Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
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J. Oral Maxillofac. Surg. · Jun 2011
Case ReportsDexmedetomidine sedation for awake fiberoptic intubation of patients with difficult airways due to severe odontogenic cervicofacial infections.
Odontogenic infections present challenging airway scenarios to surgeons and anesthesiologists. Among specialists, there is controversy over airway management for those patients with airways made difficult by trismus and swelling with anatomic impingement and derangement. Awake fiberoptic intubation has achieved favor in the oral and maxillofacial surgery and anesthesiology communities for management of such difficult airways, but patient comfort and anxiety management with traditional agents may prove hazardous because of potential suppression of protective mechanisms and respiratory depression. ⋯ Dexmedetomidine sedation is advocated for use in awake fiberoptic intubation of patients with cervicofacial infections and difficult airways because of its ability to provide sedation, analgesia, reversible anterograde amnesia, and anxiolysis without impairment of protective reflexes, respiratory depression, or hemodynamic compromise. One of the most significant challenges facing oral and maxillofacial surgeons is the difficult airway. Anatomically compromised airways present unique clinically daunting situations to both surgeon and anesthesiologist, who are both charged with the provision of safe, effective preoperative, intraoperative, and postoperative airway management. Among these conditions, odontogenic infections and patients with head and neck trauma, temporomandibular disorders, orofacial tumors, and severe craniofacial anomalies present for surgical treatment by the oral and maxillofacial surgeon.
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J. Oral Maxillofac. Surg. · May 2011
Randomized Controlled Trial Comparative StudyNicotine nasal spray as an adjuvant analgesic for third molar surgery.
To determine the efficacy of preoperatively administered nicotine nasal spray (3 mg) for analgesia after third molar (TM) surgery. ⋯ Pain is well controlled by hydrocodone/acetaminophen in most patients after TM surgery. However, there is significant variability in pain reported. Nicotinic agonists represent a new class of analgesic that can be considered for patients who are expected to have significant opioid-resistant pain after TM surgery. Caution should be used with patients in whom a small increase in heart rate would be deleterious.
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The initial evaluation and treatment of trauma victims should follow a planned approach, as delineated by the Advanced Trauma Life Support protocol, with the main concern securing a patent airway. When trauma has been associated with maxillofacial injury, it can complicate airway management owing to aspirated avulsed teeth or dental prosthetic devices. In such cases, endotracheal intubation can be life-threatening, if the foreign bodies are pushed into the upper respiratory tract. The objective of the present report was to illustrate the diagnostic and management problems related to foreign bodies from the oral cavity lodged in the upper airway after blunt maxillofacial trauma or emergency endotracheal intubation. We also discussed how this could be prevented. ⋯ The patient's oral cavity and upper airway must be inspected thoroughly before attempting endotracheal intubation. Any foreign body should be removed from the mouth and throat. This process must be undertaken, despite the stressful and limiting conditions of emergency care.
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J. Oral Maxillofac. Surg. · May 2011
Comparative StudyEffects of head-neck extension on abnormality of laryngeal mask airway function resulting from opening the mouth.
This study investigated the effects of head-neck extension on abnormalities of laryngeal mask airway (LMA) function resulting from opening the mouth. ⋯ In procedures requiring the patient to have an open mouth under general anesthesia using LMA, 45° head-neck extension achieves acceptable airway conditions.