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jtitle_s:("anesti Prog")
1.  Epinephrine: Systemic Effects and Varying Concentrations in Local Anesthesia 
Anesthesia Progress  1986;33(6):289-297.
The range of vasoconstrictors available for use with local anesthetics in dentistry has been reviewed with emphasis on epinephrine and its physiological effects. All of the vasoconstrictors reviewed provide satisfactory results in dental anesthetic solutions when administered in appropriate concentrations and volumes. Possible drug interactions of concern to dentists include the use of vasoconstrictors with inhalational anesthetics, tricyclic antidepressants, beta blockers and, possibly, phenothiazines. Data reviewed indicates that the amounts of epinephrine used in dentistry can result in significant elevations in circulating levels of ephinephrine and concomitant physiologic changes. Evidence reviewed suggests that 1:200,000 epinephrine concentration results in optional duration and depth of local anesthesia. With the potential for adverse effects from epinephrine concentrations that are needlessly increased, it appears that in most clinical situations a 1:200,000 concentration of epinephrine can be used in an efficacious manner.
PMCID: PMC2148562  PMID: 3544965
3.  Effects of Nitrous Oxide on Chloral Hydrate Sedation of Young Children 
Anesthesia Progress  1986;33(6):298-302.
This study was performed to test the hypothesis that nitrous oxide augments the effects of chloral hydrate sedation of young children. Twenty children with a mean age of 32 months were sedated on two occasions with two different treatment regimens. All subjects received a standard dose of 50 mg/kg of chloral hydrate with or without nitrous oxide during each of two treatment visits. During one visit, the subjects received 50% nitrous oxide and 50% oxygen for a period of 20 minutes followed by 100% oxygen and, during the other visit, the reverse concentrations were used. All subjects were restrained in a Papoose Board* with an auxiliary head restraint. Successful sedation, as evident by lack of crying or movement which interrupted treatment, occurred in 84% of administrations. During the first twenty minutes, subjects receiving nitrous oxide moved and cried significantly less than when they were treated without nitrous oxide. During the remainder of the appointment, there was no difference in behavior between the two treatment regimens. Vital signs remained essentially unchanged throughout all treatment with the exception of transitory elevation of the pulse and respiratory rates, which usually occurred when the mouth prop was inserted and local anesthesia was administered. It is concluded that nitrous oxide augments the effect of chloral hydrate sedation of young children, but does not do so uniformly for all children receiving sedation.
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PMCID: PMC2148557  PMID: 3468814
5.  Fracture of the Anterior Maxillary Alveolar Ridge with Laryngoscopy 
Anesthesia Progress  1986;33(6):303-305.
The following case report describes a patient who suffered an anterior maxillary alveolar ridge fracture resulting from difficult laryngoscopy and intubation. An unfortunate sequelae of this injury was the loss of two maxillary central incisors due to persistent mobility despite long term dental stabilization. To the authors' knowledge, fractures involving the premaxilla have not been reported as a complication of laryngoscopy and intubation.
PMCID: PMC2148555  PMID: 3468815
6.  Heart Block Following Syncope 
Anesthesia Progress  1986;33(6):321.
PMCID: PMC2148563  PMID: 19598691
7.  In response 
Anesthesia Progress  1986;33(6):321-322.
PMCID: PMC2148559
10.  Heart block as a sequela to a syncopal episode. 
Anesthesia Progress  1986;33(5):243-244.
PMCID: PMC2177489  PMID: 3465260
11.  Control of Nitrous Oxide Exposure in Dental Operatories Using Local Exhaust Ventilation 
Anesthesia Progress  1986;33(5):235-242.
An experimental portable local exhaust ventilation system was installed in three dental operatories where nitrous oxide was used routinely. Standard methods of exhaust ventilation design used in industry to control exposures to toxic airborne substances were applied to the dental operatory setting. The concentration of nitrous oxide in the dentists' breathing zones was measured before and after installation to determine the efficiency of the system in reducing occupational exposures. Results indicate that placement of the exhaust opening and exhaust air flow rate are important in determining the degree of control achieved. After the system had been installed in one operatory, peak exposures declined from over 600 parts per million (ppm) to less than 70 ppm: the time-weighted average exposure was below the NIOSH recommended level of 25 ppm. A permanently installed local exhaust ventilation system modeled after the portable one used in this pilot study may be feasible for most operatories and should not interfere with dental procedures. The results suggest that nitrous oxide exposures can be greatly reduced if dental operatories are equipped with local exhaust ventilation.
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PMCID: PMC2177485  PMID: 3465259
12.  Recovery Following Sedation with Midazolam or Diazepam Alone or in Combination with Fentanyl for Outpatient Surgery 
Anesthesia Progress  1986;33(5):230-234.
Midazolam is a new water-soluble benzodiazepine with a much shorter pharmacologic half-life than diazepam. Despite this shorter pharmacologic half-life, several reports indicate that patients do not recover more rapidly after sedation with midazolam than with diazepam. The purpose of this study was to compare recovery of patients sedated with either midazolam or diazepam alone or in combination with fentanyl using the digit symbol substitution test (DSST) and Trieger test. Patients were randomly divided into treatment groups and recovery tests were administered to the patients prior to sedation and at 60, 120, and 180 minutes after achieving a standardized sedative endpoint. Patients who received midazolam alone had significantly fewer numbers of correct reponses on the DSST than patients who received midazolam plus fentanyl or diazepam with or without fentanyl. When midazolam was combined with fentanyl there was no significant difference between results obtained on the DSST when compared with either diazepam group. Comparisons between all groups using dots missed or millimeter deviation on the Trieger test showed no statistical difference between any groups. These data indicate that midazolam as a single IV agent has a slightly prolonged recovery phase compared to diazepam. The addition of fentanyl to the sedation regimen allows reduction in the midazolam dose resulting in a recovery time comparable to that of diazepam.
PMCID: PMC2177484  PMID: 3465258
13.  The Benzodiazepine Receptor 
Anesthesia Progress  1986;33(5):213-219.
The benzodiazepines are among the most widely used drugs in the world. When first introduced, little was known about their mechanism of action. However, in the last 20 years, our understanding of the chemistry and function of the central nervous system (CNS) has increased substantially. This knowledge has shed some light on the mechanism of action of the benzodiazepines and other centrally acting drugs. It is well established that the benzodiazepines act by combining with specific receptors in the central nervous system. These receptors are anatomically in close association with gamma amino butyric acid (GABA) receptors and appear to reside on the neuronal membrane in the same supramolecular protein complex. GABA is the major inhibitory neurotransmitter of the CNS. The benzodiazepines act by increasing the affinity of the GABA receptor for its ligand, thereby augmenting the inhibitory effect of a given concentration of GABA. Two hypotheses of benzodiazepine ligand-receptor interactions in this supramolecular protein complex have been proposed: (1) multiple receptor subtypes analogous to the opioid receptors; (2) single receptor with multiple conformations. The multiple receptor hypothesis suggests that each pharmacologic effect of the benzodiazepines (i.e., anxiolysis) is mediated by interaction with a specific receptor subtype. On the other hand, the alternative hypothesis suggests that only one receptor exists which has a dynamic conformation. Experimental evidence in support of each hypothesis is presented and critically evaluated.
PMCID: PMC2177483  PMID: 3022619
14.  Continuing Education in Preoperative Sedation: Perspectives on Educational Methodology 
Anesthesia Progress  1986;33(5):258-261.
Preoperative sedation is a vital component of general dental practice. The final goal and supporting objectives for training programs have been developed. An emphasis must now be placed on effective methods for accomplishing this goal. The design found in the American Heart Association's ACLS training program may serve as an excellent model for future curriculum development.
PMCID: PMC2177482  PMID: 3465264
15.  Anesthesia in the Elderly 
Anesthesia Progress  1986;33(5):280.
PMCID: PMC2177481
16.  Psychological and Behavioral Dynamics in Chronic Atypical Facial Pain 
Anesthesia Progress  1986;33(5):252-257.
The authors discuss the relationship between atypical facial pain and psychiatric disturbance. They present contemporary viewpoints and describe four cases that illustrate underlying psychodynamic mechanisms associated with pain in patients who had undergone various dental procedures and other treatments without success. They identify factors which might lead to the early detection of underlying psychological problems and discuss the role of learning, the family system and other factors in producing a chronic pain syndrome.
PMCID: PMC2177480  PMID: 3465263
18.  Intraoperative Management of a Partially Severed Endotracheal Tube during Orthognathic Surgery 
Anesthesia Progress  1986;33(5):247-251.
A potential hazard of orthognathic surgery is disruption to the endotracheal tube as it passes through the nasal cavity. Instrumentation necessary to the surgical procedure can inadvertently sever the tube either partially or completely necessitating one of several procedures to correct the situation. A case report is presented which describes a situation where the patient's endotracheal tube had been partially lacerated intraoperatively. Due to lack of patency in one nostril, a method for replacement was required that allowed the new tube to pass through the same nostril as the original tube without placing excessive forces on a surgically fractured maxilla. The mechanism for the replacement procedure as well as consideration of alternative approaches is discussed.
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PMCID: PMC2177478  PMID: 3465262
20.  Unsuspected Failure of Nasotracheal Intubation 
Anesthesia Progress  1986;33(5):245-246.
This report describes a patient with a clinically normal airway who could not, even with the aid of a fiberoptic bronchoscope, be intubated nasotracheally. Failure was due to a large bony prominence projecting anteriorly into the nasopharynx from the body of the first cervical vertebrae. This bony prominence deflected both the endotracheal tube and fiberoptic tube anterolaterally such that they could not be aligned with the glottic opening for passage into the trachea. To our knowledge, this is the first reported case of “failure” of nasotracheal intubation associated with this anatomic abnormality.
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PMCID: PMC2177476  PMID: 3465261
21.  System of Acute Medical Support to Emergency during Dental Treatment in Japan 
Anesthesia Progress  1986;33(5):265-267.
The Resuscitation Committee of Hiroshima City Dental Association was established in 1983 in order to provide acute medical support in case of emergency during dental treatment at private dental clinics. This Committee is composed of representatives from the Hiroshima City Dental Association, Hiroshima University School of Dentistry, Hiroshima University School of Medicine, Hiroshima City Health Bureau, and Hiroshima City Fire and Ambulance Department. A portable ECG monitor with defibrillator and a resuscitation kit are held in readiness at the Hiroshima University Hospital. In case of emergency during dental treatment at a private dental clinic, we hurry to the clinic with the resuscitation set and give emergency treatment. We have been involved in two cases of emergency since this system started. Both of them recovered without any sequelae. Besides these activities, we give lectures annually to dentists and dental hygienists on the treatment of medical emergencies.
PMCID: PMC2177475  PMID: 3465266
22.  Effects of Lidocaine with Epinephrine on Fear Related Arousal Among Dental Phobics 
Anesthesia Progress  1986;33(5):225-229.
The effects of 2% lidocaine containing 72 μg epinephrine on fear related arousal were tested using a cross-over design on dental patients fearful of injections and other dental procedures. Heart rate and body movement in the dental operatory were monitored, and subjects' self-reported upset in the Epinephrine condition than in the No-Epinephrine condition (F = 4.8, p = .04), but the clinical significance was negligible. No interaction between initial fear levels and the drug condition could be established. Results suggest that pre-existing dental fear levels may produce greater self-report, behavioral or physiological arousal in the dental operatory than exogenous epinephrine.
PMCID: PMC2177493  PMID: 3465257
23.  Development of an Interval Scale of Anxiety Response 
Anesthesia Progress  1986;33(5):220-224.
This paper reports the development of an interval scale of anxiety response. Magnitude estimation procedures were used with three different groups of subjects to develop a suitable scale of seven anxiety descriptors. The ratio of the highest to lowest descriptor magnitudes was 21 to 1. Analyses of the descriptor sets in the various groups indicated high reliability of meaning and high objectivity. In addition, high agreement on meaning was shown for groups of differing education and socioeconomic status. A preliminary study using the scale indicates appropriate preliminary construct validity. Further reliability and validity research is needed. This scale may be useful for assessing anxiety response changes in a variety of contexts.
PMCID: PMC2177487  PMID: 3465256
24.  Intravenous Vistaril 
Anesthesia Progress  1986;33(5):281.
PMCID: PMC2177491  PMID: 19598689
25.  EKG Monitoring for Conscious-Sedation 
Anesthesia Progress  1986;33(5):281.
PMCID: PMC2177486  PMID: 19598690

Results 1-25 (79)