Anesthesia progress
-
Anesthesia progress · Jan 1995
Randomized Controlled Trial Comparative Study Clinical TrialFlumazenil reversal of conscious sedation induced with intravenous fentanyl and diazepam.
The addition of a benzodiazepine antagonist to the dental anesthesiologist's armamentarium should provide added safety for conscious sedation using benzodiazepines. A double-blind, placebo-controlled clinical trial of flumazenil, the first available benzodiazepine antagonist, was performed to evaluate its safety and efficacy following conscious sedation induced by diazepam and fentanyl. Flumazenil was found to reverse rapidly much of the central nervous system depression induced by fentanyl and diazepam conscious sedation. Flumazenil appears to be a valuable adjunct for dentists who administer intravenous benzodiazepines for conscious sedation.
-
Anesthesia progress · Jan 1995
Case ReportsType I second-degree AV block after neostigmine administration in a child with renal failure.
Neostigmine is commonly used to reverse neuromuscular blockade. A side effect can be parasympathetic stimulation, which may result in heart block. Renal failure can decrease the clearance and increase the half-life of the drug, thus increasing the likelihood of a vagomimetic response. A case is presented where a child with renal failure developed a type I second-degree heart block after neostigmine was given.
-
Anesthesia progress · Jan 1995
Biography Historical ArticleLessons from history: Horace Wells and the moral features of clinical contexts.
Horace Wells first used nitrous oxide for anesthetic purposes in December 1844. Although his life ended tragically in 1848--and before he received official recognition for his work--Wells' significance in the history of anesthesiology is now firmly established. ⋯ Wells' story provides an example of how the moral dimensions of actions taken in the health care setting can be understood only in the context of the individual, clinical, institutional, and political arenas in which they occur. Resolving ethical conflicts and dilemmas thus requires clinicians to pay attention to such factors as personal, professional, institutional, and broader social, political, and economic considerations that influence what one believes to be "best" in given circumstances.
-
Anesthesia progress · Jan 1995
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of the effects of EMLA cream and topical 5% lidocaine on discomfort during gingival probing.
This investigation compared the use of a 5% eutectic mixture of local anesthetics (EMLA) cream to a "standard" intraoral topical anesthetic (5% lidocaine) as a means of anesthetizing the gingival sulcus in a double-blind, split-mouth study with human volunteers. A 5-min application of EMLA in a customized intraoral splint resulted in a significant increase in the depth of probing of the gingival sulcus without discomfort compared to a similar application of 5% lidocaine. Following application of EMLA, the pain-free probing depth measured at three sites in the upper premolar region increased by a mean total of 2.8 mm compared to an increase of 1.9 mm with lidocaine. This study suggests EMLA may be advantageous in providing periodontal anesthesia where manipulation of the gingiva is necessary.