Anesthesia progress
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Anesthesia progress · Nov 1985
Comparative StudyA comparison of postoperative recovery times between isoflurane and enflurane for pediatric dental outpatient anesthesia.
Isoflurane is a volatile liquid anesthetic agent reported to have recovery times shorter than many anesthetic agents in current use. This study compared postoperative recovery times in pediatric patients receiving dental treatment under isoflurane to those receiving enflurane anesthesia. The study consisted of a retrospective review of anesthesia records for pediatric patients receiving isoflurane anesthesia. ⋯ The average recovery time (as measured from extubation to discharge) for isoflurane was 53 minutes and for enflurane, 46 minutes. When the matched cases were analyzed by paired t-text, no statistically significant difference in recovery times was demonstrated at the 0.05 level. These findings suggest that there is no significant difference in postoperative recovery times between isofluane and enflurane in pediatric dental outpatients undergoing general anesthesia.
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The management of drug-induced emergencies in the dental office is based on vigilance in monitoring, early detection of premorbid events, and sequential application of the "ABCs" of basic cardiac life support. The steps for treating serious adverse reactions which can occur in the dental office are reviewed. Procedures to minimize adverse drug reactions are emphasized, and the appropriate drugs and doses to use are summarized.
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Despite numerous reviews and clinical reports, much remains to be learned about the cause, treatment, and prevention of malignant hyperthermia. Among the most worrisome concerns of the clinician administering anesthesia is the malignant hyperthermia crisis. ⋯ The exact triggering mechanisms of malignant hyperthermia (MH) in humans are not known, but a crisis can be initiated by volatile general anesthetics, neuromuscular blocking agents, and amide local anesthetics. Although a history of an MH crisis is a diagnostic aid, previous uneventful exposure to anesthesia does not guarantee the safety of the patient in subsequent anesthetic procedures.(1) For these reasons, it is important for the anesthesiologist to be aware of the initial signs of MH and to be prepared to provide immediate treatment to reverse such a crisis.
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Since the use of narcotics was initially advocated 28 years ago, serious adverse reactions, including fatalities, have been reported. At least four factors appear to contribute to these reactions: multiple drug administration, excessive dosage, inadequate monitoring, and ineffectual emergency care. Because of the relatively high incidence of life-threatening reactions and the complexity of the required emergency care, the routine use of pediatric sedation techniques that require large doses of narcotics cannot be advocated for use in the private office.