Anesthesia progress
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Anesthesia progress · Jan 2009
ReviewPerioperative management of the glucose-6-phosphate dehydrogenase deficient patient: a review of literature.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells in humans. It is estimated that about 400 million people are affected by this deficiency. The G6PD enzyme catalyzes the first step in the pentose phosphate pathway, leading to antioxidants that protect cells against oxidative damage. ⋯ The most effective management strategy is to prevent hemolysis by avoiding oxidative stressors. Thus, management for pain and anxiety should include medications that are safe and have not been shown to cause hemolytic crises, such as benzodiazepines, codeine/codeine derviatives, propofol, fentanyl, and ketamine. The authors of this article make 5 particular recommendations: (1) Anyone suspected of G6PD deficiency should be screened; (2) exposure to oxidative stressors in these individuals should be avoided; (3) these patients should be informed of risks along with signs and symptoms of an acute hemolytic crisis; (4) the clinician should be able to identify both laboratory and clinical signs of hemolysis; and finally, (5) if an acute hemolytic crisis is identified, the patient should be admitted for close observation and care.
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Anesthesia progress · Jan 2009
Randomized Controlled TrialEffect of time on clinical efficacy of topical anesthesia.
The objective of this study was to determine the effect of time on the clinical efficacy of topical anesthetic in reducing pain from needle insertion alone as well as injection of anesthetic. This was a randomized, double-blind, placebo-controlled, split-mouth, clinical trial which enrolled 90 subjects, equally divided into 3 groups based upon time (2, 5, or 10 minutes) of topical anesthetic (5% lidocaine) application. Each group was further subdivided into 2: needle insertion only in the palate or needle insertion with deposition of anesthetic (0.5 mL 3% mepivacaine plain). ⋯ For needle insertion plus injection of local anesthetic, a significant difference in mean VAS was noted only after 10 minutes (14.9 mm, P < .031), yet pain scores for both topical anesthetic and placebo were elevated at this time point resulting in no reduction in actual pain. Time of application did not result in a significant difference in effect for either needle insertion only or needle insertion plus injection of local anesthetic, as analyzed by 1-way analysis of variance (ANOVA). In conclusion, topical anesthetic reduces pain of needle insertion if left on palatal mucosa for 2, 5, or 10 minutes, but has no clinical pain relief for anesthetic injection.
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Anesthesia progress · Jan 2009
Randomized Controlled Trial Comparative StudyPsychosedation with dexmedetomidine hydrochloride during minor oral surgery.
We performed intravenous sedation with dexmedetomidine hydrochloride during minor oral surgery and compared this agent with propofol. Patients were randomly divided into 2 groups: dexmedetomidine hydrochloride (D) and propofol (P) groups. In Group D, systolic blood pressure (SBP) increased immediately after the start of initial loading, although no significant differences were noted. ⋯ During maintenance administration, marked changes were observed in this parameter. No marked differences in amnestic effects and comfort were noted between the 2 groups. If the sedation level can be evaluated accurately via another objective method, intravenous sedation with dexmedetomidine hydrochloride may be useful in dental treatment.
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Anesthesia progress · Jan 2009
Case ReportsUse of masseteric and deep temporal nerve blocks for reduction of mandibular dislocation.
A patient presented with a unilateral dislocated condyle that was resistant to reduction by simple manual manipulation because of elevator muscle spasm and severe muscle and temporomandibular joint pain. A technique involving a masseteric nerve block and a temporal nerve block was used, allowing a quick, safe, and minimally painful reduction. The method used for delivering these nerve blocks is described here.
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The American Dental Association and several dental specialty organizations have published guidelines that detail requirements for monitoring patients during various levels of sedation and, in some cases, general anesthesia. In general, all these are consistent with those guidelines suggested by the American Society of Anesthesiologists for sedation and analgesia by nonanesthesiologists. ⋯ While monitoring per se is a technical issue, an appreciation of its purpose and the interpretation of the information provided require an understanding of respiratory anatomy and physiology. The focus of this continuing education article is to address the physiological aspects of respiration and to understand the appropriate use of monitors, including the interpretation of the information they provide.