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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

Flow dynamics, 125 Gelfoam, 22 General anesthesia, 20, 22, 31, 66, 122, 168 Hydroxyzine, 91 Hyperalgesia, 135 Hypercapnia, 51 Hypocapnia, 51 Inferior alveolar nerve block, 106, 135 Injection speed, 106 Intravenous deep sedation, 25 Intravenous fluids, 168 Irreversible pulpitis, 14, 135 Ketamine, 25 Laryngeal mask airway, 20 Lidocaine, 106 Local anesthesia, 106, 153 Main-stem intubation, 66 Management of pediatric cardiac arrhythmias

epistaxis, there are several nasal packing options one can employ. As was performed in our case, cotton pledgets soaked in phenylephrine can be placed in the anterior nasal cavity with direct pressure applied to the nose for at least 5 minutes. 7 Other options include hemostatic absorbable packings such as Gelfoam or Surgicel. Alternatively, a preformed nasal tampon such as the Merocel packing coated in bacitracin or lubricant jelly can be inserted along the floor of the nose, where it expands after several drops of saline solution or topical vasoconstrictor applied to

the mucosa can be largely left intact. Local Measures There are local measures that can be employed for necessary surgical procedures. Suturing can be helpful to achieve primary closure if multiple adjacent teeth are extracted. However, each additional needle puncture is a potential source for bleeding, so the benefits must outweigh the risks. Electrocautery or CO 2 laser can be used for soft tissue biopsy or for the purpose of achieving hemostasis, but these come with the risk of tissue necrosis which can become a source of postoperative bleeding. Gelfoam

combinations of these medications can undergo periodontal surgery, including flap elevation and gingivectomy, utilizing local hemostatic measures such as oxidized cellulose (Gelfoam), digital pressure, and electrocautery when necessary. 41 However, some references have recommended the consideration of skipping a single DOAC dose due to the slightly increased risk of bleeding associated with some potentially invasive dental procedures. 38 Although the above referenced studies seem to suggest the possibility of performing many procedures without requiring OAP cessation

, several early studies suggest these agents may be safe during low bleeding risk procedures such as simple dental extractions. 11 , 12 The safety of exodontia in patients on antiplatelet or anticoagulant drugs depends in part on the nature of the bleeding. Extraction sockets are readily accessible to the surgeon and respond to local hemostatic measures such as mechanical pressure, hemostatic agents (eg, Gelfoam or Surgicel), suturing, or topical tranexamic acid. 14 Therefore, the bleeding that does occur remains controllable and does not threaten patient