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jtitle_s:("anesti Prog")
1.  Who Should Have Access to the Controlled Substances in Your Office 
Anesthesia Progress  2009;56(4):113-114.
doi:10.2344/0003-3006-56.4.113
PMCID: PMC2796379  PMID: 20020790
2.  The Effect of Local Anesthetic on Quality of Recovery Characteristics Following Dental Rehabilitation Under General Anesthesia in Children 
Anesthesia Progress  2009;56(4):115-122.
This study is a randomized, prospective, double-blind study to evaluate the effects of the combination of local anesthetics and an intravenous nonsteroidal anti-inflammatory drug (NSAID) vs NSAID alone on quality of recovery following dental rehabilitation under general anesthesia (GA). Twenty-seven healthy children aged 3–5.5 years underwent dental rehabilitation under GA. Fifteen children in the experimental group received oral infiltration of local anesthetic in addition to intravenous ketorolac tromethamine, while 12 children in the control group received intravenous ketorolac tromethamine alone for postoperative pain management. Pain behaviors were evaluated immediately postoperatively using a FLACC scale and 4 hours postoperatively by self-report using various scales. Parents reported perception of child pain and comfort and any occurrences of postoperative cheek biting. The use of intraoral infiltration local anesthesia for complete dental rehabilitation under general anesthesia for children aged 3–5.5 years did not result in improved pain behaviors in the postanesthesia care unit (PACU), nor did it result in improved pain behaviors 4–6 hours postoperatively as measured by the FLACC scale, FACES scale, and subjective reports of parents or a PACU nurse. Those children receiving local anesthesia had a higher incidence of negative symptoms related to local anesthetic administration, including a higher incidence of lip and cheek biting, which was of clinical importance, but not statistically significant. Infiltration of local anesthetic for dental rehabilitation under general anesthesia did not improve quality of recovery in children aged 3–5.5 years.
doi:10.2344/0003-3006-56.4.115
PMCID: PMC2796380  PMID: 20020791
General anesthesia; Pediatric dental general anesthesia; Pain; Local anesthesia; Recovery quality
3.  Local and Systemic Toxicity of Intraoral Submucosal Injections of Phentolamine Mesylate (OraVerse) 
Anesthesia Progress  2009;56(4):123-127.
OraVerseTM, an injectable formulation of phentolamine mesylate (PM), was recently approved by the U.S. Food and Drug Administration (FDA) for reversal of anesthesia of the lip and tongue and associated functional deficits resulting from an intraoral submucosal injection of a local anesthetic containing a vasoconstrictor. Because PM had not been approved previously for submucosal administration, 2 Good Laboratory Practices (GLP) studies in dogs designed to investigate systemic toxicity and the local effects of single and repeated dosing of OraVerse on the inferior alveolar nerve and branches of the superior alveolar nerve and adjacent soft tissues after local administration were conducted. Systemic toxicity was measured by preinjection and postinjection clinical examinations, clinical chemistry, and gross and microscopic examinations of major organs after necropsy. No evidence of systemic toxicity was detected. Local nerve and adjacent tissue damage was assessed by conventional histopathology. Nerve degeneration was evident in 1 animal. Mild perineural inflammation adjacent to the inferior alveolar nerve and inflammatory exudates were observed in submucosal tissues in several animals. No changes were observed in the nerves at injection sites of dogs from any dose group that were considered directly related to the test articles. These data reveal that single and repeated intraoral administrations of OraVerse are well tolerated in beagle dogs.
doi:10.2344/0003-3006-56.4.123
PMCID: PMC2796381  PMID: 20020792
Anesthesia reversal; Local and systemic toxicity
4.  The Efficacy of a Repeated Buccal Infiltration of Articaine in Prolonging Duration of Pulpal Anesthesia in the Mandibular First Molar 
Anesthesia Progress  2009;56(4):128-134.
Previous studies have shown declining rates of pulpal anesthesia over 60 minutes when a cartridge of 4% articaine is used with 1∶100,000 epinephrine for buccal infiltration in the mandibular first molar. The authors conducted a prospective, randomized, single-blind, crossover study comparing the degree of pulpal anesthesia obtained with 2 sets of mandibular first molar buccal infiltrations, given in 2 separate appointments, to 86 adult subjects: an initial infiltration of a cartridge of 4% articaine with 1∶100,000 epinephrine plus a repeated infiltration of the same anesthetic and dose given 25 minutes following the initial infiltration versus an initial infiltration of a cartridge of 4% articaine with 1∶100,000 epinephrine plus a mock repeated infiltration given 25 minutes following the initial infiltration. The authors used an electric pulp tester to test the first molar for anesthesia in 3-minute cycles for 112 minutes after the injections. The repeated infiltration significantly improved pulpal anesthesia from 28 minutes through 109 minutes in the mandibular first molar. A repeated infiltration of a cartridge of 4% articaine with 1∶100,000 epinephrine given 25 minutes after an initial infiltration of the same type and dose of anesthetic significantly improved the duration of pulpal anesthesia, when compared with only an initial buccal infiltration, in the mandibular first molar.
doi:10.2344/0003-3006-56.4.128
PMCID: PMC2796382  PMID: 20020793
Infiltration; Articaine; Mandibular; Repeated infiltration
5.  Preoperative Medical Evaluation: Part 2: Pulmonary, Endocrine, Renal, and Miscellaneous Considerations 
Anesthesia Progress  2009;56(4):135-145.
A thorough assessment of a patient's medical status is standard practice when dental care is provided. Although this is true for procedures performed under local anesthesia alone, the information gathered may be viewed somewhat differently if the dentist is planning to provide sedation or general anesthesia as an adjunct to dental treatment. This article, the second of a 2-part sequence on preoperative assessment, will address pulmonary and other noncardiovascular disorders.
doi:10.2344/0003-3006-56.4.135
PMCID: PMC2796383  PMID: 20020794
Preoperative assessment; Medical history; Physical evaluation
6.  Continuing Education Program 
Anesthesia Progress  2009;56(4):146.
doi:10.2344/0003-3006-56.4.146
PMCID: PMC2796384
7.  JDSA JOURNAL ABSTRACTS 
Anesthesia Progress  2009;56(4):147-159.
doi:10.2344/0003-3006-56.4.147
PMCID: PMC2796385
8.  JDSA JOURNAL ABSTRACTS 
Anesthesia Progress  2009;56(3):105-108.
doi:10.2344/0003-3006-56.3.105
PMCID: PMC2749551
9.  CAN CONTINUING EDUCATION EVER BE HARMFUL? 
Anesthesia Progress  2009;56(3):73-74.
doi:10.2344/0003-3006-56.3.73
PMCID: PMC2749582  PMID: 19769419
10.  Perioperative Management of the Glucose-6-Phosphate Dehydrogenase Deficient Patient: A Review of Literature 
Anesthesia Progress  2009;56(3):86-91.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells in humans. It is estimated that about 400 million people are affected by this deficiency.1 The G6PD enzyme catalyzes the first step in the pentose phosphate pathway, leading to antioxidants that protect cells against oxidative damage.2 A G6PD-deficient patient, therefore, lacks the ability to protect red blood cells against oxidative stresses from certain drugs, metabolic conditions, infections, and ingestion of fava beans.3 The following is a literature review, including disease background, pathophysiology, and clinical implications, to help guide the clinician in management of the G6PD-deficient patient. A literature search was conducted in the following databases: PubMed, The Cochrane Library, Web of Science, OMIM, and Google; this was supplemented by a search for selected authors. Keywords used were glucose-6-phosphate dehydrogenase (G6PD) deficiency, anesthesia, analgesia, anxiolysis, management, favism, hemolytic anemia, benzodiazepines, codeine, codeine derivatives, ketamine, barbiturates, propofol, opioids, fentanyl, and inhalation anesthetics. Based on titles and abstracts, 23 papers and 1 website were identified. The highest prevalence of G6PD is reported in Africa, southern Europe, the Middle East, Southeast Asia, and the central and southern Pacific islands; however, G6PD deficiency has now migrated to become a worldwide disease. Numerous drugs, infections, and metabolic conditions have been shown to cause acute hemolysis of red blood cells in the G6PD-deficient patient, with the rare need for blood transfusion. Benzodiazepines, codeine/codeine derivatives, propofol, fentanyl, and ketamine were not found to cause hemolytic crises in the G6PD-deficient patient. The most effective management strategy is to prevent hemolysis by avoiding oxidative stressors. Thus, management for pain and anxiety should include medications that are safe and have not been shown to cause hemolytic crises, such as benzodiazepines, codeine/codeine derviatives, propofol, fentanyl, and ketamine. The authors of this article make 5 particular recommendations: (1) Anyone suspected of G6PD deficiency should be screened; (2) exposure to oxidative stressors in these individuals should be avoided; (3) these patients should be informed of risks along with signs and symptoms of an acute hemolytic crisis; (4) the clinician should be able to identify both laboratory and clinical signs of hemolysis; and finally, (5) if an acute hemolytic crisis is identified, the patient should be admitted for close observation and care.
doi:10.2344/0003-3006-56.3.86
PMCID: PMC2749581  PMID: 19769422
Glucose-6-phosphate dehydrogenase; G6PD; Blood disease; Blood deficiency; G6PD deficiency; G6PD management; Favism; Hemolysis; Hemolytic crisis; Anemia
11.  Psychosedation With Dexmedetomidine Hydrochloride During Minor Oral Surgery 
Anesthesia Progress  2009;56(3):75-80.
We performed intravenous sedation with dexmedetomidine hydrochloride during minor oral surgery and compared this agent with propofol. Patients were randomly divided into 2 groups: dexmedetomidine hydrochloride (D) and propofol (P) groups. In Group D, systolic blood pressure (SBP) increased immediately after the start of initial loading, although no significant differences were noted. Both SBP and diastolic blood pressure (DBP) gradually decreased during maintenance administration and were significantly lower than pretreatment values. The heart rate decreased immediately after the start of administration and was significantly lower during both initial loading and maintenance administration; the heart rate was also significantly lower than that in Group P. In Group D, arterial blood oxygen saturation (SpO2) significantly decreased after the sedation level reached an optimum level until the end of administration. The bispectral index (BIS) value gradually decreased during initial loading. At the optimal sedation level, it decreased to 80 to 85. During maintenance administration, marked changes were observed in this parameter. No marked differences in amnestic effects and comfort were noted between the 2 groups. If the sedation level can be evaluated accurately via another objective method, intravenous sedation with dexmedetomidine hydrochloride may be useful in dental treatment.
doi:10.2344/0003-3006-56.3.75
PMCID: PMC2749586  PMID: 19769420
Intravenous sedation; Dexmedetomidine; Hydrocholoide; Minor oral surgery
12.  Preoperative Medical Evaluation: Part 1: General Principles and Cardiovascular Considerations 
Anesthesia Progress  2009;56(3):92-103.
A thorough assessment of a patient's medical status is standard practice when dental care is provided. Although this is true for procedures performed under local anesthesia alone, the information gathered may be viewed somewhat differently if the dentist is planning to use sedation or general anesthesia as an adjunct to dental treatment. This article is the first of a 2-part sequence and will address general principles and cardiovascular considerations. A second article will address pulmonary, metabolic, and miscellaneous disorders.
doi:10.2344/0003-3006-56.3.92
PMCID: PMC2749585  PMID: 19769423
Preoperative assessment; Medical history; Physical evaluation
13.  Continuing Education Program 
Anesthesia Progress  2009;56(3):104.
doi:10.2344/0003-3006-56.3.104
PMCID: PMC2749584
14.  Comparative Efficacy of 2 Topical Anesthetics for the Placement of Orthodontic Temporary Anchorage Devices 
Anesthesia Progress  2009;56(3):81-85.
This study compared the effectiveness of topical benzocaine 20% versus a combination of lidocaine, tetracaine, and phenylephrine in providing sufficient analgesia for the placement of orthodontic temporary anchorage devices (TADs). The 2 topical anesthetics were tested against each other bilaterally using a randomized, double-blind, crossover design. The agents were left in place for the amount of time prescribed by the manufacturer. The TAD was then placed, and each subject rated the degree of pain on a Heft-Parker visual analogue scale. A pulse oximeter was used to record the preoperative and postoperative pulse rates. Statistically significant differences in perceived pain (P < .05) and success rate (P < .01) between drugs were seen, but no significant difference in pulse rate change between the topical anesthetics was observed (P > .05). It was concluded that when the efficacy of topical benzocaine and of a combination product was compared as the sole anesthetic to facilitate acceptable pain control for placement of orthodontic temporary anchorage devices, the combination product was considerably more efficacious.
doi:10.2344/0003-3006-56.3.81
PMCID: PMC2749583  PMID: 19769421
Orthodontic temporary anchorage devices; Topical anesthesia; Topical anesthetics; Lidocaine; Tetracaine; Benzocaine; Phenylephrine
16.  AMERICAN SOCIETY OF DENTIST ANESTHESIOLOGISTS ANNOUNCES NEW BOARD OF DIRECTORS 
Anesthesia Progress  2009;56(2):70.
doi:10.2344/0003-3006-56.2.70
PMCID: PMC2699698
17.  Correction 
Anesthesia Progress  2009;56(2):69.
doi:10.2344/0003-3006-56.2.69
PMCID: PMC2699697
18.  INFORMATION FOR AUTHORS 
Anesthesia Progress  2009;56(2):67-68.
doi:10.2344/0003-3006-56.2.67
PMCID: PMC2699696
19.  JDSA Journal Abstracts 
Anesthesia Progress  2009;56(2):63-66.
doi:10.2344/0003-3006-56.2.63
PMCID: PMC2699695
20.  ANESTHESIA IN COSMETIC SURGERY 
Anesthesia Progress  2009;56(2):62.
doi:10.2344/0003-3006-56.2.62
PMCID: PMC2699694
21.  Cardiovascular Monitoring: Physiological and Technical Considerations 
Anesthesia Progress  2009;56(2):53-60.
The American Dental Association and several dental specialty organizations have published guidelines that detail requirements for monitoring patients during various levels of sedation and, in some cases, general anesthesia. In general, all of these are consistent with those guidelines suggested by the American Society of Anesthesiologists Task Force for Sedation and Analgesia by Non-Anesthesiologists. It is well-accepted that the principal negative impact of sedation and anesthesia pertains to the compromise of respiratory function, but attentive monitoring of cardiovascular function is also important. While monitoring per se is a technical issue, an appreciation of its purpose and the interpretation of the information provided require an understanding of basic cardiovascular anatomy and physiology. The focus of this continuing education article is to address essential physiological aspects of cardiovascular function and to understand the appropriate use of monitors, including the interpretation of the information they provide.
doi:10.2344/0003-3006-56.2.53
PMCID: PMC2699693  PMID: 19642720
Monitoring; Cardiovascular; Electrocardiography; Plethysmography; Blood pressure; Sedation
22.  Negative Pressure Pulmonary Edema After Oral and Maxillofacial Surgery 
Anesthesia Progress  2009;56(2):49-52.
Negative pressure pulmonary edema (NPPE) following upper airway obstruction (UAO) has been reported in several clinical situations. The main cause of NPPE is reported to be increased negative intrathoracic pressure. We present a case of NPPE that occurred after general anesthesia for plate removal after jaw deformity surgery. After completion of the surgery, administration of inhaled anesthetics was stopped and the patient opened his eyes on verbal command. Immediately after extubation, the patient stopped breathing and became cyanotic. Acute UAO following laryngospasm was suspected. Soon after reintubation, pink, frothy fluid came out of the endotracheal tube, and a tentative diagnosis of NPPE was made. Continuous positive airway pressure was applied. In addition, furosemide and dexamethasone were administered. By the next day, the symptoms had almost disappeared.
doi:10.2344/0003-3006-56.2.49
PMCID: PMC2699692  PMID: 19642719
Negative pressure pulmonary edema; Upper airway obstruction; Continuous positive airway pressure
23.  Review and Management of the Dental Patient With Long QT Syndrome (LQTS) 
Anesthesia Progress  2009;56(2):42-48.
Long QT syndrome (LQTS) is a unique cardiovascular condition, with both congenital and acquired forms that afflict patients. These patients show a lengthening of the repolarization phase of the cardiac cycle, which can be best visualized on an electrocardiogram (ECG). The ECG changes can include QT interval (the time between the start of the Q wave and the end of the T wave, as seen on an ECG) and T wave abnormalities, as well as progression to torsades de pointes and ventricular fibrillation. The ECG changes are most commonly elicited by physical activity, emotional stress, and certain medications. This condition represents a challenge for the oral and maxillofacial surgeon. Patients with LQTS must receive proper medical management and a controlled and anxiety-free surgical environment. The purpose of this article was to present a review of LQTS and provide recommendations for effective surgical management. Additionally, a case report of a patient with LQTS, treated by one of the authors, has been included.
doi:10.2344/0003-3006-56.2.42
PMCID: PMC2699691  PMID: 19642718
Long QT syndrome; Torsades de pointes; Ventricular fibrillation
24.  Effect of Time on Clinical Efficacy of Topical Anesthesia 
Anesthesia Progress  2009;56(2):36-41.
The objective of this study was to determine the effect of time on the clinical efficacy of topical anesthetic in reducing pain from needle insertion alone as well as injection of anesthetic. This was a randomized, double-blind, placebo-controlled, split-mouth, clinical trial which enrolled 90 subjects, equally divided into 3 groups based upon time (2, 5, or 10 minutes) of topical anesthetic (5% lidocaine) application. Each group was further subdivided into 2: needle insertion only in the palate or needle insertion with deposition of anesthetic (0.5 mL 3% mepivacaine plain). Each subject received drug on one side and placebo on the other. Subjects recorded pain on a 100-mm visual analog scale (VAS). The results showed that for needle insertion only, 5% lidocaine reduced pain as determined by a significant difference in mean VAS after 2 minutes (20.1 mm, P < .002), 5 minutes (15.7 mm, P < .022), and 10 minutes (13.7 mm, P < .04), as analyzed by paired t tests. For needle insertion plus injection of local anesthetic, a significant difference in mean VAS was noted only after 10 minutes (14.9 mm, P < .031), yet pain scores for both topical anesthetic and placebo were elevated at this time point resulting in no reduction in actual pain. Time of application did not result in a significant difference in effect for either needle insertion only or needle insertion plus injection of local anesthetic, as analyzed by 1-way analysis of variance (ANOVA). In conclusion, topical anesthetic reduces pain of needle insertion if left on palatal mucosa for 2, 5, or 10 minutes, but has no clinical pain relief for anesthetic injection.
doi:10.2344/0003-3006-56.2.36
PMCID: PMC2699690  PMID: 19642717
Topical anesthesia; Local anesthesia; Pain
25.  BEAUTIFUL AUSTRALIAN GOLD COAST TO HOST 2009 IFDAS MEETING 
Anesthesia Progress  2009;56(2):35.
doi:10.2344/0003-3006-56.2.35
PMCID: PMC2699689

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