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1.  Ketorolac-induced bronchospasm in an aspirin-intolerant patient. 
Anesthesia Progress  1994;41(4):102-107.
A patient, in her mid-twenties, presented with "severe polypoid sinusitis" for sphenoethmoidectomy under general anesthesia. Upon preoperative medical evaluation, it was discovered that she was "allergic" to aspirin and suffered from stress-induced asthma. Before induction of anesthesia, the patient was administered intravenous hydrocortisone and two puffs of her albuterol inhaler to prevent a possible bronchospasm due to stress of the surgery or irritation from the endotracheal tube or other stimuli. The patient was maintained throughout the case with an inhalation anesthetic for its bronchodilatory effect. The surgery proceeded unremarkably, and the patient was then administered ketorolac tromethamine for postoperative pain. After an awake extubation, the patient was transferred to the postanesthesia care unit (PACU) for further monitoring. After 15 min in the PACU, the patient claimed having difficulty breathing. She was then administered terbutaline to produce bronchodilation, but her condition did not improve. Shortly thereafter, aminophylline, midazolam, and methylprednisolone were also administered intravenously. Meanwhile, the patient had to be reintubated and placed on ventilator support with heavy sedation. At this point, it was discovered that ketorolac may have been the cause of this response. Although the patient's condition began to improve, the histamine H1- and H2-receptor blockers diphenhydramine and ranitidine were coadministered. When the patient's condition returned toward normal, she was extubated. The patient's breathing continued to improve. Thereafter, she was transferred to an overnight observation bed and later dismissed to return home. The patient was advised of the episode and warned against future intake of other nonsteroidal antiinflammatory drugs.
PMCID: PMC2148844  PMID: 8934961
2.  JDSA Journal Abstracts 
Anesthesia Progress  1994;41(4):108-115.
Images
PMCID: PMC2148841
3.  Infrared laser diode irradiation has no behavioral or biochemical effect on pain in the sciatic nerve ligation-induced mononeuropathy in rat. 
Anesthesia Progress  1994;41(4):95-99.
The aim of this study was to evaluate the effect of acute and repeated (5 days) treatment with various types of infrared (IR) diode lasers and probes (single- vs cluster-beam) on the pain response in rats with peripheral mononeuropathy produced by sciatic nerve ligation. Male Sprague-Dawley rats were anesthetized with sodium pentobarbital, and the mid-thigh was surgically exposed to reveal the sciatic nerve, around which four ligatures were loosely tied. On postoperative day 5, the skin over the sciatic nerve lesion was subjected to a 30-min daily local exposure from a 904-nm IR diode laser (700 Hz, average output power 10 mW) with a single-beam probe, a 830-nm IR diode laser (700 Hz) with either a single-beam (average output power 50 mW) or cluster-beam probe (average output power 15 mW), or placebo for 5 consecutive days. Two pain responses (foot-withdrawal time and the hind-paw elevation time) were measured on both sides using the radiant heat method on days 5 and 9. In addition, cold allodynia was measured on day 9 of treatment by placing the rats on a chilled metal plate (4 degrees C) and measuring the duration of elevation of either of the hind paws. On day 9, the animals were sacrificed for collection of the samples of brain and lumbar spinal cord for the determination of the tissue concentrations of dynorphin A1-8-like immunoactivity (DYN) using specific radioimmunoassay (RIA). The hind-paw withdrawal and elevation times on the right side in all groups subjected to the various methods of IR laser irradiation did not differ significantly as compared with the placebo-treated group when measured on days 5 and 9 after surgery. No statistically significant differences in withdrawal response and elevation time of the unaffected left hind paw were noted either. The measurement of cold allodynia similarly failed to reveal any effect in laser-treated groups versus placebo. The RIA analysis found that tissue concentrations of DYN were significantly elevated in the spinal cord ipsilaterally to the ligation side, as compared with the contralateral side, in all rats with sciatic nerve ligation. All modalities of IR diode laser treatment did not produce any significant difference in the brain and spinal cord level of DYN on postoperative day 9 in all treatment groups. It is concluded that repeated IR diode laser treatment did not reduce hyperalgesia induced by sciatic nerve ligation in rats.
PMCID: PMC2148839  PMID: 8934959
4.  TENS-induced pain control in a malignant hyperthermia-susceptible patient. 
Anesthesia Progress  1994;41(4):100-101.
Malignant hyperthermia (MH) is a severe and often fatal disease that is triggered by exposure to the neuromuscular blocking drug succinylcholine and/or volatile general anesthetics (eg, halothane). Although all local anesthetics are now considered to be safe in malignant hyperthermia patients, some individuals still prefer not to use amide-type anesthetics. Here we report a case of a MH-susceptible patient who successfully received restorative dental treatment with transcutaneous electrical nerve stimulation. We suggest that this may be a safe alternative to consider in patients who have an aversion to chemical anesthetic agents.
PMCID: PMC2148838  PMID: 8934960
6.  JDSA Journal Abstracts 
Anesthesia Progress  1994;41(3):83-91.
Images
PMCID: PMC2148822
7.  Unexpected atrial fibrillation during tooth extraction in a sedated elderly patient. 
Anesthesia Progress  1994;41(3):77-80.
A case is reported of unexpected atrial fibrillation in response to tooth extraction under intravenous sedation in a 70-yr-old patient with thoracic aneurysm of the aorta. Atrial fibrillation developed after the additional injection of a 2% solution of lidocaine containing 1:200,000 epinephrine. After 20 min, the arrhythmia disappeared spontaneously. The arrhythmia was associated with insufficient analgesia for tooth extraction, epinephrine in the local anesthetic, decreased blood pressure, and the presence of cardiovascular disease. Even when a low concentration of epinephrine is employed, caution should be paid to development of unexpected cardiovascular reactions in elderly patients with severe cardiovascular disease. We conclude that an electrocardiogram, blood pressure device, and pulse oximeter should be used in high-risk patients in order to prevent and detect potentially dangerous cardiovascular emergencies, even if dental treatment is scheduled under local anesthesia.
PMCID: PMC2148821  PMID: 8934964
8.  Propofol for sedation in a mentally retarded dental patient. 
Anesthesia Progress  1994;41(3):81-82.
A 21-yr-old mentally retarded and cardiovascularly compromised woman who required dental restorative work and extractions was admitted to our clinic. We had previously successfully sedated her with propofol and midazolam. In this case she was sedated with a 1% propofol solution administered initially at a rate of 8 mg/kg-hr. After 5 min, the infusion rate was lowered to 5 mg/kg-hr, and after the local anesthetic injection, was adjusted to 3 mg/kg-hr. After 15 min, the patient became restless, and the propofol infusion rate was again increased to 5 mg/kg-hr. The patient's airway was well maintained during the entire procedure; she remained well sedated, and no adverse effects were experienced.
PMCID: PMC2148817  PMID: 8934965
12.  Author's Reply 
Anesthesia Progress  1994;41(2):61-62.
PMCID: PMC2148811
13.  Efficacy of a topical anesthetic on pain and unpleasantness during scaling of gingival pockets. 
Anesthesia Progress  1994;41(2):35-39.
The efficacy of a topical anesthetic on pain and unpleasantness provoked by scaling of gingival pockets was investigated in 20 patients with mild chronic periodontitis. A eutectic mixture of local anesthetics (EMLA) and a placebo cream, both occluded by Orahesive Oral Bandages, were applied in a balanced, randomized, double-blind, split-mouth design, which enabled within-subject comparison of the anesthetic and the placebo in the upper and the lower jaw. Pretreatment interviews showed that approximately two-thirds of the patients considered gingival scaling to be associated with some degree of pain and unpleasantness. Pain intensity and unpleasantness were evaluated on 100-mm visual analog scales (VAS). Application of EMLA reduced both pain intensity and unpleasantness significantly compared to placebo cream. Median reductions in VAS pain intensity in the upper and lower jaw were 58.9% and 61.9%, and corresponding reductions in VAS unpleasantness were 31.9% and 25.6%, respectively. Generally, the patients accepted the anesthetic procedure well. The residual perception of pain and unpleasantness following topical anesthesia may be dependent on activation of nonanesthetized nociceptive fibers in the tooth pulp. However, the present study clearly demonstrates the efficacy of a topical anesthetic in a clinical situation, which may be recommended as a simple pharmacologic strategy to reduce pain and unpleasantness during scaling procedures.
PMCID: PMC2148810  PMID: 8638858
14.  Dentists and anesthesia: commentary. 
Anesthesia Progress  1994;41(2):59-62.
PMCID: PMC2148809  PMID: 8638861
16.  Effective postoperative pain prevention through administration of bupivacaine and diclofenac. 
Anesthesia Progress  1994;41(1):6-10.
The efficacies of bupivacaine and lidocaine together with a preoperatively administered single-dose oral combination of normal- and sustained-release preparations of diclofenac in preventing postoperative pain after third molar removal were compared in a double-blind crossover study. Bilaterally impacted lower third molars were removed in two sessions. Each patient was given one type of local anesthetic on one session and the other in the second. Pain was recorded using a visual analog scale. When the diclofenac combination (150 mg) was given before the operation, postoperative analgesia was better with bupivacaine plus diclofenac than with lidocaine plus diclofenac. Twenty-five out of 40 patients preferred bupivacaine to lidocaine for local anesthesia. It is possible to achieve effective postoperative pain prevention by combining bupivacaine and preoperative normal- and sustained-release preparations of diclofenac.
PMCID: PMC2148714  PMID: 8629744
17.  Pulse oximetry signals local anesthetic-induced methemoglobinemia. 
Anesthesia Progress  1994;41(1):11-12.
An otherwise healthy patient with a fractured mandible was scheduled to undergo an open reduction under general anesthesia. Just before transport to the operating room, bimaxillary arch bars were placed under local anesthesia with 4% prilocaine and 1:200,000 epinephrine. Although induction of anesthesia and nasoendotracheal intubation were uneventful, pulse oximetry values fell to 89% despite adequate ventilation and an inspired oxygen concentration of 50%. Inquiry by the anesthesiologist and arterial blood gas measurements revealed that methemoglobinemia had developed in response to the large amount 576 mg) of prilocaine administered. A total of 150 mg of methylene blue administered in two doses corrected the problem. The oral surgeon, having recently switched to prilocaine because of a manufacturer's recall of lidocaine, was unaware of the potential of prilocaine to cause this disorder.
PMCID: PMC2148713  PMID: 8629741
18.  Asystole and bradycardia during maxillofacial surgery. 
Anesthesia Progress  1994;41(1):13-16.
A Chinese female undergoing maxillary osteotomy developed asystole when the maxillary tuberosity was cut. Surgery was stopped. After about 10 sec and before instituting cardiac massage, sinus rhythm and bradycardia ensued. Atropine was administered intravenously, resulting in an increase in heart rate. No further episodes of asystole or bradycardia were encountered.
PMCID: PMC2148710  PMID: 8629742
19.  JDSA Journal Abstracts 
Anesthesia Progress  1994;41(1):19-22.
Images
PMCID: PMC2148709
20.  Respiratory effects of a balanced anesthetic technique--revisited fifteen years later. 
Anesthesia Progress  1994;41(1):1-5.
Five hundred and fifty patients underwent general anesthesia with fentanyl, diazepam, and methohexital. Forty-seven (8.5%) developed signs of hypoventilation or airway obstruction. Arterial blood gas analysis revealed mild hypoxemia in three of the 47 cases and mild hypercarbia in six. Airway obstruction was more predictive of abnormal blood gas values than was hypoventilation.
PMCID: PMC2148708  PMID: 8629740
21.  A case of sinus arrest caused by opening the mouth under general anesthesia. 
Anesthesia Progress  1994;41(1):17-18.
We report a case in which transient sinus arrest was observed under general anesthesia. This was associated with opening the mouth and was thought to be caused by a trigeminovagal reflex. The reflex was interrupted by blocking bilaterally the third division of trigeminal nerve.
PMCID: PMC2148706  PMID: 8629743
22.  The efficacy and memory effects of oral triazolam premedication in highly anxious dental patients. 
Anesthesia Progress  1994;41(3):70-76.
Triazolam (0.375 or 0.50 mg) or placebo was administered orally to 31 highly anxious dental patients in a double-blind clinical trial 1 hr before treatment. The drug was safe and highly effective, in comparison to placebo, in reducing both anxious cognitions and disruptive movement during oral injections of local anesthetic and drilling. Episodic memory and implicit memory were both adversely affected by the active drug but not the placebo.
PMCID: PMC2148823  PMID: 8934963
23.  Topical anesthesia: differentiating the pharmacological and psychological contributions to efficacy. 
Anesthesia Progress  1994;41(2):40-47.
Pain can be influenced by both pharmacologic and psychologic factors. The purpose of this study was to investigate the pharmacologic and psychologic factors. The purpose of this study was to investigate the pharmacologic and psychologic processes that may play a role when topical anesthesia is used to reduce the pain of dental injections. Subjects were assigned to one of two belief manipulation conditions: one-half of the subjects were led to believe they would receive a placebo, while the remaining subjects were told they would receive the active agent. In reality, all subjects received two separate injections at contralateral sites, one preceded by a placebo and the other by a 20% benzocaine gel. The order in which injections were given was associated with differences in pain report. Second injections were more painful than first injections. Whether injections were preceded by an active or placebo agent did not alter subjects' experienced pain. Likewise, the belief manipulation did not affect the pain report. However, subjects who believed they would receive the active agent anticipated significantly less pain than subjects who thought they would receive placebo. The widespread belief that topical anesthetics are effective at reducing injection pain may serve to reduce the anticipatory anxiety associated with an impending dental injection, thus making the injection experience less aversive.
PMCID: PMC2148807  PMID: 8638859

Results 1-23 (23)