Anesthesia progress
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Anesthesia progress · Jan 2004
Randomized Controlled Trial Clinical TrialA randomized controlled trial comparing mandibular local anesthesia techniques in children receiving nitrous oxide-oxygen sedation.
The aim of this study was to test the hypothesis that dental pain control using infiltration/intrapapillary injection was less effective than inferior alveolar block/long buccal infiltration anesthesia in children. A total of 101 healthy children, aged 5-8 years, who had no contraindication for local anesthetic and who needed a pulpotomy treatment and stainless steel crown placement in a lower primary molar were studied. A 2-group randomized blinded controlled design was employed comparing the 2 local anesthesia techniques using 2% lidocaine, 1:100,000 epinephrine. ⋯ Nine percent of children required supplementary local anesthetic: 4 of 52 (7.7%) in the block/long buccal group and 5 of 49 (10.2%) in the infiltration/intrapapillary group (P = .07). The hypothesis that block/long buccal would be more effective than infiltration/intrapapillary was not supported. There was no difference in pain control effectiveness between infiltration/intrapapillary injection and inferior alveolar block/long buccal infiltration using 2% lidocaine with 1:100,000 epinephrine when mandibular primary molars received pulpotomy treatment and stainless steel crowns.
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Anesthesia progress · Jan 2004
Randomized Controlled Trial Clinical TrialThe feasibility of bispectral index monitoring for intravenous sedation during dental treatment.
Intravenous sedation during dental treatment is primarily used in outpatient clinics. Maintenance of a level of sedation sufficient to allow treatment while using the minimum dose possible and to induce faster waking is very important. The benefits of bispectral index monitoring have recently been reported for many applications, and it is expected to prove useful in intravenous sedation during dental treatment. ⋯ Thus, we investigated the usefulness of bispectral index monitoring for patients under intravenous sedation during dental treatment. The incidence of "good" electroencephalograms, for which the electromyogram was less than 50 dB, signal quality index was more than 25%, and impedance was less than 10 kOhms, was 82.4% +/- 9.2%. These findings suggest that bispectral index monitoring will prove effective for intravenous sedation during dental treatment.
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Anesthesia progress · Jan 2004
ReviewDental anesthesia management of methemoglobinemia-susceptible patients: a case report and review of literature.
A healthy but slightly pale 24-year-old female patient with a history of "turning blue" following dental procedures performed under local anesthesia claimed allergies to sulfa drugs, aspirin, Benadryl, and "all caines." The patient also acknowledged mild cyanosis after extreme exertion, Native American ancestry, and a 1996 diagnosis of methemoglobinemia following administration of a sulfa drug. Previous medical and dental records were reviewed. Restoration of several teeth and extraction of 2 third-molar teeth were completed under general anesthesia. ⋯ Vital signs, including pulse oximetry, remained stable, and the patient was dismissed after a 2-hour recovery/observation period. The patient experienced no postoperative complications. This case report provides a review of literature and clinical guidelines for management of methemoglobinemia-susceptible patients.
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Anesthesia progress · Jan 2004
Clinical TrialEffects of a midazolam-ketamine admixture in human volunteers.
As the ideal sedative does not exist for all situations, we examined the effect of a midazolam-ketamine sedoanalgesic admixture in human volunteers. Ten ASA physical status I volunteers were administered loading doses of 0.07 mg/kg of midazolam followed by 0.7 mg/kg of ketamine. The same amount of midazolam and ketamine was then infused constantly over 1 hour via a 60 drops (gtts)/mL i.v. infusion set. ⋯ Plasma dopamine levels remained unchanged. There were no cases of unpleasant dreaming, dysphoria, or emergence-type reactions. This combined nonnarcotic sedoanalgesic technique maintains spontaneous ventilation and stable cardiorespiratory parameters and may be considered as an alternative to traditional conscious sedation or general anesthesia.
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Anesthesia progress · Jan 2004
Noninvasive assessment of diffusion hypoxia following administration of nitrous oxide-oxygen.
The phenomenon of diffusion hypoxia is commonly believed to occur unless nitrous oxide-oxygen inhalation sedation is followed by "washout" with 100% oxygen for 5 minutes upon termination of the flow of nitrous oxide. When systematically studied, however, this phenomenon generally appears to be unfounded. ⋯ The occurrence of hypoxia was determined objectively, using pulse oximetry and a standardized psychomotor skills test (Trieger test). Diffusion hypoxia was not observed using these criteria.