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1.  Sensory experience induced by nitrous oxide analgesia. 
Anesthesia Progress  1990;37(6):282-285.
Preliminary findings on a group of 15 dental patients, treated with nitrous oxide indicated frequent occurrence of several, well-defined sensory experiences related to various modalities. A subsequent controlled experiment carried out on 44 volunteers, inhaling a 35% N2O + 65% O2 sedative gas-mixture as well as O2 alone in two different sessions confirmed a large variety of sensations not related to external stimuli. Taste and/or odor and thermal sensations were often reported as well as changes in auditory or visual perception of the environment in addition to reports of general heaviness, relaxation or tingling.
PMCID: PMC2162559  PMID: 2097907
2.  Therapeutic strategies for cancer pain management. 
Anesthesia Progress  1990;37(6):265-270.
Clinical issues related to treating the oncology pain patient have gained considerable attention in the medical and health care literature. Addressed are management strategies which focus specifically on cognitive-behavioral, psychosocial, and pharmacologic approaches to treating the oncology pain patient. Each strategy possesses unique qualities that can benefit the care and management of the cancer patient and provide a better understanding of the disease entity and the patient's ability to develop coping strategies that may be effective in understanding and confronting pain associated with cancer.
PMCID: PMC2162558  PMID: 2097904
3.  Pharmacologic desensitization for dental phobias: clinical observations. 
Anesthesia Progress  1990;37(6):308-311.
The elimination of the extreme fear reported by dental phobic patients traditionally involves psychologic interventions such as systematic desensitization. Observations resulting from a conscious sedation approach, as outlined in two case histories, suggest that a desensitization phenomena is occurring. This pharmacologic desensitization appears to mimic elements of systematic desensitization. Optimal management of fearful patients may sometimes require conjunctive support from both dental behavioral scientists and dental anesthesiologists.
PMCID: PMC2162557  PMID: 1982984
4.  Absorption and elimination of midazolam by submucosal and intramuscular routes. 
Anesthesia Progress  1990;37(6):277-281.
The purpose of this investigation was to compare the rate of absorption and clearance time of midazolam (Versed) when administered by the submucosal (SM) route), and the intramuscular (IM) route in ten healthy adult volunteers, ranging in age from 25 to 35 years. Each subject received midazolam 0.08 mg/kg, to a maximum of 5 mg, by the SM and IM routes at two week intervals. Vital signs and arterial oxygen saturation levels were monitored every five minutes throughout the 180 minute study period. Blood samples (3 ml) were collected via an intravenous line, prior to midazolam administration and at 2, 5, 10, 20, 30, 45, 60, 90, 120, 150 and 180 minutes, centrifuged and analyzed by gas-liquid chromatography. The mean absorption rates and the mean elimination times of the two routes were not significantly different. The mean peak absorption was reached at 10 minutes by the SM route (80.4 ng/ml) and at 20 minutes (92.0 ng/ml) by the IM route, with considerable individual variability. Vital signs were stable throughout the study period in all subjects with both routes. All subjects reported pain at the injection site during SM injection which continued for up to 48 hours. No pain related to the IM injection was reported.
PMCID: PMC2162556  PMID: 2097906
5.  An analysis of the effectiveness of two topical anesthetics. 
Anesthesia Progress  1990;37(6):290-292.
This study compared the effectiveness of topical benzocaine 20%, lidocaine 5%, and a placebo in reducing the pain caused by needle insertion when the medicament was placed in the mucobuccal fold above the maxillary canine eminence. Both topical anesthetics and the placebo were randomly tested against each other bilaterally. For uniformity the agents were left in place for three minutes before needle insertion. A 27 gauge short needle mounted on an aspirating syringe was then inserted just past the bevel. Each subject rated the degree of pain on a visual analogue scale 100 mm in length. A pulse oximeter was used to record the heart rate. The results indicate that both topical anesthetics are significantly better than the placebo in reducing pain caused by needle insertion, although no statistically significant differences were found between the two topical anesthetics. Statistically significant differences in heart rate were seen, but these differences were not clinically significant. It is concluded that benzocaine 20% and lidocaine 5% significantly reduce the pain during needle insertion.
PMCID: PMC2162554  PMID: 2097909
6.  Psychedelic effects of a subanesthetic concentration of nitrous oxide. 
Anesthesia Progress  1990;37(6):271-276.
The subjective effects of nitrous oxide were examined by administering questionnaires to volunteers (16 men and 16 women) breathing 30% nitrous oxide or 100% oxygen. Nitrous oxide produced a variety of subjective effects, including some that are characteristic of psychedelic drugs, such as happy, euphoric mood changes, changes in body awareness and image, alterations of time perception, and experiences of a dreamy, detached reverie state. The subjective effects, including those of a psychedelic nature, were very similar to the subject effects we observed in a previous study of nitrous oxide. However, euphoric mood changes were more pronounced, and adverse effects were less pronounced, in the present study, possibly due to the shorter duration of gas inhalation or the minimal tests of performance involved. Some other differences in subjective effects between the present and previous studies were identified by a discriminant analysis and seemed related to specific differences in experimental conditions. This suggests that the environment can influence which drug effects emerge, or at least their relative prominence. Clinicians should be familiar with the range of subjective effects that patients inhaling nitrous oxide may experience.
PMCID: PMC2162553  PMID: 2097905
7.  Seizure-like activity during fentanyl anesthesia. A case report. 
Anesthesia Progress  1990;37(6):306-307.
Fentanyl induced seizures have been described previously in the literature. Clinical observations has labeled the movements seen in fentanyl anesthesia as seizure activity but electroencephalographic studies have not supported this. A case of seizure-like activity after the administration of fentanyl in a 20-year-old female is reported.
PMCID: PMC2162552  PMID: 2151504
8.  Submental administration of succinylcholine in children. 
Anesthesia Progress  1990;37(6):296-300.
During inhalation induction of the pediatric patient, laryngospasm can develop before intravenous access has been established. The intramuscular administration of succinylcholine is commonly used in such instances. This study was designed to determine if the injection of succinylcholine by an extraoral submental approach would be an acceptable method of terminating laryngospasm when compared to conventional intramuscular sites. Following induction with halothane and nitrous oxide in oxygen, a total of fifteen ASA 1 children were given 3.0 mg/kg intramuscular succinylcholine either intralingually by a submental approach, or using the upper leg musculature in order to electromyographically measure the time to maximum (or 90 percent depression from baseline) twitch depression. The intralingual submental injection had a mean twitch depression of 265 +/- 62.5 seconds compared to the quadriceps femoris at 295 +/- 42.6 seconds. A group with digital massage of the intralingual injection site produced a mean depression time of 133 +/- 11.9 seconds and was also the only group providing 100% success rate in reaching the desired twitch depression level. This may suggest that the operator should consider digital massage to produce a more predictable and desirable result.
PMCID: PMC2162551  PMID: 2097911
12.  Arterial oxygen saturation in children receiving rectal midazolam as premedication for oral surgical procedures. 
Anesthesia Progress  1990;37(6):286-289.
Eighty healthy children, between the ages of 2 and 7 years, undergoing dental procedures were monitored with a pulse oximeter for changes in arterial oxygen saturation. The children were randomly allocated into 4 groups in this double-blind study. Three groups received rectal midazolam, and the other group a placebo (saline) as premedication 30 min prior to induction of anesthesia. Group A children received midazolam 0.25 mg/kg, Group B 0.35 mg/kg and Group C 0.45 mg/kg. The results from this trial show no statistical significant difference between the treatment groups as to the effect on either systolic or diastolic blood pressure, respiration, or pulse rates at either pre- or post-sedation levels. However, the oxygen saturation levels for groups B and C differed significantly from those of the placebo groups 30 minutes after premedication (P = 0.0259).
PMCID: PMC2162544  PMID: 2097908
13.  Periodontal ligament injection: alternative solutions. 
Anesthesia Progress  1990;37(6):293-295.
This study was undertaken to investigate whether plain lidocaine, 3% plain mepivacaine and 3% prilocaine with felypressin were suitable epinephrine-free local anesthetic solutions for use in periodontal ligament anesthesia as alternatives to lidocaine with 1:80,000 epinephrine. Two hundred and seven patients received one of the four test solutions via a periodontal ligament injection and the success rate of anesthesia was confirmed using an electric pulp stimulator. Although neither mepivacaine nor prilocaine were as effective as lidocaine with epinephrine, the success rates of these three solutions were not statistically different. A single periodontal ligament injection of any of the solutions tested resulted in a low incidence of anesthesia. The success rate of lidocaine without epinephrine was consistently poor.
PMCID: PMC2162543  PMID: 2097910
14.  Comparative trial of succinylcholine vs low dose atracurium-lidocaine combination for intubation in short outpatient procedures. 
Anesthesia Progress  1990;37(5):238-243.
Despite its many disadvantages, succinylcholine is the most commonly used drug for intubation of patients for short out-patient procedure. This double blind trial compared a low dose atracurium/lidocaine combination to succinylcholine for intubation in 40 ASA1 adult patients. Low dose atracurium/lidocaine provided clinical intubating conditions at two minutes and cardiovascular stability equivalent to succinylcholine with significantly less myalgia. Spontaneous respiration was slower after low dose atracurium/lidocaine relative to succinylcholine. Low dose atracurium/lidocaine may provide an acceptable alternative to succinylcholine for intubation in short outpatient procedures.
PMCID: PMC2148610  PMID: 2096747
15.  Evaluation of the accuracy of non-invasive automatic blood pressure monitors. 
Anesthesia Progress  1990;37(5):244-247.
Non-invasive automatic blood pressure monitors (BP-103N, DINAMAP 845XT, Finapres 2300) were compared with the auscultatory method. The blood pressure readings given by the oscillometric method (BP-103N, DINAMAP 845XT) were accurate and reproducible. Agreement with the auscultatory method was especially good for systolic pressure. For diastolic pressure readings, there was less agreement with the results of the auscultatory method. The finger arterial pressure method (Finapres 2300) occasionally displayed greater variability than the devices using the oscillometric method.
PMCID: PMC2148609  PMID: 2096748
16.  Peripheral nerve injury during anesthesia. 
Anesthesia Progress  1990;37(5):258-260.
A case is presented where a peripheral nerve injury occurred due to the pressure of a restraint buckle causing a postoperative motor and sensory deficit. Because these are iatrogenic injuries it is useful to review the mechanism of injury and means of prevention.
PMCID: PMC2148608  PMID: 2096751
17.  Utilization and mechanism of action of tricyclic antidepressants in the treatment of chronic facial pain: a review of the literature. 
Anesthesia Progress  1990;37(5):223-229.
Tricyclic antidepressants show promise in the treatment of chronic facial pain. The antinociceptive activity of this class of drugs appears to be independent of any antidepressant effects. An hypothesis is proposed that tricyclics antidepressants activate a descending serotonergic (5-HT1) antinociceptive pathway which in turn influences endogenous opioids. This antinociceptive pathway appears to utilize an endogenous pain modulation system. Future studies may demonstrate the operative mechanisms of action and open understanding as to etiologic factors.
PMCID: PMC2148604  PMID: 2096745
18.  Comparison of articaine and prilocaine anesthesia by infiltration in maxillary and mandibular arches. 
Anesthesia Progress  1990;37(5):230-237.
Claims that labial infiltration of the local anesthetic articaine HCl (Ultracaine DS) results in anesthesia of mandibular pulpal as well as maxillary and mandibular lingual soft tissue have never been scientifically substantiated. The aim of this investigation was to evaluate these claims, by comparing articaine to a standard anesthetic, prilocaine HCl (Citanest Forte). To investigate this, a double blind, randomized study was conducted in healthy adult volunteers. In each volunteer, the ability to induce maxillary and mandibular anesthesia following labial infiltration with articaine was compared to prilocaine given contralaterally. Anesthesia was determined by measuring sensation to electrical stimulation at the tooth, labial and lingual soft tissue for each of the 4 non-carious, non-restored, canines. Results showed that mandibular canine pulpal anesthesia had a success rate of 65% for articaine and 50% for prilocaine. Success rates for palatal and lingual anesthesia averaged 5% for each agent. As determined by chi-square analysis, no statistically significant differences were found between articaine and prilocaine for any tissue at any of the 6 sites (P greater than 0.05). A time-course assessment also failed to demonstrate a difference between the two drugs. Therefore these data are not consistent with superior anesthesia efficacy being produced by articaine at any site, including the mandibular pulpal, lingual or maxillary palatal tissues, in the canine teeth studied.
PMCID: PMC2148603  PMID: 2096746
19.  Recognition, assessment and safe management of the medically compromised patient in dentistry. 
Anesthesia Progress  1990;37(5):217-222.
A method of common risk disease recognition, physical status assessment and safe management of the medically compromised patient in dentistry is presented. This routine applies to all dentistry treatment, with special attention to pain/anxiety/stress control by any modality.
PMCID: PMC2148601  PMID: 2151419
20.  Administration of methohexital for pediatric outpatient dentistry. 
Anesthesia Progress  1990;37(5):248-251.
Rectally administered methohexital is a safe, effective sedative to ameliorate the stress of the surgical experience for the uncooperative child. The rapid onset, relatively short duration, and patient acceptance of this technique make it applicable for many pediatric outpatient procedures. Induction doses of 20-30 mg/kg of a 10% methohexital solution can produce sleep in 7-8 minutes. In some situations, the rectal route of administration has advantages over more commonly used techniques.
PMCID: PMC2148599  PMID: 2096749
21.  Scavenging system developed for the Magill anesthetic circuit for use in the dental office. 
Anesthesia Progress  1990;37(5):252-257.
Numerous potential problems have been associated with long term or occupational exposure to both nitrous oxide and halothane. Despite the lack of firmly established cause-and-effect relationships, particularly in humans, it would seem prudent to use techniques that minimize operator exposure. With this in mind, a scavenging system for use in both conscious sedation and general anesthetic techniques was developed which fulfills the requirements of both general dentists as well as those administering general anesthesia. This paper describes this system and its adaptation to the commonly used Magill circuit. It also briefly reviews the factors involved in potential toxicity caused by long term exposure to nitrous oxide and halothane.
PMCID: PMC2148607  PMID: 2096750
22.  Management of respiratory complications in clinical dental practice. Pathophysiological and technical considerations. 
Anesthesia Progress  1990;37(4):169-175.
Preoperative assessment and continuous support of respiratory function are essential components of medical care during dental treatment. This article describes the principles of respiratory support and reviews the pathophysiology and management of common disorders that may present acute complications during daily dental practice.
PMCID: PMC2148680  PMID: 2151418
23.  Noneffectiveness of midazolam on the thalamic-evoked responses in ventrobasal complex. 
Anesthesia Progress  1990;37(4):190-193.
The effect of midazolam on the rat thalamic-evoked responses in ventrobasal complex following strong electrical stimulation of the upper lip was investigated. The animals received i.p. doses of 5, 10, 20 mg/kg midazolam, or physiological saline. Relative amplitudes of the large negative potentials, which were considered to be an excitation of ventrobasal cells, were not suppressed after midazolam injection. No significant differences were found in latencies of the potentials before and after administration of the drug. It is suggested that the effective sites of midazolam may not be located at a diencephalon level.
PMCID: PMC2148678  PMID: 2096741
24.  Arterial oxygen desaturation during awake endotracheal intubation. 
Anesthesia Progress  1990;37(4):201-204.
Five patients requiring general anesthesia but presenting with compromised airways were successfully intubated by blind awake intubation with the aid of regional anesthesia and the use of appropriate sedation. Arterial blood gases were collected at three intervals: presedation, postsedation, and postintubation. Analysis of the blood gases revealed varying degrees of hypoxemia, hypercarbia, and acidosis following deep sedation before intubation. A decrease in oxygen saturation was also observed. Supplemental oxygen is suggested to avoid the effects of arterial desaturation during the sedation process. If oxygen is not administered, the risk of moderate hypoxia associated with blind awake intubation must be considered along with alternative problems including loss of protective reflexes or the inability to ventilate during induction and intubation via a direct technique.
PMCID: PMC2148677  PMID: 2129002
25.  Nitrous oxide and infertility. 
Anesthesia Progress  1990;37(4):176-180.
Our laboratory has reported changes in luteinizing hormone releasing hormone (LHRH) from the hypothalamus following nitrous oxide (N2O) exposure. LHRH augments LH release, which in turn causes ovulation. This study evaluated how N2O disrupts ovulation and the possible resulting infertility. Adult virgin female rats (N = 64) were housed with a 12 h:12 h light cycle. Daily vaginal smears were taken and only rats exhibiting two consecutive normal 4-day ovulatory cycles were used. Thirty-two rats were placed in an environmental chamber and exposed to a mix of hydrated 30% N2O and compressed air delivered at 1.6 L/min for 8 h/day for 4 days (one cycle); controls received compressed air. All rats exposed to N2O exhibited disrupted cycles following the first day of the 4-day exposure. From a group of 12 N2O-exposed rats, 11 went into constant proestrus (day of ovulatory surge) for up to 3 weeks. Control rats cycled normally. Following each exposure, eight rats were perfused, brains sectioned, and LHRH cells identified by immunocytochemistry. Eight control rats also underwent this procedure. A threefold increase in LHRH cells was noted in N2O rats. In addition, 12 rats received 30% N2O for 4 days, followed by mating with proven male breeders for 4 days, as were controls. Six of 12 N2O rats and 12 of 12 control rats gave birth. Contrary to previous reports, no significant difference was noted in litter size or weight. The constant proestrus seen after N2O exposure is due to disruption of LHRH cells in the hypothalamus (blocked LHRH release). It is this disruption of LHRH, and therefore ovulation, which results in infertility.
PMCID: PMC2148676  PMID: 2096739

Results 1-25 (64)