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The Use of Pharyngeal Throat Packs in Dental Anesthesia
Takuro Sanuki DDS, PhD,
 Naotaka Kishimoto DDS, PhD,
 Shota Tsukimoto DDS, PhD, and
 Kanta Kido DDS, PhD
Article Category: Commentary
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
DOI: 10.2344/anpr-70-03-07
Page Range: 196 – 197

The insertion of a pharyngeal throat pack (PTP) has historically been thought to prevent aspiration and ingestion, reduce postoperative nausea and vomiting (PONV), and stabilize the airway during general anesthesia by preventing leakage and maintaining tidal volume. 1

However, some evidence has emerged in recently to suggest PTPs may not deliver on all the purported effects and may actually be harmful. Powell et al 2 showed that a PTP does not act as an effective barrier against blood ingestion during orthognathic surgery. Furthermore, they also indicated that a PTP had no positive or negative effect on PONV but may

Robert C. Bosack DDS
Article Category: Other
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
Page Range: 202 – 205

Historical Selection: Anderson JA. Respiratory monitoring for anesthesia and sedation. Anesth Prog. 1987;34:228–231.

The kind words and thoughts that prompted my Heidbrink award are deeply appreciated. The opportunity to stand on Dr Heidbrink’s shoulders as we improve the quality and safety of dental anesthesiology is truly a great honor. With this honor comes the charge of selecting a currently relevant, historical “landmark” article for commentary. As our current Anesthesia Progress (AP) website populates only back to 2005, I had to look deeper—a lot deeper. Hours of scouring the AP archives were eventually rewarded with the re-discovery

Kyle J. Kramer DDS, MS
Article Category: Editorial
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
Page Range: 157 – 158

The very structure and nature of the US health care system engenders many challenges, several of which arise from the fact that each state determines its respective rules and regulations, including those that pertain to dentistry. It comes as no surprise, then, that no universally accepted set of laws exists to provide oversight for the use of office-based sedation and general anesthesia for dentistry. This has led to many states enacting rules and regulations that lack fairness, equity, and, quite frankly, common sense.

Some states have very strict rules governing dentists providing sedation and/or general anesthesia (ie, dentist anesthesia providers)

Toru Yamamoto DDS, PhD,
 Tatsuru Tsurumaki DDS, PhD,
 Hiroko Kanemaru DDS, PhD, and
 Kenji Seo DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
Page Range: 173 – 177

A tracheal bronchus is a congenital abnormality of the tracheobronchial tree in which a displaced or accessory bronchus arises from the trachea superior to its bifurcation. We herein report a case in which a tracheal bronchus was incidentally found after induction of general anesthesia, and we discuss the potential airway management problems that may have ensued. An 80-year-old man was scheduled for buccal mucosa resection and abdominal skin grafting for treatment of squamous cell carcinoma of the left buccal mucosa. Because of trismus and anticipated airway difficulty, an awake intubation was performed under sedation. A 3-branched structure was incidentally observed at the first branching site that was supposed to be the carina. The tip of the endotracheal tube was repositioned 3 cm above the tracheal trifurcation, and the rest of the procedure proceeded uneventfully. A flexible fiberoptic scope is not used in many anesthesia cases, making the identification of such tracheal or bronchial abnormalities more difficult. Therefore, it is important to carefully check the bronchial morphology on any available chest radiographs before surgery, listen to lung sounds after intubation, and assess thoracic lung compliance without neglecting routine safety checks.

Mark A. Saxen DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
Page Range: 206 – 208

Simpao A, Randazzo I, Chittams J, et al. Anesthesia and sedation exposure and neurodevelopmental outcomes in infants undergoing congenital cardiac surgery: a retrospective cohort study. Anesthesiology. 2023;139(4):393–404. doi: 10.1097/ALN.00000000000 04684

Children undergoing complex cardiac surgery are exposed to substantial cumulative doses of sedative medications and volatile anesthetics and are more frequently anesthetized with ketamine as compared with otherwise healthy children. This study hypothesized that lower neurodevelopmental scores would be associated with this population at 18 months of age due to increased exposure to sedation and anesthesia. Cumulative minimum alveolar concentration hours of exposure to volatile anesthetic agents and

Shota Abe DDS,
 Kanami Suzuki DDS,
 Maki Hamamura DDS,
 Takashi Tamanoi DDS,
 Koji Takahashi DDS,
 Keiichiro Wakamatsu DDS,
 Kenji Yoshida DDS, PhD,
 Hiroyoshi Kawaai DDS, PhD, and
 Shinya Yamazaki DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
Page Range: 184 – 190

We present the case of a 46-year-old man who received ephedrine for hypotension after surgery for a mandibular lesion under intravenous (IV) moderate sedation with dexmedetomidine (DEX) and experienced transient ventricular tachycardia (VT). The patient was scheduled to have cystectomy and multiple apicoectomies for the mandibular periapical infection and the simple bone cyst. Other than obesity, snoring, and a nonalcoholic fatty liver, he denied any other significant medical history, medications, or allergies. The surgery was successful; however, his blood pressure dropped after stopping the DEX infusion. Ephedrine was administered IV several times, which resulted in the onset of VT on the electrocardiogram (ECG). His blood pressure could not be measured at the time, but he was able to respond and breathe independently. A defibrillator was immediately made available. The ECG revealed a spontaneous transition from VT to atrial fibrillation with ST depression. Because he was unable to revert to a normal sinus rhythm, the patient was transferred to a general hospital, where he underwent additional testing. No abnormalities were observed in his heart or brain. After DEX administration, its long-lasting alpha-2 adrenoceptor agonist effects can cause vasodilation and inhibition of sympathetic activity, leading to hypotension in some patients. Should that occur, ephedrine can be used to increase blood pressure, but it may also provoke transient coronary artery spasms and lead to VT. Consequently, extreme caution should be exercised in patients who develop hypotension following DEX administration. We also recognize the significance of regular training sessions, such as advanced cardiac life support programs.

Yoshio Hayakawa DDS, PhD,
 Keiko Fujii-Abe DDS, PhD,
 Sayaka Akitomi DDS,
 Shihomi Niwa DDS,
 Michiru Abe DDS,
 Manami Otsuka DDS, PhD,
 Maho Ikeda DDS,
 Takumi Ishikawa DDS, PhD,
 Manami Yajima DDS, PhD, and
 Hiroshi Kawahara DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
Page Range: 159 – 167

Objective

Remimazolam is a new, ultra-short-acting benzodiazepine that can be used for induction and maintenance of general anesthesia. We compared the hemodynamic stability and depth of anesthesia during general anesthesia using remimazolam or propofol along with remifentanil for oral and maxillofacial surgery.

Methods

A total of 95 patients were divided into remimazolam and propofol groups and then subdivided into bispectral index (BIS) and patient state index (PSI) groups. Blood pressure, heart rate, and BIS/PSI values were compared at fixed time points perioperatively. Time to loss of consciousness and total opioid doses were also compared across groups. Other items that were compared included intraoperative arousal and postoperative nausea and vomiting.

Results

Propofol produced more significant hemodynamic depression than remimazolam, although both groups were stable. BIS/PSI values were similar in both groups. Time to loss of consciousness was significantly shorter in the remimazolam group. Total opioid dosing was higher in the remimazolam group, and there were no differences regarding other postoperative complications.

Conclusion

The perioperative hemodynamics with remimazolam were more stable that with propofol, especially during induction. Therefore, remimazolam may be a safe alternative to propofol for providing TIVA general anesthetics.

Tiffany Smith BS,
 Rachel Blum BS, and
 Raquel Rozdolski DMD
Article Category: Case Report
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
Page Range: 178 – 183

This case report describes a 51-year-old man who swallowed an amalgam fragment dislodged during dental treatment performed without a throat screen. The patient was transferred to the emergency department, where the foreign body was confirmed to be in the esophagus following radiographic imaging. Foreign body removal from the esophagus is routinely achieved via esophagogastroduodenoscopy (EGD). However, this incident occurred in September 2020, at the height of the COVID-19 pandemic. Because of the patient's preoperative positive COVID-19 test, the option for EGD retrieval was eliminated per hospital protocol. Instead, a noninvasive approach with serial radiographic monitoring was deemed mandatory to observe the fragment as it passed through the gastrointestinal tract, warranted by the small size of the foreign body and the patient's lack of signs and symptoms of respiratory distress. This case report reinforces the importance of using airway protection during every dental procedure. Furthermore, reevaluation of EGD as the gold standard for treatment of ingested small materials may be warranted.

Takuro Sanuki DDS, PhD,
 Hidetaka Kuroda DDS, PhD,
 Uno Imaizumi DDS, PhD,
 Shota Tsukimoto DDS, PhD,
 Norika Katagiri DDS, PhD,
 Ayako Mizutani DDS, PhD,
 Mari Ohnaka DDS,
 Shinji Kurata DDS, PhD,
 Naotaka Kishimoto DDS, PhD, and
 Kanta Kido DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
Page Range: 168 – 172

Objective

The impact of the COVID-19 pandemic on dental anesthesiologists has not been examined. This study aimed to determine how the COVID-19 pandemic affected Japanese dental anesthesiologists’ professional lives.

Methods

An online questionnaire related to the effects of COVID-19 on dental anesthesiologists’ professional lives was emailed to 351 board-certified dental anesthesiology specialists from the Japanese Dental Society of Anesthesiology. The endpoints of this study were changes in income and job satisfaction as a dental anesthesiologist from 2019 prior to the COVID-19 pandemic.

Results

A total of 141 dental anesthesiologists participated in the survey. Most respondents reported no change in income relative to 2019 for 2020 or 2021. Significantly more dental anesthesiologists reported income decreases relative to 2019 for 2020 (39%) vs 2021 (21.3%; P = .001). Very few dental anesthesiologists reported income increases relative to 2019 for 2020 (2.1%) vs 2021 (15.6%; P < .001). Job satisfaction as a dental anesthesiologist remained unchanged for all 3 years.

Conclusion

Even though many Japanese dental anesthesiologist specialists lost income because of COVID-19, they maintained their job satisfaction.

Jay A. Anderson DDS, MD
Article Category: Other
Volume/Issue: Volume 70: Issue 4
Online Publication Date: Jan 15, 2024
Page Range: 198 – 201

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.

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