Anesthesia progress
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Anesthesia progress · Jan 1997
Comparative Study Clinical Trial Controlled Clinical TrialComparison of lidocaine with and without bupivacaine for local dental anesthesia.
The purpose of this study was to investigate the effectiveness of a combination of bupivacaine and lidocaine and that of lidocaine alone for local dental anesthesia. First, on different days, healthy volunteers were given 2% lidocaine with 1/80,000 epinephrine or 2% lidocaine with 1/80,000 epinephrine + 0.5% bupivacaine, after which pain was produced with a pulp tester. No difference was found in the time until onset of anesthetic effect between the preparations. ⋯ The mean maximal serum concentration of lidocaine was higher in patients receiving lidocaine alone (1.77 +/- 0.03 microgram/ml) than in those receiving both anesthetics (0.99 +/- 0.45 microgram/ml). Furthermore, the mean plasma concentration of epinephrine 1 min after injection was significantly higher in patients receiving lidocaine alone (0.671 ng/ml) than in patients receiving both lidocaine and bupivacaine (0.323 ng/ml). The results of this study suggest that the combination of lidocaine with epinephrine and bupivacaine produces lower systemic levels of the anesthetic and epinephrine and a longer duration of activity than lidocaine with epinephrine alone for local dental anesthesia.
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Anesthesia progress · Jan 1997
Meta Analysis Comparative StudyThe efficacy of nonopioid analgesics for postoperative dental pain: a meta-analysis.
The evidence for the efficacy of nonopioid analgesics in the dental pain model was examined by conducting a meta-analysis. Studies were obtained by searching the literature from August 1996 back to 1975 using the terms pain, analgesics, and dentistry. This led to the review of 294 articles, of which 33 studies met the inclusion criteria. ⋯ Collectively, therapeutic doses of the nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used in dentistry were significantly more efficacious than the combination of acetaminophen (600 or 650 mg) with codeine (60 mg). Similarly, specific doses of each of diflunisal, flurbiprofen, ibuprofen, and ketorolac were significantly more efficacious than the commonly used acetaminophen-codeine combination. These quantitative results show that particular NSAIDs may be more efficacious than the acetaminophen-codeine combination for relief of postoperative dental pain.
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Anesthesia progress · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialA pilot study comparing ketoprofen and acetaminophen with hydrocodone for the relief of postoperative periodontal discomfort.
The aim of this study was to compare ketoprofen to acetaminophen with hydrocodone (A/H) in a postoperative periodontal pain model. A double-blind protocol was used. Thirty minutes prior to each procedure, subjects were given orally either 100 mg ketoprofen or a placebo tablet. ⋯ A/H provided significantly better pain relief at Hours 5 and 6, while overall discomfort levels were significantly higher with ketoprofen than with placebo at Hours 3 and 4. Pain levels were low for both groups. It is recommended that additional analgesics for mild to moderate pain should be tested.
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Anesthesia progress · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialAvoidance of nitrous oxide and increased isoflurane during alfentanil based anesthesia decreases the incidence of postoperative nausea.
Postoperative nausea and vomiting have been associated with the use of nitrous oxide. Alfentanil, when combined with nitrous oxide, also results in a high incidence of postoperative nausea and vomiting. To further define this emesis-potentiating effect of N2O, 119 patients were chosen for study and divided into two groups: group A (n = 59) was administered a mixture of alfentanil, N2O, and O2 with 0.25% isoflurane, group B (n = 60) was administered a mixture of oxygen, room air, isofluorane, and alfentanil. ⋯ The incidence of vomiting was 5% (3/60) in group B and 15% (8/59) in group A (P = 0.067). Forty-four percent (26/59) of the patients in group A and 20% (12/59) in group B were nauseated postoperatively (P = 0.005). Our data suggest that elimination of N2O from alfentanil-based anesthetics lessens the incidence of nausea.
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Anesthesia progress · Jan 1997
Review Case ReportsOxygen desaturation in a child receiving a combination of ketamine and midazolam for dental extractions.
A combination of 0.35 mg/kg midazolam and 5 mg/kg ketamine, administered orally for pediatric sedation, resulted in a severe decreases in blood oxygen saturation postoperatively. The patient, a 2-yr-old child, did not respond to command or mild physical stimulation in the recovery room 60 min after receiving the drugs. ⋯ No adverse effects were observed thereafter, and the postoperative recovery was uneventful. Combining different classes of drugs may result in less variability in patients response, but there is a greater potential for drug-induced side effects and drug interactions.