Dental clinics of North America
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The ideal neuromuscular blocking drug for dental and other outpatient procedures would be nondepolarizing (therefore reversible), highly potent, have a rapid onset and short duration of action, be highly specific for the nicotinic acetylcholine receptor, be eliminated independently of renal or hepatic metabolism, and have minimal side effects such as tachycardia and histamine release. The newer neuromuscular blocking drugs vecuronium and atracurium approach this ideal much more closely than the older drugs curare, metocurine, and gallamine. Aside from considerations of slightly higher cost, the neuromuscular blocking agents of choice remain succinylcholine for rapid, short-lived paralysis, vecuronium and atracurium for relaxation of 15- to 60-minute duration and when cardiovascular stability is vital, and pancuronium for longer surgical procedures. Vecuronium and atracurium have achieved and will continue to achieve predominance in the anesthetic management of the short-procedure patient.
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Dent. Clin. North Am. · Jan 1987
Historical ArticleAnesthetic management. Historical, present, future.
This article deals with specific agents that either have been or are being employed for the production of general anesthesia or sedative states for the control of pain or anxiety in the dental setting. Change, progress, trends, and contributions to the field of dental anesthesia made by dentists are stressed. In addition, a brief synopsis of the most popular present-day techniques and agents is discussed. Finally, the future of the field of dental anesthesia and the role to be played by dentists is considered.
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Intraoperative anesthetic complications can be prevented or minimized if the anesthetist is able to anticipate such problems in the preanesthetic period. Therefore, an adequate preanesthetic medical history that includes previous anesthetic experiences and past and current drug therapy is extremely important. ⋯ The signs of an impending disaster are subtle and nonspecific in the anesthetized patient. Therefore, continuous vigilance of the patient's physiologic status coupled with a high index of suspicion are essential to safe anesthetic management of dental patients.
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This is a short review of the history of anesthetic technique and opinions regarding the present day responsibilities of the dentist anesthesiologist and how it differs from the traditional laissez-faire approach.
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General anesthesia is provided in the dental office primarily to reduce fear, block pain, produce amnesia, and provide a more comfortable surgical environment. Because the perception of pain is a major obstacle to the obtainment of dental health in the United States, general anesthesia has become an essential part of the practice of dentistry. It benefits both the patient and the surgeon to make dentistry a pleasant, painless experience.