Anesthesia progress
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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.
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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
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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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
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.