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-implants during orthodontic treatment is strongly influenced by the perception of pain associated with the insertion procedure, frequently a reflection of the needle puncture for the application of infiltrative anesthesia. 1 , 7 The placement of mini-implants in the oral cavity with only the application of topical anesthesia has been suggested in the literature. 1 , 8 , 9 There are advantages involved in this practice, such as greater comfort for the patient, simplicity of the anesthetic technique, reduction in stress and anxiety of the patient before insertion of the

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

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

general anesthesia, demonstrating its usefulness as an IV anesthetic. 2 – 4 Remimazolam was approved in Japan for use via continuous IV infusion for general anesthesia in adult patients in 2020. 5 Because remimazolam's metabolism is independent of organ (i.e., renal) function, it may be considered an appropriate agent for the anesthetic management of hemodialysis patients and may have added benefits beyond other IV anesthetics like midazolam and propofol. However, to our knowledge, there has been no report on general anesthesia using remimazolam in hemodialysis