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jtitle_s:("anesti Prog")
2.  Safety and effectiveness of intranasal administration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric dental procedures. 
Anesthesia Progress  1993;40(3):63-66.
Thirty children presenting to the dental clinic of a pediatric hospital who required brief but urgent dental care, and who could not be satisfactorily examined or treated, were administered one of three medications--ketamine (Ketalar), 3 mg/kg; midazolam (Versed), 0.4 mg/kg; or sufentanil (Sufenta), 1.5 or 1.0 micrograms/kg--intranasally in a randomized, double-blinded protocol. The patients were brought to the day surgery area following appropriate fasting and administered one of the medications diluted in a dose of 0.1 mL/kg normal saline while sitting in a nurse's arms. Cardiorespiratory monitors were applied when tolerated, and the child was placed on the operating room table. Each child was injected locally with up to one dental cartridge of 2% lidocaine with 1:100,000 epinephrine before dental extractions. A sedation score was recorded using a scale where 1 = hysterical/untreatable, 5 = ideal sedation, and 10 = obtunded and desaturated, requiring airway management assistance. Midazolam administration resulted in acceptable sedation (mean score: 4) with no desaturations below 90% as measured by pulse oximetry and a mean recovery room observation time of only 3 +/- 2 min (+/- SD). Ketamine also had a mean sedation score of 4 and a short recovery period (7 +/- 7 min); however, two children experienced brief desaturations. Sufentanil at 1.5 micrograms/kg was noted to produce much more heavily sedated children (mean score 7), with a high incidence of significant oximetry desaturation (80%) and prolonged recovery room duration (58 +/- 40 min). Use of 1.0 microgram/kg sufentanil resulted in no desaturations, less sedation (mean score 4), and a brief recovery time (7 +/- 13 min).(ABSTRACT TRUNCATED AT 250 WORDS)
PMCID: PMC2148744  PMID: 7645790
3.  Evaluation of a clinical recovery score after general anesthesia. 
Anesthesia Progress  1993;40(3):67-71.
A clinical recovery score (CRS) assessing recovery after general anesthesia was compared with the Digit-Symbol Substitution Test (DSST), Trieger Test (TT), a patient-completed visual analogue scale for alertness (VAS), and an independent observer's evaluation of recovery. The CRS included ratings of the following parameters: activity, respiration, circulation, consciousness, ambulation, color, and nausea and vomiting. Forty patients requiring the removal of three or four third molars participated in the study. All patients received the same general anesthetic technique. Each patient was evaluated by the five methods preoperatively, on admission to the recovery room, and at 15-min intervals until discharge. The four recovery tests (CRS, DSST, TT, VAS) were evaluated using chi 2 analysis to determine if there was any overall difference among the tests using the observer's determination of home readiness as the standard for discharge. The CRS was significantly more in agreement with the observer's determination than were the paper and pencil tests. The recovery tests were also evaluated with regard to instances of early dismissal or prolonged retention of the patient, again using the observer's determination as the "gold standard." The CRS was the only recovery test devoid of early dismissals. We conclude that the CRS provides a valid, simple measure of recovery that can be readily used in offices providing outpatient anesthesia and in studies measuring clinical recovery from anesthesia or sedation.
PMCID: PMC2148743  PMID: 7645791
4.  Response 
Anesthesia Progress  1993;40(3):100.
PMCID: PMC2148742
5.  The safety and efficacy of outpatient midazolam intravenous sedation for oral surgery with and without fentanyl. 
Anesthesia Progress  1993;40(3):57-62.
This study examined midazolam and midazolam plus fentanyl in a placebo-controlled, double-blind clinical trial. It tested the hypothesis that combined drug therapy results in significantly poorer safety but no difference in efficacy compared to the single drug approach. Subjects were among 207 mildly anxious young adults having their third molars removed. Fentanyl had a significant depressant effect on respiration. Fifty of 79 (63%) subjects who received a midazolam-fentanyl combination became apneic, while only two of 78 (3%) who received midazolam alone were apneic (Fisher's Exact Test, P < 0.001). Two subjects (2.5%) in the combination group and none in the midazolam alone group had oxygen saturations drop below 90%. About twice as many subjects in the combination group had end-tidal carbon dioxide (EtCO2) levels greater than 25% above baseline. While these results are consistent with those for apnea, contingency analyses of the oxygen saturation and EtCO2 results were not statistically significant. Subjects in the combination group were more than four times as likely to have excellent versus good, fair, or poor sedation at a given level of intraoperative pain, and behavioral (movement and verbalization) but not cognitive measures of anxiety were attenuated.
PMCID: PMC2148741  PMID: 7645789
6.  Electronic dental anesthesia. 
Anesthesia Progress  1993;40(3):99-100.
PMCID: PMC2148738  PMID: 7645794
7.  ASDA specialty application. 
Anesthesia Progress  1993;40(3):99.
PMCID: PMC2148737  PMID: 7645793
8.  Literature Abstracts 
Anesthesia Progress  1993;40(2):38-45.
PMCID: PMC2148734
9.  Local anesthetic update. 
Anesthesia Progress  1993;40(2):29-34.
The development of new local anesthetics has not been an area of particularly active research for a number of years. However, as the use of regional anesthesia has expanded, additional anesthetic requirements and techniques have stimulated the search for newer drugs and ways of modifying existing ones. This article reviews some of the more recent developments in this field.
PMCID: PMC2148733  PMID: 8185087
10.  Objective measurement of the analgesic effect of midazolam in humans. 
Anesthesia Progress  1993;40(2):35-37.
The effect of midazolam sedation on late evoked potentials (EPs) elicited from painful stimulation of the median nerve was investigated in 20 human volunteers. EPs were recorded from the contralateral scalp at baseline and at 5, 30, and 60 min post-midazolam infusion. Relative amplitudes of the late EPs were significantly reduced after intravenous midazolam infusion and did not return to normal during the 60 min of the experiment. Given the correlation between EP amplitude and subjective reports of experimental pain, the data support the suggestion that midazolam may have some analgesic effect.
PMCID: PMC2148731  PMID: 8185088
13.  Intravenous cannulation: a different approach. 
Anesthesia Progress  1993;40(1):20-22.
This article presents a different method of venous cannulation. It has been used successfully to teach dental residents working on pediatric and developmentally disabled patients. The technique includes using a syringe of 1% lidocaine hydrochloride attached to a 25-ga needle to produce a skin wheal by "jet injection." This is accomplished by placing the bevel of the needle downward and forcing the syringe in a downward and backward direction, with pressure being continuously exerted on the plunger. A 20-ga, 1 1/4-inch catheter is then attached to the syringe containing the remaining lidocaine hydrochloride. The catheter is bent, with its bevel up, approximately three-fourths of the way from the tip to form a gradually sloping bend of approximately 40 degrees to 45 degrees. The catheter is then inserted into the skin wheal and advanced into the vein. The advantages of this technique are that it (1) can eliminate the pain associated with a subcutaneous infiltration of a local anesthetic solution, (2) provides a method of venous cannulation that is easier to master by the novice, and (3) gives a visual check on successful catheterization of the vein.
PMCID: PMC2148630  PMID: 8185086
14.  Auricular electrical stimulation and dental pain threshold. 
Anesthesia Progress  1993;40(1):14-19.
A modified double-blind evaluation of naloxone reversibility of dental analgesia produced by auricular electrical stimulation (AES) was examined in 40 subjects assigned randomly to one of four groups: AES followed by saline (AS), AES followed by naloxone (AN), placebo AES followed by saline (PS), and placebo AES followed by naloxone (PN). Dental pain threshold was tested using a hand-held dental pulp tester. A second investigator administered the true or placebo AES using an electrical stimulator. A third investigator injected intravenously saline or naloxone. The subjects and investigators 1 and 3 were blind to all treatment conditions. A repeated measures analysis of variance revealed a significant difference among the four groups. The AES groups exhibited a statistically significant 18% elevation of pain threshold, whereas the two placebo stimulation groups (PS and PN) remained essentially unchanged. The mean pain threshold increased to more than 23% for group AS, but fell to less than 12% for the subjects in group AN, who were given naloxone. These findings indicate a small but significant elevation of pain threshold by AES, an effect partially blocked by naloxone, suggesting an endogenous opioid system as one mechanism for AES analgesia.
PMCID: PMC2148627  PMID: 8185085
16.  Articaine and lidocaine for maxillary infiltration anesthesia. 
Anesthesia Progress  1993;40(4):114-116.
This study was undertaken to compare the anesthetic properties of articaine hydrochloride with 1:200,000 epinephrine (Ultracain DS) and lidocaine with 1:80,000 epinephrine (Xylocain-Adrenalin) for maxillary infiltration anesthesia. Twenty healthy dental student volunteers were included in this double-blind study. Each subject received 0.6 mL of each test solution at different times. Infiltration anesthesia was performed on the upper lateral incisor. The onset and duration of anesthesia were monitored using an electric pulp tester. No statistically significant differences were seen in the onset and duration of anesthesia between the articaine and lidocaine solutions.
PMCID: PMC2148588  PMID: 7943919
17.  Cerebral arterial blood flow velocity during induction of general anesthesia: rapid intravenous induction versus awake intubation. 
Anesthesia Progress  1993;40(4):122-126.
Changes in middle cerebral arterial flow velocity (MCAV) during rapid intravenous induction and awake intubation using transcranial Doppler sonography were investigated. The study involved 20 patients without disorders of the central nervous or cardiovascular systems who were scheduled for maxillofacial surgery. In the intravenous induction group, anesthesia was induced with sodium thiopental, and orotracheal or nasotracheal intubation was facilitated with succinylcholine chloride or alcuronium chloride. In the awake intubation group, orotracheal or nasotracheal intubation was performed under intravenous sedation with diazepam and topical anesthesia with 4% lidocaine. Arterial blood pressures, heart rate, and MCAV were monitored at specific intervals. During intravenous induction, blood pressures decreased after the administration of thiopental and muscle relaxants and increased during endotracheal intubation. MCAV was remarkably slowed after the administration of thiopental and during mask ventilation. During awake intubation, blood pressures were increased by endotracheal intubation. MCAV was decreased from the administration of diazepam to the transtracheal injection of lidocaine, but returned to the control value from endotracheal spray to endotracheal intubation. These results suggest that smooth awake intubation may be the safest method of induction for patients with cerebrovascular disorders.
PMCID: PMC2148587  PMID: 7943921
19.  Modern history of dental anesthesia in Japan. 
Anesthesia Progress  1993;40(4):109-113.
PMCID: PMC2148583  PMID: 7943918
20.  Oral triazolam pretreatment for intravenous sedation. 
Anesthesia Progress  1993;40(4):117-121.
This double-blind, controlled clinical trial assessed the anxiety relief provided by oral triazolam given before intravenous sedation. Twenty-two healthy adults undergoing third-molar surgery with intravenous sedation were enrolled in this study. Subjects were randomly assigned to receive either 0.25 mg of triazolam p.o. or an identically appearing placebo 45 to 60 min before venipuncture. Immediately before test drug administration, subjects completed the Corah Anxiety Scale, a Visual Analog Scale (VAS) assessing state anxiety, and the Interval Scale of Anxiety Response (ISAR). The VAS and ISAR were repeated immediately before venipuncture. Intravenous sedation medications consisted of fentanyl, midazolam, and methohexital. At 24 hr, assessments of the venipuncture and global experience were obtained. Results indicated that the characteristics of the triazolam and placebo patients were similar at baseline. With triazolam pretreatment, both the VAS and ISAR scores decreased significantly. Dose requirements for conscious sedation medications were decreased in the triazolam group. Patients rated the venipuncture experience significantly less unpleasant when pretreated with triazolam, and global ratings of the overall surgical experience favored triazolam. An oral-intravenous combination sedation technique using 0.25 mg of triazolam may have a significant therapeutic advantage for outpatient oral surgery.
PMCID: PMC2148582  PMID: 7943920
21.  Total intravenous anesthesia with propofol for thymectomy in a patient with myasthenia gravis. 
Anesthesia Progress  1993;40(4):127-129.
Experience with the use of propofol for induction and maintenance of anesthesia in patients with myasthenia gravis is limited. This case report documents the safe use of propofol in a patient with myasthenia gravis. Because of its unique pharmacodynamic and pharmacokinetic profile, propofol may be an ideal agent for safe use in the young patient with myasthenia gravis.
PMCID: PMC2148581  PMID: 7943922
22.  Long-term effects on dental care behavior and dental health after treatments for dental fear. 
Anesthesia Progress  1993;40(3):72-77.
Three different treatments for dental fear were tested in a long-term perspective study. Twenty-nine patients with severe dental anxiety and avoidance behavior were assigned to Behavioral Therapy (BT, n = 12), PRemedication with bensodiazepine (PR, n = 8) or dental treatment under General Anesthesia (GA, n = 9). Ten years after initial treatment the patients were reexamined. Changes in dental anxiety and dental care attendance were reported. Patients' dental health status was assessed by radiographic survey. Regular dental attendance was reported by 19 patients (65.5%), with a significantly better result for the BT group (91.6%) compared to the GA group (33.3%). Reported level of dental anxiety, as measured by the Dental Anxiety Scale, revealed a significant reduction during the 10-yr period except among GA patients and those reporting irregular dental attendance behavior. A rise in mood as assessed by the Mood Adjective Checklist was revealed in the total group, with a better effect in the BT and PR groups as well as in patients who reported regular dental attendance. A substantial general improvement in oral health was seen during the 10-yr period, especially among patients receiving regular dental care. Thus, for a majority of patients in this study, directed treatment for dental anxiety and avoidance behavior made it possible to maintain regular dental care behavior during a 10-yr period.
PMCID: PMC2148740  PMID: 7645792
23.  A Bit of History 
Anesthesia Progress  1993;40(1):24.
PMCID: PMC2148628  PMID: 19598706
24.  Editorial 
Anesthesia Progress  1993;40(4):101.
PMCID: PMC2148584  PMID: 19598707

Results 1-24 (24)