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all cases of allergic reactions are due to anesthesia. Here we report a case of anaphylaxis possibly associated with Gelfoam (Pfizer Canada) sponge. CASE REPORT A 2-year-old, 11-kg female patient with William's syndrome presented for dental rehabilitation under general anesthesia at the Hospital for Sick Children, Toronto, Ontario, Canada. She had undergone 3 prior general anesthetics because of her syndrome: 1 for examination under anesthesia and ptosis repair and 2 general anesthetics under bypass for correction of aortic stenosis

transplantation. 7 , 8 The etiology of this patient's disease is unknown. The incidence of bronchiolitis obliterans has not been reported with consistency in the literature. Patients may first present with vague flu-like signs or symptoms or it may be an incidental diagnostic finding. 4 Management can involve intermittent courses of corticosteroids, antibiotics, and inhaled bronchodilators. 4 Electronic cigarettes or e-cigarettes have become the most commonly used nicotine product among Canadian 8 and American youth in recent years. These popular electronic devices

and cough peak flow rates from 1.6 to 8.5 L/s. 14 In addition, the mouth opening area for those previous studies was measured 11 to range from 1.97 to 4.95 cm 2 . For this report, the simulated mouth opening used was 3.8 cm 2 . A tape measure was affixed to the orifice to measure the height of the expelled material as captured on slow-motion video. Analysis Immediately after each simulated procedure or cough, the participants were taken to a dark room and a Certified 9-bulb UV light (Canadian Tire, Corporation Limited, Toronto

significant respiratory depression or apnea secondary to inadvertent opioid overdose. Naloxone kits have become more readily available in health clinics, pharmacies, workplaces, and at home. 17 – 19 In the United States, naloxone distribution programs are increasing, 20 while in Canada, the naloxone kits are available without a prescription and often free of charge, resulting from sponsorship by public health programs. 18 Each take-home kit contains 1 to 2 intramuscular naloxone doses of 0.4 mg. A systematic review published in 2016 reported that take-home naloxone

with injection of anesthetic (A2, B2, C2). This study design is summarized in Figure 1 . Figure 1 Study design. Figure 1. Study design. The topical anesthetic paste used was 5% lidocaine (Dentsply Inc, Canada). The site tested was the palatal soft tissue adjacent to the first premolar, chosen because the perception of pain on injection in the palate is usually perceived to be the highest in the oral cavity. The contralateral side received placebo. At the first visit, each