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application of hyperosmolar solutions. 14,15 Similar to what occurs at the blood brain barrier, 16 the effects of hyperosmolar solutions have been linked to a transient shrinkage of perineurial cells with subsequent widening of zonulae occludens. 8,17 Antonijevic et al 14 found that a 0.5 M solution of mannitol was most effective in opening the perineurial membrane to allow for enhanced penetrability for macromolecules and/or ions. They demonstrated that the efficacy of both hydrophilic and lipophilic compounds could be improved dramatically by the concomitant

previous study by Wolf et al 7 demonstrated that lidocaine in combination with mannitol significantly improved the success of the IAN block. The proposed mechanism is that mannitol opens the perineurial membrane to allow for enhanced penetrability for lipophilic compounds 8 (such as lidocaine), and it may also directly affect nerve conduction. 9 While Wolf et al 7 demonstrated that 2.84 mL of 36 mg lidocaine with 18 μg epinephrine (1.80 mL) plus 0.5 M mannitol (1.04 mL) was significantly better than 1.8 mL of 36 mg lidocaine with 18 μg epinephrine for the IAN

. Previous studies by Wolf et al 7 and Smith et al 8 demonstrated that lidocaine with epinephrine in combination with 0.5 M mannitol significantly improved the success of the IAN block (defined as the total of all the times of pulpal anesthesia [80 readings], for each tooth, over the 60 minutes) in asymptomatic subjects. Kreimer et al 9 found, for mandibular posterior teeth in patients with symptomatic irreversible pulpitis, that the addition of 0.5 M mannitol to 1.9 mL of lidocaine with epinephrine resulted in a statistically higher success rate (success was defined as

Wolf et al, 20 Smith et al, 21 and Cohen et al 22 demonstrated that lidocaine in combination with mannitol significantly improved the success of inferior alveolar nerve blocks (defined as the total of all the times of complete pulpal anesthesia as measured by the 80 readings, for each tooth, over 60 minutes) in asymptomatic subjects. Kreimer et al 23 found, for mandibular posterior teeth in patients with symptomatic irreversible pulpitis, that the addition of 0.5 M mannitol to 1.9 mL of lidocaine with epinephrine resulted in a statistically significantly higher

Lidocaine hydrochloride with 1 : 200,000 epinephrine single buccal injection, 95 Lipsomal bupivacaine, 178 Local anesthesia, 95 Low peripheral oxygen saturation, 153 Magnetic resonance imaging (MRI), 60 Malignant hyperthermia, 21 Mannitol, 3, 145 Maxillary third molar, 95 Mental and incisive nerve block, 15 Methemglobin, 99 Methemoglobinemia, 99 Midazolam, 162 Moderate sedation, 162 Molar extraction, 42 Mucosal lesions, 25 Outpatient surgery, 162

synergism, 31 Epistaxis, 26 General anesthesia, 22 Heart disease, 22 H-index, 14 Inferior alveolar nerve block, 157 Injection pressure, 61 Injection speed, 61 Intubation, 26 Intubation without neuro-muscular blockade, 3 Laryngospasm, 22 Left ventricular noncompaction, 22 Lidocaine, 57, 157 Mannitol, 157 Medical emergencies, 82, 126 Mepivacaine, 57 Molar extraction, 73 Nasopharyngeal, 26 Nasotracheal tube, 26 Nonsteroidal anti-inflammatory drug, 73 Office