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jtitle_s:("anesti Prog")
1.  Reduction in Venous Complications of Intravenous Diazepam 
Anesthesia Progress  1985;32(6):241-243.
Nonsteroidal anti-inflammatory agents (NSAIAs), administered preoperatively and for three days postoperatively, were evaluated for reduction in the occurrence of venous complications following conscious sedation with intravenous diazepam. Patients receiving NSAIAs had significant reduction in overall incidence of postoperative venous complications when compared to a control group receiving postoperative narcotic analgesics.
PMCID: PMC2175425  PMID: 3868308
2.  Pulse Oximetry Monitoring of Sedated Pediatric Dental Patients 
Anesthesia Progress  1985;32(6):237-240.
Hypoxemia is recognized as a major complication of sedating pediatric dental patients. Traditional methods of patient monitoring show changes only with moderate to severe hypoxemia. This study compared pulse oximetry, a new monitoring technology, to traditional techniques in their ability to detect hypoxemia in sedated children. The results demonstrated that pulse oximetry is a more sensitive monitor of mild to moderate hypoxemia than measurements of heart rate, blood pressure, respiratory rate, or visual observation for cyanosis in sedated pediatric dental patients.
PMCID: PMC2175424  PMID: 3868307
3.  The specialty of anesthesiology in dentistry. 
Anesthesia Progress  1985;32(6):244-246.
PMCID: PMC2175422  PMID: 3868309
4.  Double-Blind Comparison of Rectally Administered Diazepam to Placebo for Pediatric Sedation: The Cardiovascular Response 
Anesthesia Progress  1985;32(6):232-236.
The sedative and cardiovascular effects of rectally administered diazepam (0.6 mg/kg) were compared to placebo in uncooperative children who required sedation during dental treatment. Twelve healthy preschool children, who required amalgam restorations, were treated during two standardized restorative appointments in a double-blind, crossover study. Blood pressure and pulse were obtained during four specified intervals during the appointment. The behavior of the children during the treatment visits was videotaped and later statistically analyzed using a kinesics/vocalization instrument. Behavioral ratings of cooperation were significantly improved during the treatment visit following diazepam. All interfering bodily movements, patient vocalizations and operator commands for the diazepam group were reduced significantly (p≤0.0001). No significant differences were observed for noninterfering behavioral response. Rectally administered diazepam did not alter blood pressure or pulse significantly in these sedated children when compared to the placebo. These findings indicate that rectal diazepam is an effective sedative agent with minimal effect on the cardiovascular system for the management of the young pediatric dental patient.
PMCID: PMC2175420  PMID: 3868306
5.  Drug Induced Emergencies 
Anesthesia Progress  1985;32(6):225-228.
The management of drug-induced emergencies in the dental office is based on vigilance in monitoring, early detection of premorbid events, and sequential application of the “ABCs” of basic cardiac life support. The steps for treating serious adverse reactions which can occur in the dental office are reviewed. Procedures to minimize adverse drug reactions are emphasized, and the appropriate drugs and doses to use are summarized.
PMCID: PMC2175418  PMID: 3868304
6.  A Comparison of Post-Operative Recovery Between Isoflurane and Enflurane for Pediatric Dental Outpatient Anesthesia 
Anesthesia Progress  1985;32(6):229-231.
Isoflurane is a volatile liquid anesthetic agent reported to have recovery times shorter than many anesthetic agents in current use. This study compared postoperative recovery times in pediatric patients receiving dental treatment under isoflurane to those receiving enflurane anesthesia. The study consisted of a retrospective review of anesthesia records for pediatric patients receiving isoflurane anesthesia. These patients were then matched to patients receiving enflurane anesthesia for age, weight, sex, race, and treatment time. A total of nine matched pairs were available for review. The average recovery time (as measured from extubation to discharge) for isoflurane was 53 minutes and for enflurane, 46 minutes. When the matched cases were analyzed by paired t-text, no statistically significant difference in recovery times was demonstrated at the 0.05 level. These findings suggest that there is no significant difference in postoperative recovery times between isofluane and enflurane in pediatric dental outpatients undergoing general anesthesia.
PMCID: PMC2175417  PMID: 3868305
7.  Measurement of Meperidine Induced Respiratory Depression Using a New Non-Invasive Technique 
Anesthesia Progress  1985;32(5):194-198.
Inductive plethysmography was used to assess the magnitude and duration of respiratory depression caused by doses of meperidine commonly administered during dental intravenous sedation. Minute volume measurements exhibited a high degree of accuracy when compared to simultaneous spirometry. Intravenously administered meperidine 25 mg/70 kg and 50 mg/70 kg both caused a significant shift to the right in their respective ventilatory-pco2 response curves. The magnitude and duration of this respiratory depression was dose related. Even relatively low doses of meperidine used in dental intravenous sedation cause respiratory depression.
PMCID: PMC2175416  PMID: 3866502
8.  Nalbuphine Sedation in a Patient with Long Term, High Dose Chemotherapeutically Controlled Psychosis 
Anesthesia Progress  1985;32(5):209-210.
Consideration of which pharmacologic agent to use when a patient requires sedation prior to an oral surgery procedure entails a number of factors, including past medical history, current medications and dose level, duration of administration, pharmacologic interactions, and the dental needs of the patient. The case described in this report illustrates the importance of consideration of these factors in a patient who required sedation prior to oral surgery while taking 800 mg chlorpromazine, 300 mg amantadine hydrochloride, and 900 mg of cimetidine daily. The possible pharmacologic interactions which could occur from concomitantly administering either diazepam or a narcotic in the presence of these agents are numerous and significant. The choice of sedative agent was further complicated by the fact that the patient was prescribed chlorpromazine and amantadine in doses which far exceeded the usual therapeutic levels and had been maintained for an extended period of time, over 8 months. Consequently, any adverse reactions that may have resulted when sedating a patient taking chlorapromazine and amantadine hydrochloride in lower doses for a shorter duration would be more likely to occur with greater speed and severity in a patient receiving such high-dose, long-term therapy. Also, unusual reactions which have not been reported with usual therapeutic dose levels might also occur since these high doses approach toxic levels for some patients. Additionally, a sedative agent had to be used which would not interfere with the antipsychotic effects of chlorpromazine since the patient's psychiatric condition required maintenance of these unusually high therapeutic levels. The following case report gives the rationale and outcome of utilizing nalbuphine for obtunding pain and producing sedation during an oral surgery procedure under such complex therapeutic conditions.
PMCID: PMC2175415  PMID: 3866505
9.  Midazolam and Somatosensory Evoked Potentials 
Anesthesia Progress  1985;32(5):199-201.
The effect of midazolam, a water-soluble benzodiazepine, on the somatosensory evoked potentials (SEPs) following strong electrical stimulation of the upper lip, was investigated in Wistar albino rats. SEPs were recorded from the surface of the skull in the contralateral temporal area. A computer was used to obtain the averaged SEPs. The rats received intraperitoneal dosages of 1.25, 2.5, or 5.0 mg/kg of midazolam, or physiological saline. Relative amplitudes of the P1N1 wave were reduced significantly after midazolam injection. Amplitude recovered to the control level about 120 min after the injection in the 1.25 mg/kg group. In 2.5 and 5.0 mg/kg groups, midazolam-induced suppression did not recover within 120 min. No significant differences were found in the latencies of P1 and N1 before and after midazolam injection. It is suggested that midazolam has a mild analgesic effect due to central suppression of the pain perception following noxious stimuli.
PMCID: PMC2175414  PMID: 2935054
10.  Ketamine anesthesia. 
Anesthesia Progress  1985;32(5):185-188.
PMCID: PMC2175412  PMID: 3866500
11.  Trigeminal Neuralgia: Management of Two Cases with Hypnotherapy 
Anesthesia Progress  1985;32(5):206-208.
Tic douloureux, unlike other chronic pain disorders, exhibits a number of very specific features unassociated with either sensory loss or demonstrable neuropathology.1 The etiology is obscure but various contributory factors have been cited, and the condition is considered an important cause of face pain. Although a variety of drugs and surgical procedures have been employed to control the symptoms, the results in many cases have been temporary with many adverse side effects.2 For many years, hypnotherapy has been utilized as a valid tool for the control of severe protracted pain, and relief of symptoms has been achieved in many instances where other modalities of pain management had been inadequate. The author presents two cases in which hypnotherapy was employed for the management of symptoms associated with idiopathic trigeminal neuralgia.
PMCID: PMC2175410  PMID: 3866504
13.  Comparison of Periodontal Intraligamental Anesthesia Using Etidocaine HCL and Lidocaine HCL 
Anesthesia Progress  1985;32(5):202-205.
A double-blind method was used to compare anesthesia duration following intraligamental administration of 1.5% etidocaine with 1:200,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine. Durations of anesthesia in pulpal and soft tissues were monitored following periodontal ligament injections adjacent to the maxillary canines of 20 individuals. Complete pulpal anesthesia was attained in 35% of the teeth injected with etidocaine and in 55% of those receiving lidocaine. Soft tissue anesthesia was consistently achieved. Both pulpal and soft tissue anesthesia were of longer duration following the use of lidocaine solution. These findings suggest that anesthetic duration following periodontal ligament injections is more related to the concentration of vasoconstrictor than to the anesthetic solution employed.
PMCID: PMC2175406  PMID: 3866503
14.  Subcutaneous Emphysema 
Anesthesia Progress  1985;32(4):161-163.
This case describes the development of subcutaneous emphysema following restorative dentistry performed under general anesthesia. Initial treatment consisted of intravenous epinephrine and dexamethasone due to difficulty in breathing and laryngeal stridor. Dexamethasone and other adjunctive drugs were administered over the 4 days following surgery while the symptoms subsided. The author emphasizes the importance of early recognition and prompt management in managing this unusual complication.
PMCID: PMC2148539  PMID: 3865564
15.  Evaluation of the Gow-Gates Mandibular Block for Oral Surgery 
Anesthesia Progress  1985;32(4):143-146.
The Gow-Gates mandibular block technique for administration of local anesthesia was compared to conventional nerve block techniques in patients undergoing the removal of impacted third molars, using a within-subject experimental design. Both techniques resulted in acceptable quality of anesthesia. Success rate of the Gow-Gates technique was significantly greater than with conventional techniques. Limitations of the Gow-Gates technique were slower onset of anesthesia, variable buccal nerve anesthesia, and increased intraoperative bleeding.
PMCID: PMC2148538  PMID: 3865562
16.  The Role of Needle Purging in Reducing Transfer of Microorganisms From Local Anesthetic Cartridge Diaphragms 
Anesthesia Progress  1985;32(4):157-160.
The literature is reviewed to demonstrate the significant amount of contamination on the external surface of the anesthetic cartridge diaphragm. Current methods of cartridge diaphragm decontamination to prevent injection of pathogens are discussed. A series of bacteriologic tests were conducted to determine the probability of transfer of pathogens from the diaphragm surface through the needle lumen of three different sizes to the deposition site. Results of needle purging suggest that a significant reduction in the transfer of microorganisms is possible using this technique.
PMCID: PMC2148537  PMID: 3907421
17.  Malignant Hyperthermia 
Anesthesia Progress  1985;32(4):140-142.
Despite numerous reviews and clinical reports, much remains to be learned about the cause, treatment, and prevention of malignant hyperthermia.
Among the most worrisome concerns of the clinician administering anesthesia is the malignant hyperthermia crisis. When it arises, it is always frightening—and sometimes fatal. Usually occurring very suddenly and without warning, malignant hyperthermia is considered to be a hypercatabolic crisis; the condition is known to affect humans and certain breeds of pigs. The exact triggering mechanisms of malignant hyperthermia (MH) in humans are not known, but a crisis can be initiated by volatile general anesthetics, neuromuscular blocking agents, and amide local anesthetics. Although a history of an MH crisis is a diagnostic aid, previous uneventful exposure to anesthesia does not guarantee the safety of the patient in subsequent anesthetic procedures.1 For these reasons, it is important for the anesthesiologist to be aware of the initial signs of MH and to be prepared to provide immediate treatment to reverse such a crisis.
PMCID: PMC2148536  PMID: 3865561
18.  The Effect of Pentobarbital on Lidocaine Toxicity and Brainstem Concentration 
Anesthesia Progress  1985;32(4):147-150.
The effect of pretreatment with 20 mg/kg sodium pentobarbital on the acute intravenous toxicity of 2% lidocaine was determined in rats. Pretreatment increased the LD50 of lidocaine from 20.2 mg/kg to 26.9 mg/kg (p<0.05). This 25% decrease in lethality was accompanied by similar decreases in the concentrations of lidocaine (relative to the injected dose) in serum and brainstem samples collected immediately after death. Under the conditions of this study, pentobarbital apparently protects against lidocaine lethality by increasing the relative distribution of local anesthetic to tissues outside of the central nervous system.
PMCID: PMC2148535  PMID: 3865563
19.  Risk Appraisal of Narcotic Sedation for Children 
Anesthesia Progress  1985;32(4):129-139.
Since the use of narcotics was initially advocated 28 years ago, serious adverse reactions, including fatalities, have been reported. At least four factors appear to contribute to these reactions: multiple drug administration, excessive dosage, inadequate monitoring, and ineffectual emergency care. Because of the relatively high incidence of life-threatening reactions and the complexity of the required emergency care, the routine use of pediatric sedation techniques that require large doses of narcotics cannot be advocated for use in the private office.
PMCID: PMC2148533  PMID: 2866736
20.  Relief of Dental Pain: A Controlled 12-Hour Comparison of Etodolac, Aspirin, and Placebo 
Anesthesia Progress  1985;32(4):151-156.
Single doses of the study drugs were evaluated for 12 hours by 201 out-patients reporting moderate or severe pain following oral surgery. The results of this double-blind study indicated that 50, 100, and 200 mg of etodolac as well as 650 mg of aspirin were significantly more effective than placebo. A dose-response relationship was found for the three doses of etodolac, which was significant for summed pain relief scores for up to 8 hours. In terms of total analgesic effect, etodolac 200 mg was significantly superior to placebo for 8 hours, while aspirin and the two lower doses of etodolac were similarly effective in the range of 3-6 hours postdrug. All doses showed a favorable onset of analgesia (½-1 hour). Etodolac 200 mg resulted in a duration of action which was approximately twice as long as aspirin's and also produced a peak pain relief which was significantly greater than the lower doses of etodolac and aspirin. All study medications were well tolerated with no reports of significant adverse side effects. No dose-related effects were observed with etodolac
PMCID: PMC2148530  PMID: 2934008
21.  Sedative Effects and Cardiorespiratory Influences of Intravenous Flunitrazepam Premedication 
Anesthesia Progress  1985;32(3):98-103.
Sedative effects and the influence on cardiorespiratory functions of flunitrazepam, 0.015 mg/kg intravenously, were studied in 13 healthy adult volunteers. Immediately after administration, 12 of the 13 subjects responded when their names were called, while one subject required gentle patting on the shoulder to evoke a response. The scores of EEG and electro-oculogram were decreased. Cardiorespiratory changes were mild and not significant clinically. Anterograde amnesia was remarkable. Equilibrium functions were normal at 180 min postdose. Only one subject complained of pain at injection. It was concluded that intravenous injection of 0.015 mg/kg flunitrazepam was an optimal dose for sedation in healthy adults.
PMCID: PMC2148512  PMID: 3865560
22.  Postoperative Delirium Secondary to Atropine Premedication 
Anesthesia Progress  1985;32(3):107-108.
Anticholinergic agents used as preoperative medications have the ability to induce postanesthetic delirium reactions. We present a case of postanesthetic delirium secondary to premedication with atropine which was treated with intravenous physostigmine. This case is presented to alert the clinician to the possibility of this reaction occurring with the use of atropine, and to demonstrate the use of physostigmine in reversing postanesthetic delirium reactions caused by anticholinergics.
PMCID: PMC2148511  PMID: 3865557
23.  A New Technique for Stabilization of the Endotracheal Tube 
Anesthesia Progress  1985;32(3):109-110.
An inexpensive and readily available device for securing the endotracheal tube in oral or nasal intubations is described. The device consists of a Velcro-fastened strap which is adjustable to any size tubing and two additional cloth straps which are tied around the patient's head. This device is very stable when properly tied and minimizes the possibility of extubation or damage to the nasal tissues caused by movement of the endotracheal tubing during surgery.
PMCID: PMC2148509  PMID: 3865558
24.  General Anesthesia and Fragile X Syndrome: Report of a Case 
Anesthesia Progress  1985;32(3):104-106.
A case report of an 11-year-old Caucasian boy with the fragile X syndrome is presented. The fragile X syndrome is a form of X-linked mental retardation with a connective tissue component that involves mitral valve prolapse. Antibiotic prophylaxis, electrocardiographic abnormalities, and special anesthetic management considerations are elements of treating patients with fragile X syndrome. The patient received morphine sulfate and scopolamine as a preoperative premedication. Ketamine was also administered intramuscularly prior to induction to gaseous anesthetic. Pancuronium was used to facilitate nasotracheal intubation. A wandering atrial pacemaker and progressive hypocapnia, both of which were managed without complication, were the only problems encountered in the anesthetic procedure.
PMCID: PMC2148507  PMID: 2934007
25.  Physostigmine: An Antidote for Excessive CNS Depression or Paradoxical Rage Reactions Resulting from Intravenous Diazepam 
Anesthesia Progress  1985;32(3):87-92.
A review of the pharmacology and use of the drug physostigmine is presented. Of particular interest is the drug's capability to reverse excessive somnolence or paradoxical responses caused by intravenous diazepam (Valium®) and other clinically available benzodiazepines. Its use for the treatment of anticholinergic syndrome is discussed and incidence and characterization of side effects documented. Recommendations are made for appropriate emergency use.
PMCID: PMC2148506  PMID: 3865559

Results 1-25 (43)