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jtitle_s:("anesti Prog")
1.  Comparison of Two Intravenous Sedation Techniques for Percutaneous Radiofrequency Trigeminal Rhizotomy 
Anesthesia Progress  1987;34(6):207-210.
Conscious sedation, as used in dentistry and oral surgery, has been used satisfactorily to manage patients undergoing the intense pain encountered in radio frequency trigeminal rhizotomy for tic douloureux. The pain produced by this procedure cannot be blocked by local anesthesia. General anesthesia cannot be used because of the need for sensory testing in an awake, cooperative patient. Conscious sedation using alphaprodine, hydroxyzine, methohexital, and intensive behavioral modification was compared with a neuroleptic intravenous sedation technique using droperidol, fentanyl, and thiopental. Patients managed with conscious sedation were found to be more amnestic for the pain of surgery, a difference that persisted six months later.
PMCID: PMC2190044  PMID: 3481517
2.  Comparison of Inferior Dental Nerve Block Injections in Child Patients Using 30-Gauge and 25-Gauge Short Needles 
Anesthesia Progress  1987;34(6):215-219.
Thirty-gauge needles are generally not recommended by dental schools, yet many dentists use them. Thin needles (30 gauge) can aspirate blood, have similar deflection to thick needles (25 gauge), and resist breakage. Measurable clinical differences between inferior dental block injections using 25-gauge or 30-gauge short needles for children is addressed in this research paper. Random allocation assigned 76 cases to 30-gauge and 62 cases to 25-gauge tribeveled. Twenty-seven-gauge short needles are in routine use for inferior dental nerve block injections in our clinics. After informed written consent was obtained, inferior dental block injections were carefully administered to children (62 males and 76 females, mean age 10 years ± 3 [SD], range 4—18 years) by faculty and students in pediatric dentistry and observed by one of two trained observers. After aspiration in two planes (180°), 0.5 mL of 2% lidocaine with 1:100,000 epinephrine was deposited in the lingual block area then 1.0 mL in the inferior dental area after touching bone. Any aspirate was recorded and subjective pain scores were taken immediately using a visual analogue scale. Five minutes after the commencement of the injection, the efficacy was tested objectively by two light needle pricks of the mucosa adjacent to the cuspid. The comparability of groups as regards age and sex was verified. Half of the injections were effective at five minutes in each group. There were no significant differences in efficacy, or pain scores. Both 25- and 30-gauge groups had nine instances of slight aspiration and two instances of more marked aspirations. The overall aspiration rate was 16%. It is concluded that 25- and 30-gauge needles do not differ significantly with respect to efficacy, pain, or aspiration. Children do not think that inferior dental nerve block injections hurt very much, and there is no evidence to support a change from 25- to 30-gauge needles.
PMCID: PMC2190042  PMID: 3481519
3.  Conscious Sedation for Minor Gynecologic Surgery in the Ambulatory Patient 
Anesthesia Progress  1987;34(6):211-214.
A conscious sedation regimen consisting of alphaprodine, hydroxyzine, and methohexital together with intensive behavior modification was evaluated in an open pilot study for patients undergoing minor gynecologic surgery. This combination was found to result in hemodynamic stability, satisfactory patient compliance, and patient and surgeon acceptance. Patients were unable to recognize words taught to them just after drugs were administered.
Electroencephalogram (EEG) changes seen in general anesthesia or deep sedation were not found in the EEG records of a subset of patients. These findings suggest that conscious sedation can provide adequate relief of pain and anxiety for minor gynecologic procedures when local anesthesia can achieve only partial pain relief.
PMCID: PMC2190040  PMID: 3481518
4.  The Treatment of Trigeminal Neuralgia 
Anesthesia Progress  1987;34(6):199-201.
The etiology of trigeminal neuralgia has yet to be elucidated. Thus it is not surprising that no ideal treatment is currently available. The current treatment of choice is medical; Pharmacologic management should be tried to its fullest extent. Increasing dosages and using combination drug therapies are recommended before considering a surgical approach. If drug therapy does not alleviate the pain, a surgical approach may be indicated, although 100% effectivity is not expected. Until the true etiology of trigeminal neuralgia is established, controversy will remain in the treatment of this complex disorder.
PMCID: PMC2190038  PMID: 3326429
5.  Psychologic Interventions for the Anxious Dental Patient 
Anesthesia Progress  1987;34(6):220-227.
This article asserts that pharmacologic usage can be reduced by understanding that pain is composed of somatic, affective, and cognitive elements; the dentist should be assertive in addressing and dealing with the emotional and psychological aspects of the anxious and fearful patient. The dentist can measure levels of anxiety and fear through self-report and records of dental care; an easily administered test of dental anxiety, such as the Dental Anxiety Scale; and a structured interview in a nonoperatory setting. For those patients exhibiting a moderate amount of anxiety, attention to basic aspects of good clinic care should be sufficient. For those patients manifesting a high level of anxiety, a treatment program implemented by a dental clinical assistant is outlined and recommended. The treatment program is intended to increase patient relaxation, positive cognitive coping statements, sensory information, sense of control, and confidence in handling the dental procedures. At any level of anxiety, it is recommended that patients be abundantly praised for any element of success in dealing with the stress of their dental experience. Lastly, for those patients who do not respond to treatment efforts to reduce anxiety, it is recommended that the dentist establish a regular consultation with a psychologist who is an expert in treating dental fear and anxiety.
PMCID: PMC2190037  PMID: 3481520
7.  Respiratory Monitoring for Anesthesia and Sedation 
Anesthesia Progress  1987;34(6):228-231.
This article reviews the theory and practice of routine respiratory monitoring during anesthesia and sedation. Oxygen monitoring and capnography methods are reviewed. The current ventilation monitoring system of choice is considered a combination of the pulse oximeter and capnography. Guidelines are provided for monitoring standards.
PMCID: PMC2190035  PMID: 3326430
8.  Validity and Reliability of the Interval Scale of Anxiety Response 
Anesthesia Progress  1987;34(6):202-206.
The Interval Scale of Anxiety Response (ISAR) is shown to be a valid and reliable instrument for measuring situation dental anxiety in adults. The ISAR demonstrates differences that are known or expected between various population subgroups. Thus, significantly higher scores, indicating greater levels of anxiety, are reported by women compared with men; by hospital clinic patients compared with private practice patients; by occasional compared with regular users of dental care; by those with lower educational levels; and by those patients undergoing exodontia compared with patients having other dental procedures. Younger adults also report significantly higher anxiety scores during treatment than older adults. The ISAR is also significantly associated with other measures of anxiety and pain, and with a measure of dentistrated difficulty of extraction. Reliability is assessed favorably and present-time administration is found to improve ISAR accuracy over its retrospective use.
PMCID: PMC2190041  PMID: 3481516
9.  The role of research in pain control for dentistry. 
Anesthesia Progress  1987;34(6):232-237.
PMCID: PMC2190046  PMID: 3326431
10.  Midazolam: Review of a Versatile Agent for Use in Dentistry 
Anesthesia Progress  1987;34(5):164-170.
Midazolam is a relatively new benzodiazepine that is widely used in both medicine and dentistry. Its multiplicity of uses makes it unique among the benzodiazepines, and its water solubility and lack of active metabolites give it distinct advantages over diazepam. This paper reviews the clinical pharmacology of midazolam, provides comparison with diazepam and presents current information regarding its indications, limitations, advantages, disadvantages, methods of administration and precautions for use.
PMCID: PMC2148551  PMID: 3318568
11.  Absorption of Bupivacaine after Topical Application to the Oropharynx 
Anesthesia Progress  1987;34(5):187-190.
Bupivacaine in dosages of 20, 40, 60, or 80 mg was applied by spray to the oropharynx of 24 volunteers. Blood levels of bupivacaine were detectable at 10 minutes, peaked at 60-90 minutes, and were still measurable at 150 minutes after administration. The maximum bupivacaine plasma level recorded in any volunteer was 0.96 —g/mL (after 80 mg). Increase in pulse rate and decrease in systolic blood pressure were significantly correlated with increasing bupivacaine dosage. No clinical signs or symptoms of drug toxicity were observed in any subject.
PMCID: PMC2148550  PMID: 3479919
12.  A Nasal Mask for Chinese (Rodrigo-Leung Mask) 
Anesthesia Progress  1987;34(5):195-196.
For people of Chinese descent, facial configuration differs from that of other Asians as well as Caucasians, and the standard nasal masks used in dentistry do not fit their faces well. A simple, easily sterilizable nasal mask has been developed for this purpose and is adaptable to existing nitrous oxide machines.
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PMCID: PMC2148549  PMID: 3479921
13.  A Clinical Trial in Oral Surgery of the Analgesic Efficacy of a Suprofen/Codeine Combination 
Anesthesia Progress  1987;34(5):177-180.
Suprofen as well as codeine have been shown to be effective analgesics. In this study, a 200-mg suprofen/60-mg codeine dose is scored for analgesic efficacy and safety compared to suprofen (200 mg), codeine (60 mg), and placebo. One hundred sixty-five healthy, adult patients were asked to rate degree of pain experienced over a six-hour period after medication. The combination treatment was found to offer maximum pain relief. Dentists should be aware that flank pain and renal function abnormalities have been reported in postmarketing surveillance.
PMCID: PMC2148546  PMID: 3479917
14.  A Comparison of the Periodontal Ligament Injection Using 2% Lidocaine with 1:100,000 Epinephrine and Saline in Human Mandibular Premolars 
Anesthesia Progress  1987;34(5):181-186.
The purpose of this study is to evaluate, with the electric pulp tester, the anesthetic efficacy of the periodontal ligament injection using 2% lidocaine with 1:100,000 epinephrine and saline in human mandibular premolars. The periodontal ligament injection using 2% lidocaine with 1:100,000 epinephrine was found to be an effective technique for anesthetizing mandibular first premolars. However, the duration of profound pulpal anesthesia was approximately 10 minutes. The periodontal ligament injection using sterile saline was not an effective technique for anesthesia. Teeth mesial and distal to the injected tooth may also become anesthetized with this injection technique. The initial needle penetration and injection of the anesthetic solution in clinically healthy teeth were only mildly discomforting. No increase in tooth mobility was observed 45 minutes after the periodontal ligament injection. No clinically observable pulpal or periodontal damage was seen at 3 weeks after the injection.
PMCID: PMC2148545  PMID: 3479918
15.  Evaluation and Management of Hypersensitivity to Local Anesthetics in Pediatric Dentistry 
Anesthesia Progress  1987;34(5):191-194.
The clinical histories of four children with a history of adverse reactions to local anesthesia and who required dental treatment are reviewed retrospectively. The children described had been referred to the allergy unit for evaluation between 1984 and 1985 and are representative of the dilemma of cases of suspected hypersensitivity to local anesthetics. The first two cases had been previously treated without the use of regional anesthesia because of a family history of atopic reactions as well as equivocal skin testing to local anesthetic. The third child had experienced bizarre adverse reactions to a variety of foods and detergents erroneously interpreted as possible deterrents to the use of local anesthetics. All four children were challenged with progressively increasing concentrations of lidocaine according to a described protocol. In three cases no reaction was observed and dental procedures were performed without difficulty using lidocaine for local anesthetics. A history of bronchoconstriction in the fourth child and the contradictory results of skin tests to local anesthetics, prompted the administration of pretreatment medication aimed at preventing bronchial hyperactivity related to dental anesthesia.
PMCID: PMC2148544  PMID: 3479920
16.  A Guideline to Local Anesthetic Allergy Testing 
Anesthesia Progress  1987;34(5):157-163.
Patients with a history of adverse reactions to a local anesthetic may often be incorrectly labeled as “allergic.” Determining if a patient is allergic to a local anesthetic is essential in the selection of appropriate pain control techniques. Local anesthetic allergy testing may be performed safely and with reasonable accuracy by a knowledgeable practitioner. This paper presents guidelines for an allergy testing method.
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PMCID: PMC2148541  PMID: 3318567
17.  Pancuronium Rapid Induction Sequence 
Anesthesia Progress  1987;34(5):171-176.
Succinylcholine is traditionally used as the muscle relaxant of choice for rapid induction sequence intubation. There are, however, many absolute and relative contraindications for the use of succinylcholine necessitating the need for an alternative muscle relaxant. This study was undertaken to evaluate the effectiveness of pancuronium bromide for muscle relaxation in the rapid induction sequence in comparison to succinylcholine. A double-blind study was undertaken in 90 patients divided into two groups: One group was intubated at 60 seconds and the other at 90 seconds. Each group was divided into four subgroups by random selection and received of the following regimens: (a) succinylcholine, 1.5 mg/kg preceded by 3 mg of d-tubocurarine; (b) pancuronium bromide, 0.1 mg/kg; (c) pancuronium bromide, 0.125 mg/kg; and (d) pancuronium bromide, 0.15 mg/kg as relaxants in rapid sequence intubation. A rapid sequence intubation was performed with each intubation by a staff member or experienced house officer. Pre- and postinduction blood pressure and heart rate were taken. Postinduction blood gases were taken. The times to completion of intubation were recorded. Cord position, ease of intubation and overall relaxation were evaluated. The results indicate that in experienced hands pancuronium bromide in a dose of 0.1-0.15 mg/kg is as an effective muscle relaxant for rapid induction sequence intubation as is succinylcholine. It is an acceptable alternative when succinylcholine is contraindicated. Intubating conditions are best 90 seconds after the administration of pancuronium bromide.
PMCID: PMC2148540  PMID: 3479916
18.  Effects of Anesthesia 
Anesthesia Progress  1987;34(4):152-153.
PMCID: PMC2186294
19.  Anaesthetic Equipment 
Anesthesia Progress  1987;34(4):152.
PMCID: PMC2186293
20.  Midazolam Does Not Affect the Field Potentials in the Caudal Part of the Spinal Trigeminal Nucleus 
Anesthesia Progress  1987;34(4):134-136.
The effect of midazolam on the field potentials (FPs) in the caudal part of the spinal trigeminal nucleus following strong electrical stimulation of the upper lip was investigated in Wistar albino rats. The rats received i.p. dosages of 5, 10, or 20 mg/kg midazolam, or physiological saline. Relative amplitudes of the negative deflection were not suppressed after midazolam injection. No significant differences were found in the latencies of the potentials before and after midazolam injection. It is suggested that the main action site of midazolam may be located at a higher level than the spinal trigeminal nucleus.
PMCID: PMC2186290  PMID: 3481513
21.  A Randomized Double-Blind Pilot Study to Compare Conscious Sedation Produced by Diazepam Against Sufentanil 
Anesthesia Progress  1987;34(4):137-141.
Intravenous sufentanil, an analog of fentanyl, was compared to diazepam for conscious sedation in ambulatory dental outpatients. Ten patients undergoing the surgical removal of impacted third molars served as subjects in a double-blind, within-subject, single crossover study. Sedation was achieved with a combination of 30% nitrous oxide/70% oxygen by nasal mask and either diazepam (0.05—0.15 mg/kg) or sufentanic (0.05—0.15 μg/kg) titrated to a clinical endpoint of altered speech and relaxation. Intraoperative physiologic monitoring, patients' and the oral surgeon's subjective estimates of efficacy and psychomotor recovery were used to compare the two treatments. Both patients (eight of 10) and surgeons (six of 10) preferred sufentanil sedation. No significant differences were noted between treatments for psychomotor recovery. These preliminary data in a small sample suggest that sufentanil produces adequate conscious sedation in dental outpatients and should be evaluated further with larger patient samples.
PMCID: PMC2186288  PMID: 2964215
22.  The Gow-Gates Technique for Mandibular Block Anesthesia 
Anesthesia Progress  1987;34(4):142-149.
Reliable profound mandibular block anesthesia is questionable when depositing the anesthetic solution at the lingula. Complications can occur and the needle may impact a number of important anatomical structures by deep penetration. The Gow-Gates technique for mandibular anesthesia obviates these problems.
In this paper the Gow-Gates technique is reinterpreted using a geometrical approach based on lines and planes and is proved mathematically. In so doing a simple yet concise method of reaching the injection site is presented with a definite relationship between the anatomical pathway of the needle and a formal geometrical and mathematical pattern.
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PMCID: PMC2186284  PMID: 3481514
23.  Serum Concentration and Drug Effect After Intravenous and Rectal Administration of Diazepam 
Anesthesia Progress  1987;34(4):128-133.
In a randomized crossover study on sedation in outpatient oral surgery, the relation between the serum profile and the drug effect profile for intravenously (i.v.) and rectally administered diazepam was studied. Both sedation methods were found to be equally efficient at a mean dose of 0.25 mg/kg (range, 0.14—0.45) for i.v. administration, and 0.53 mg/kg (range, 0.50—0.58) for rectal administration. Both the serum concentration and the effect reached their mean peaks at the same time; however, this was 15 min later after rectal sedation than after i.v. sedation. Intravenous administration yielded a significantly higher serum concentration of diazepam at the clinical endpoint than did rectal administration, but the mean effect levels at the clinical endpoint were equal for both sedation methods. No linear correlation between log-serum concentration and the patient's estimation of effect was found.
PMCID: PMC2186279  PMID: 3481512
24.  Alarms for pulse oximeters. 
Anesthesia Progress  1987;34(4):151.
PMCID: PMC2186278  PMID: 3481515

Results 1-25 (60)