Journal of oral surgery (American Dental Association : 1965)
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Postoperative analgesic requirements of a series of 45 patients who underwent orthognathic surgery are presented. Of the first 25 patients treated before a minimal analgesic protocol was begun, 21 received narcotic medication for relief of discomfort. In the second group of 20 patients, five received mild analgesics and one received a narcotic. A combination of factors such as paresthesia, immobilization, premedication, steroids, and residual effects of general anesthetic agents probably contributed to the relative lack of severe pain after orthognathic surgery.
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Malignant hyperthermia is a life-threatening complication of general anesthesia. Its cause is not precisely known but it appears to be related to a genetic defect that allows increased release or decreased reaccumulation of calcium by the sarcoplasmic reticulum whech then results in a hypermetabolic state. As with any unexpected complication when a patient is under general anesthesia, early diagnosis and treatment are essential. ⋯ Therapy should be accurate and immediate. The essentials of therapy are discontinuance of the anesthetic agent; immediate, active, and aggressive cooling; administration of procaine or procaine amide, 1 mg/kg/min until the pulse slows; correction of electrolyte and acid-base imbalances; maintenance of urinary output with furosemide and large volumes of fluids, intravenously; and supportive care. A thorough knowledge of the management of malignant hyperthermia ahd the pathophysiology of the complications that may occur with general anesthesia will allow the oral surgeon to fully meet his obligations to his patients.
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Enflurane was administered to 100 unselected patients undergoing various oral surgical procedures. The anesthetic provided smooth induction, maintenance, and rapid recovery. ⋯ Postanesthesia incidences of nausea, vomiting, and excitement were minimal. Our experience suggests that enflurane may be the preferred anesthetic agent both for minor dental procedures in outpatients as well as for major oral surgical procedures in hospitalized patients.