Anesthesia & pain control in dentistry
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Anesth Pain Control Dent · Jan 1993
ReviewCirculatory effects of vasoconstrictors combined with local anesthetics.
Vasoconstrictors are clinically used as adjuvants to local anesthetics to improve anesthetic action and to minimize local bleeding. Accidental intravascular injection or rapid systemic absorption of vasoconstrictors can induce a number of potentially life-threatening circulatory risks, which are described in this paper.
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Anesth Pain Control Dent · Jan 1993
Case ReportsAn anaphylactoid reaction following local anesthesia: a case report.
A case report of an adverse reaction to a preparation of an amide local anesthetic, prilocaine with epinephrine, is presented. Signs and symptoms were consistent with an anaphylactic reaction and the patient responded positively to treatment based on this assumption. Treatment included administration of epinephrine injected sublingually and oxygen by inhalation. ⋯ A number of explanations are possible and a final diagnosis of an anaphylactoid reaction was made. Local anesthetic allergies and their management are reviewed. The literature demonstrates that an allergic reaction to amide local anesthetics can occur and a thorough history, intradermal testing, and subcutaneous challenge are reasonable approaches to determine a safe agent for subsequent use.
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Arterial oxygen saturation (SaO2) was monitored postoperatively with pulse oximetry in 80 dental patients receiving nitrous oxide and oxygen. These patients were divided into four equal groups, three of which received nitrous oxide (N2O) and oxygen (O2) in ratios of 20:80, 40:60, and 60:40, respectively. The fourth group received 100% O2 and served as the control. ⋯ One patient in the 40% N2O group experienced an SaO2 of less than 90%, but no patient experienced clinically significant hypoxia. In the 40% and 60% N2O groups, the percent change of SaO2 from the baseline was greater, and the SaO2 returned to baseline slower. The difference in mean SaO2 between smokers and nonsmokers was greater in the 40% N2O group.
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This case demonstrates the necessity of adequate emergency management during dental treatment. A 57-year-old man loses consciousness immediately after the injection of a dental local anesthetic. For medical assistance, a neighboring general practitioner is first telephoned without success. ⋯ Finally, an emergency doctor is dispatched and arrives approximately 35 minutes after the emergency situation began. The electrocardiogram shows a supraventricular tachycardia which, after an immediate cardioversion, converts to a sinus rhythm connected with a restoration of the circulatory function. This case exemplifies the consequences of an inadequate response to a sudden emergency.
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Anesth Pain Control Dent · Jan 1993
Prevention of anaphylactic-anaphylactoid reactions to anesthetics in high-risk allergic patients.
To confirm the role of preventive procedures in high-risk allergic patients, immunological tests in vivo for anesthetics were carried out in 251 atopic patients. The 6-month follow-up showed a complete absence of adverse reactions during the clinical use of hypnotic and muscle relaxant drugs. In the case of local anesthetics, five adverse reactions were observed after dental treatment--four were related to a psychogenic mechanism, and one could not be clearly linked to the local anesthetic. It is possible to confirm that the use of a tested drug that yields negative results has a lower probability of inducing anaphylactic-anaphylactoid reactions during anesthesia.