change in HR. These results indicated a dominant parasympathetic effect of propofol and a dominant sympathetic effect of midazolam in both periods. These results should be considered during conscious sedation, especially in patients at risk of cardiovascular complications.

We studied the antithyroid action of cigarette smoking products (nicotine, cotinine, and thiocyanate) in the physiological culture system of porcine thyroid follicles. Iodide uptake, iodine organification, de novo thyroid hormone formation, and iodide efflux were measured in the presence of 0–200 μmol/l nicotine, cotinine, or potassium thiocyanate. Nicotine and cotinine did not inhibit iodide transport or thyroid hormone formation. Thiocyanate concentrations equivalent to serum levels of smokers showed three independent antithyroid actions: (i) inhibition of iodide transport, (ii) inhibition of iodine organification, and (iii) increased iodide efflux. Inhibition of iodide transport by thiocyanate was competitive with iodide and independent of TSH concentration. Thiocyanate did not inhibit TSH mediated cAMP production or Na+K+ATPase activity, a sodium pump for iodide transport. When 50 μmol/l thiocyanate was added 2 h after incubation with iodide or when 1 μmol/l thiocyanate was added from the beginning of incubation, iodine organification was inhibited without changing iodide transport. De novo thyroid hormone formation was clearly inhibited by 50 μmol/l thiocyanate. Thiocyanate increased iodide efflux although the degrees of iodide efflux by 10 μmol/l and 100 μmol/l thiocyanate did not differ significantly. In summary, thiocyanate, a product of smoking, has three independent antithyroid activities. The data of iodide transport kinetics suggest that thiocyanate can be an antithyroid agent particularly in iodine deficiency.

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Advances in medicine have greatly increased the survival of patients with severe health problems and have significantly prolonged life in elderly individuals with systemic disorders. Concomitant advances in dentistry and evolving societal expectations regarding dental health and function have likewise ensured that these patients are increasingly retaining their teeth and/or seeking dental care. The administration of local anaesthetics and the performance of extensive dental procedures may cause stress and systemic disturbances in such patients. In order to avoid potentially serious reactions, dentists are obligated to monitor continuously their medically challenged patients. Monitoring provides three important benefits. First, it helps the dentist detect acute medical emergencies that may require an immediate response. Second, monitoring may reveal gradual deleterious trends that can often be easily reversed before a true emergency occurs. Third, monitoring can assist the dentist in evaluating the efficacy of any emergency treatments or preventive measures that are rendered. The purposes of this article are to: briefly review monitoring techniques and devices, discuss their suitability for use in the dental office, and provide some tips for their application during dental care. In overall decreasing order of routine importance, monitoring resources include the following: responsible personnel, non-invasive blood pressure monitor, pulse oximeter, ECG, and the pretracheal stethoscope or capnograph.