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Pediatric, 22 Pediatric anesthesia, 162 Pediatric cardiac arrhythmias, 110 Pediatric difficult airway, 118 Periodontal ligament, 14 Periodontics, 153 Postdischarge adverse event, 91 Postoperative pain, 140 Preemptive, 57 Preoperative pain, 135 Procedural sedation, 31 Propofol, 8 Propofol sedation, 159 Pulseless ventricular tachycardia, 162 Randomized clinical trial, 46 Remifentanil, 8, 51 Repeated general anesthesia, 71 Respiratory, 100

during this time there is a potential for “preemptive” analgesia to take place. The theory of preemptive analgesia basically states that if the modulation of the pain receptors can occur prior to the onset of central nervous system pain transmission, the overall pain experience will be lowered. It is postulated that the sensitization of nerves permits more rapid and profound transmission of pain sensations. 1 However, there is a conflicting body of research to show that if a nonsteroidal anti-inflammatory medication (NSAID) is administered before the surgery

of adenosine and N-methyl-D-aspartate (NMDA) receptors. The serotonin specific re-uptake inhibitor, paroxetine, is also described as having some analgesic properties. Chapter 6 describes the use of local anesthetics in the control of pain, including local, regional, or epidural injection, with emphasis on preemptive analgesia preventing central nervous system “wind up,” which could lead to a chronic pain state. Several chapters address the use of opioid analgesics. In the pages on mechanisms of action, a new receptor is described, the morphine 6

Achieving profound pulpal anesthesia in permanent teeth diagnosed with irreversible pulpitis has always been problematic, with the limited success ranging between 60 and 80% with maxillary infiltration 1 , 2 to between 13 and 65% with inferior alveolar nerve block. 3 – 6 Researchers have been continuously searching for adjunctive therapies, such as supplementary injection, preemptive analgesia, and sedation, to improve the success of perceived pulpal anesthesia in these teeth. Ibuprofen, a nonsteroidal anti-inflammatory drug, has