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, physiology, pharmacologic management, and other concerns surrounding the anesthetic management of the hypertensive patient. CLASSIFICATION AND GUIDELINES There are 2 types of hypertension: essential hypertension and secondary hypertension. Essential hypertension accounts for approximately 95% of the cases and represents a form of hypertension without a clear cause. 4 However, many health care providers recognize that a number of factors may contribute to increased blood pressure, including but not limited to obesity, insulin resistance, high

Maxillary and mandibular osteotomies may be associated with significant blood loss and postoperative airway compromise. Deliberate hypotensive anesthesia, head up tilt, and local anesthesia with vasoconstrictor can reduce blood loss to the extent that blood transfusion is now uncommon. 1 It is, however, important to avoid excessive opioid-induced postoperative narcosis and respiratory depression associated with these techniques. Anesthetic maintenance with propofol and remifentanil is fast becoming the technique of choice for orthognathic surgery in our

GENERAL PROPERTIES OF LOCAL ANESTHETICS Local anesthetics interrupt neural conduction by inhibiting the influx of sodium ions. In most cases, this follows their diffusion through the neural membrane into the axoplasm, where they enter sodium channels and prevent them from assuming an active or “open” state. The local anesthetic molecule consists of 3 components: (a) lipophilic aromatic ring, (b) intermediate ester or amide chain, and (c) terminal amine. Each of these contributes distinct properties to the molecule ( Figure 1

– 1058 . 8 Dale O , Brown BR Jr . Clinical pharmacokinetics of the inhalational anaesthetics . Clin Pharmacokinet . 1987 ; 12 : 145 – 167 . 9 Waste anesthetic gases fact sheet No. OSHA 91-38 . United States Dept of Labor Occupational Safety and Health Administration Web site . Available at: http

Inhalational anesthesia still has a very significant role in the ambulatory and office-based setting, particularly with pediatric and needle-phobic patients. 5 Ideally, an anesthetic agent should possess the following characteristics: it should be highly potent, nonflammable, and nontoxic; it should be stable in light, alkali, and soda lime; it should have low blood solubility; it should be nonirritating to respiratory mucosa; and it should have minimal or no biotransformation and minimal cardiovascular and respiratory effects. 6 HISTORY

Local anesthetics interrupt neural conduction by inhibiting the influx of sodium ions through channels or ionophores within neuronal membranes. Normally these channels exist in a resting state, during which sodium ions are denied entry. When the neuron is stimulated, the channel assumes an activated or open state, in which sodium ions diffuse into the cell, initiating depolarization. Following this sudden change in membrane voltage, the sodium channel assumes an inactivated state, during which further influx is denied while active transport mechanisms

. Procedure and Treatment The staff dental anesthesiologist and resident administered anesthesia while the pediatric dental resident, under supervision of the staff pediatric dentist, performed the dental procedures. The principal investigator was not involved in direct patient care. Anesthetic protocols were standardized to a limited extent to simulate nonacademic practice. Intravenous analgesics are not always given routinely in many practices, including both hospital and ambulatory settings. The current standard of practice is variable in this regard

the scientific literature regarding statistical data on local anesthetic use in dentistry since 2005 were reviewed using PubMed and Medline databases. The search included 1 or a combination of the following keywords, in singular or plural: administration, anaesthesia, anaesthetic, anesthetic, articaine, carticaine, comparison, data, dental, dentist, epinephrine, lidocaine, local, mepivacaine, prilocaine, statistic, and vasoconstrictor. Search results were evaluated for relevance, and original publications were obtained. The reference lists were reviewed to obtain

Introduction General anesthesia is a drug-induced state that is characterized by an absence of perception to all sensations. In 1920, Guedel described ether anesthesia according to 4 stages, each of which reflects greater depression of brain function: Stage I—analgesia; Stage II—delirium; Stage III—surgical anesthesia; and Stage IV—medullary paralysis and death. Today, these stages are merely of historical interest; they are not observed reliably when modern intravenous or inhalation agents and techniques are used. The so-called anesthetic

Reports of adverse reactions to local anesthetics are usually attributed to a reaction to epinephrine, vasovagal syncope, or overdose toxicity. Patients may then interpret adverse reactions as an allergy to local anesthetic. True allergy to amide local anesthetics is considered to be rare. 1 All injectable local anesthetics are composed of 3 different structural parts: (a) an aromatic or lipophilic portion, necessary for the drug to penetrate the lipid-rich nerve membrane; (b) an amino terminus, ensuring solubility in aqueous medium