Anesthesia progress
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Midazolam is increasingly being used for oral sedation in pediatric dentistry. Unfortunately, it is available only as a parenteral formulation in Canada and the United States. Preparation of the parenteral solution for oral use is not uniform and leads the clinician to question the stability of this drug when used in conjunction with these vehicles. ⋯ Over the 102-day study period, there was no significant change in concentration in any of the solutions. On day 102, the remaining midazolam was within 7% of the day zero concentration. Therefore, these formulations of midazolam are stable at room temperature for a period of 102 days and would be suitable for clinical use.
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Anesthesia progress · Jan 1997
Case ReportsIntraoperative damage and correction of pilot balloon during orthognathic surgery.
A case of intraoperative damage to the nasotracheal tube pilot balloon and its correction is discussed.
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Anesthesia progress · Jan 1997
Timing and side effects of flumazenil for dental outpatients receiving intravenous sedation with midazolam.
We studied the timing and side effects of flumazenil treatment for 10 healthy volunteers and 46 dental outpatients who received intravenous sedation with midazolam. For the volunteers, vital signs were monitored before and after intravenous injection of midazolam and flumazenil. In addition, grip strength, signs and symptoms, and performance on the Romberg's test and addition tests were evaluated 30 min and 60 min after midazolam injection as well as after flumazenil injection. ⋯ One patient in group S had drowsiness that did not resolve after injection of flumazenil and continued until the following day. Our results indicate that flumazenil should be given at least 60 min after intravenous sedation with midazolam in dental outpatients. Moreover, caution should be exercised with regard to the potential side effects of flumazenil.
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When using a nasal cannula to sample gases expired by a patient, air from the room may dilute the sample. For this reason, the accuracy of the partial pressure of end-tidal carbon dioxide (ETCO2) measurements is questionable. We experimentally examined the reliability of ETCO2 measurements through a nasal cannula and found that they depended on both biological factors (tidal volume and respiratory rates) and mechanical factors (the diameter and the length of the cannula and the diameter of the prongs). These results suggest that the correct use of an appropriate sampling cannula will provide reliable ETCO2 measurements without clinical problems.
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Anesthesia progress · Jan 1997
The incidence of complications associated with local anesthesia in dentistry.
Local anesthetics are frequently administered in dentistry and thus can be expected to be a major source of drug-related complications in the dental office. Additionally, the dentist will more often be confronted with the treatment of risk patients; thus, the incidence of side effects can be expected to rise. In this study, 2731 patients receiving dental anesthesia were evaluated by questionnaire for risk factors, type and dosage of local anesthetic applied, type and duration of treatment, and complications associated with the administration of the local anesthetic. ⋯ Additionally, doses of local anesthetics proved not to be strictly determined according to body weight, especially for patients weighing less than 50 kg. In summary, it can be stated that dental local anesthesia can be considered safe. Nevertheless, the incidence of complications due to dental anesthesia can be expected to be further reduced if (a) patients are routinely evaluated for risk factors with an adequate medical history prior to dental treatment, (b) doses of local anesthetics are strictly determined according to body weight, (c) anesthetics with low concentrations of epinephrine are used, and (d) the concept of a differentiated dental anesthesia is applied.