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jtitle_s:("anesti Prog")
1.  Drugs Used for Parenteral Sedation in Dental Practice 
Anesthesia Progress  1988;35(5):199-205.
The relative efficacy and safety of drugs and combinations used clinically in dentistry as premedicants to alleviate patient apprehension are largely unsubstantiated. To evaluate the efficacy and safety of agents used for parenteral sedation through controlled clinical trials, it is first necessary to identify which drugs, doses, and routes of administration are actually used in practice. A survey instrument was developed to characterize the drugs used clinically for anesthesia and sedation by dentists with advanced training in pain control. A random sample of 500 dentists who frequently use anesthesia and sedation in practice was selected from the Fellows of the American Dental Society of Anesthesiology. The first mailing was followed by a second mailing to nonrespondents after 30 days. The respondents report a variety of parenteral sedation techniques in combination with local anesthesia (the response categories are not mutually exclusive): nitrous oxide (64%), intravenous conscious sedation (59%), intravenous “deep” sedation (47%), and outpatient general anesthesia (27%). Drugs most commonly reported for intravenous sedation include diazepam, methohexital, midazolam, and combinations of these drugs with narcotics. A total of 82 distinct drugs and combinations was reported for intravenous sedation and anesthesia. Oral premedication and intramuscular sedation are rarely used by this group. Most general anesthesia reported is done on an outpatient basis in private practice. These results indicate that a wide variety of drugs is employed for parenteral sedation in dental practice, but the most common practice among dentists with advanced training in anesthesia is local anesthesia supplemented with intravenous sedation consisting of a benzodiazepine and an opioid or a barbiturate.
PMCID: PMC2167868  PMID: 3250279
3.  Plasma Epinephrine Levels and Cardiovascular Response to High Administered Doses of Epinephrine in Local Anesthesia 
Anesthesia Progress  1987;34(1):10-13.
The effects of administering an epinephrine-containing local anesthetic on plasma catecholamine levels and cardiovascular parameters were evaluated. Significant elevations were observed following administration of 8 dental cartridges of 2% lidocaine with epinephrine 1:100,000 (144 μg) throughout the 20 minute observation period, while minimal changes were observed in the patients who received 6 cartridges of 3% mepivicaine. One minute after injection, the mean plasma epinephrine level in the group receiving epinephrine was 27.5 times higher than baseline. Concurrent elevations in systolic pressure (15%), heart rate (33%), and the rate-pressure product (52%) were also observed. These results indicate that significant amounts of epinephrine can be systemically absorbed following intraoral injection and the absorbed epinephrine can alter the cardiovascular status of the patient.
PMCID: PMC2186227  PMID: 3472472
4.  Comparison of Conorphone, A Mixed Agonist-Antagonist Analgesic, to Codeine for Postoperative Dental Pain 
Anesthesia Progress  1984;31(2):77-81.
The analgesic efficacy of two doses of conorphone (20 and 40 mg), a mixed agonist-antagonist analgesic, were compared to two doses of codeine for postoperative pain in the oral surgery model. Each subject received 2 of the 4 possible treatment at two separate sessions in an incomplete block, single crossover design. Both doses of conorphone and the 60 mg dose of codeine were superior to 30 mg of codeine for the various indices of analgesic activity. The 40 mg dose of conorphone resulted in a high incidence of side effects (25/30 subjects) such as drowsiness, dizziness, nausea and vomiting. The low dose of conorphone resulted in side effects similar to 60 mg of codeine with the exception of a greater incidence of drowsiness. These data suggest that while 40 mg of conorphone may not be well tolerated clinically, 20 mg of conorphone may be an alternative to 60 mg of codeine for postoperative pain.
PMCID: PMC2515536  PMID: 6597688
5.  Prospective Study of Venous Complications Following Intravenous Diazepam in Dental Outpatients* 
Anesthesia Progress  1981;28(5):126-128.
The incidence of venous complications following intravenous diazepam administered to 190 dental out-patients was investigated in a prospective, randomized study. The administration into the smaller veins of the hand and forearm resulted in a significant increase in the incidence of thrombophlebitis. Use of a plastic catheter in place of an infusion needle or flushing with 150 ml of saline did not alter the incidence of venous complications. These results suggest that use of the larger veins of the antecubital fossa can lower the incidence of venous complications encountered in clinical practice following the intravenous administration of diazepam. These findings also suggest that use of a plastic catheter or post-drug administration flushing with saline does not affect the incidence of venous complications.
PMCID: PMC2516458  PMID: 6950674
6.  Survey of Curriculum and Instruction: Continuing Education Courses in Pain Control* 
Anesthesia Progress  1977;24(6):198-204.
Pain and anxiety control is taught at the continuing education level in a large number of diverse courses. This paper reports the results of a survey of those courses held in 1976. The majority of courses centered on the use of inhalation or intravenous sedation. Relatively few courses were offered on the other aspects of pain and anxiety control. Very little attempt is being made at formally evaluating the competence of participants in these courses. Few courses appear to adequately cover the prevention and management of complications. Suggestions for changes in the teaching of pain and anxiety control at the continuing education level are made based on these findings.
Pain and anxiety control encompasses the application of various physical, chemical and psychological modalities in the prevention and treatment of peri-operative patient apprehension and pain. Patient apprehension about dental procedures is felt to influence the seeking of remedial and preventive dental care by a significant portion of the population. Efforts to improve the training of dentists in pain and anxiety control modalities have included several workshops sponsored by the American Dental Society of Anesthesia, the formulation of guidelines for courses at the predoctoral, postdoctoral and continuing education levels, and the establishment of postdoctoral pain control training programs at several dental schools.
Recent graduates have been trained in pain control in predoctoral programs which vary widely in content and length. A large number of practitioners seek training in pain control through continuing education courses offered by dental schools, hospitals and a variety of other institutions. This paper reports the results of a survey of these courses and suggests several recommendations based on the findings.
PMCID: PMC2516152  PMID: 276282

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