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When used as a primary or supplemental technique, various authors have reported an increase in heart rate with the intraosseous injection of epinephrine- and levonordefrin-containing anesthetic solutions. 1 – 6 The increase in heart rate has ranged from 8 to 32 beats/min. As demonstrated by a number of studies, 1 – 6 the patient usually perceives the increase in heart rate. In previous studies, 1 – 6 the local anesthetic solution was administered intraosseously over a 1- to 2-minute period using a conventional syringe. The Wand

Furthermore, IANB induces a prolonged soft-tissue numbness that lasts far longer than pulpal anesthesia, which may disrupt the patient's normal daily activities. 4 Besides, in up to 89% of patients presenting with SIP, IANB causes moderate to severe pain during needle insertion, placement, and solution deposition. 5 Therefore, seeking an alternative to IANB has been a topic of interest throughout the years. Several supplemental and primary techniques, such as buccal infiltration and intraligamentary, periodontal ligament, intrapulpal, and intraosseous (IO) injections

the operating room nurses had taken ACLS/PALS previously. In fact, the nurse correctly began CPR based on AHA guidelines. It was speculated that the chest compressions circulated both vecuronium and fentanyl. Additionally, had we not been able to quickly establish venous access, intraosseous infusion techniques would have been very useful during this case. We strongly suggest that not only anesthesiologists but also nurses need to be current with AHA guidelines, even though these emergencies are rare. Although the responsible anesthesiologist felt real panic, his

pulpal anesthesia. Practitioners should consider supplemental techniques, such as intraosseous 24 – 32 or periodontal ligament injections 33 , 34 when an IANB fails to provide pulpal anesthesia for a particular tooth. Because we studied a young adult population, the results of this study may not apply to children or the elderly. Kanaa et al 19 compared a cartridge of 2% lidocaine with 1 : 100,000 epinephrine to 4% articaine with 1 : 100,000 epinephrine for buccal infiltration anesthesia of the mandibular first molar. The articaine solution had a

associated with nociception and acute inflammation expression 23 and is widely used as a marker for detecting thin pain-sensitive nerves (Aδ and C fibers) in the pain pathway. 16 The results show that the ratio of pain-sensitive nerves accounted for >70% in the mandible. Intraosseous nerves comprise few efferent motor nerves and many afferent pain-sensitive nerves because there is no dynamic tissue, such as voluntary muscle, in the intraosseous tissue. Pain and Local Anesthesia in the Mandible The results demonstrate that many pain

articaine to work, 20 an intraosseous injection was delivered using the Stabident (Fairfax Dental, Inc, Miami, FL) intraosseous anesthesia delivery system. The maxillary teeth also received a Stabident intraosseous injection, but no maxillary buccal infiltration of 4% articaine with 1:100,000 epinephrine was administered. All subjects received 1.8 mL of 2% lidocaine with 1:100,000 epinephrine via the intraosseous injection distal to the tooth to be treated as described by Nusstein et al, 21 unless a second molar was being treated in which the injection was delivered