Anesthesia progress
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Anesthesia progress · Jan 2007
An alternative approach to the monitoring of respiration by dynamic air-pressure sensor.
Monitoring and assessing of patient respiratory function during conscious sedation are important because many drugs used for conscious sedation produce respiratory depression and subsequent hypoventilation. The purpose of this study is to assess the value of a dynamic air-pressure sensor for respiratory monitoring of clothed patients. Eight clothed adult volunteers were reclined on a dental chair positioned horizontally. ⋯ A strong correlation between TV(exp) and integral P(exp) was observed in all subjects. Measuring integral P(exp) by dynamic air-pressure sensor makes it possible to estimate respiratory volume breath by breath, and the respiratory pressure-time integral waveform was useful in visually monitoring the respiration pattern. We believe that in the future this device will be used to monitor respiratory physiology in clothed patients, contributing to safer sedative procedures.
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Nitrous oxide (N(2)O) has been used for well over 150 years in clinical dentistry for its analgesic and anxiolytic properties. This small and simple inorganic chemical molecule has indisputable effects of analgesia, anxiolysis, and anesthesia that are of great clinical interest. Recent studies have helped to clarify the analgesic mechanisms of N(2)O, but the mechanisms involved in its anxiolytic and anesthetic actions remain less clear. ⋯ The anxiolytic effect of N(2)O, on the other hand, resembles that of benzodiazepines and may be initiated at selected subunits of the gamma-aminobutyric acid type A (GABA(A)) receptor. Similarly, the anesthetic effect of N(2)O may involve actions at GABA(A) receptors and possibly at N-methyl-D-aspartate receptors as well. This article reviews the latest information on the proposed modes of action for these clinical effects of N(2)O.
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Anesthesia progress · Jan 2007
Randomized Controlled TrialAnesthetic efficacy of buccal and lingual infiltrations of lidocaine following an inferior alveolar nerve block in mandibular posterior teeth.
The authors, using a crossover design, randomly administered, in a single-blind manner, 3 sets of injections: an inferior alveolar nerve block (IANB) plus a mock buccal and a mock lingual infiltration of the mandibular first molar, an IANB plus a buccal infiltration and a mock lingual infiltration of the mandibular first molar, and an IANB plus a mock buccal infiltration and a lingual infiltration of the mandibular first molar in 3 separate appointments spaced at least 1 week apart. An electric pulp tester was used to test for anesthesia of the premolars and molars in 3-minute cycles for 60 minutes. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes following completion of the injection sets, and the 80 reading was continuously sustained for 60 minutes. ⋯ For the IANB plus mock buccal infiltration and lingual infiltration, successful pulpal anesthesia ranged from 54 to 76% from the second molar to second premolar. There was no significant difference (P > .05) in anesthetic success between the IANB plus buccal or lingual infiltrations and the IANB plus mock buccal infiltration and mock lingual infiltration. We conclude that adding a buccal or lingual infiltration of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine to an IANB did not significantly increase anesthetic success in mandibular posterior teeth.
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Anesthesia progress · Jan 2007
Case ReportsAnesthetic management of the trigeminocardiac reflex during mesiodens removal-a case report.
We describe a case in which reflection of a palatal flap for removal of a mesiodens is presented as the triggering factor for bradycardia caused by stimulation of the trigeminocardiac reflex. The management of the case, as well as the reflex arc, is discussed.