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
Practice Guideline GuidelineChanges in guidelines for cardiopulmonary resuscitation and emergency cardiac care.
At the Fifth National Conference on Cardiopulmonary Resuscitation and Emergency Cardiac Care held in Dallas in February 1992, changes in the guidelines for basic life support and advanced cardiac life support were recommended. These changes are defined and explained in this article.
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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.
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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.