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During a hot midsummer's day in 2003, an estimated 50 million inhabitants of New York City, multiple surrounding states, and parts of Canada experienced one of the largest blackouts in history. The impact of the power loss was omnipresent. In the operating room, safely administering anesthesia amidst a major power failure instantly presented a formidable challenge. This report will recount the immediate response to this unexpected incident and propose several recommendations for the preparation and management of any similar future occurrences. A 23

. This is particularly true for moderate or deep sedation techniques using midazolam, propofol, and conventional doses of opioids. However, for patients with well-defined risks, especially when inhalation agents are to be used, prophylaxis may be justified. Apfel not only has authored an impressive list of clinical studies but has performed an extensive analysis of the literature. 3 His recommendation regarding risk assessment and management provides an excellent guideline for sedation and anesthesia in dental practice ( Table 2 ). 3 , 20 Table 2

hospitalization. 23 , 24 Pump malfunctions or failure rates are reported to be 68% in some studies, although these rates have been declining rapidly over the last 10 to 15 years likely due to technological improvements. 24 A joint statement from European and American diabetes research groups attributed the majority of AEs to user error, and their concluding recommendations focused on improved patient education and support systems to further reduce the frequency of AEs. 15 Nonetheless, improvements in insulin pump technology and mechanical function remain an important

current can interfere with the functioning of the pacemaker or ICD. Potential interactions include inducing ventricular arrhythmias or fibrillation, asynchronous pacing, inhibition of pacing, inappropriate shock therapy, and electrical reset. 10 The likelihood of these interactions is greatly reduced with the use of bipolar electrocautery, largely because there is no current going through the patient; however, the preoperative recommendations for these devices are universal. It is necessary in the preoperative phase to set these devices to an asynchronous pacing mode

). While this was once a popular medication, it has been supplanted by short-acting benzodiazepines and other agents. Sheroan et al 3 demonstrated similar success rates in triple-drug cocktails comparing chloral hydrate, meperidine, and hydroxyzine vs midazolam, meperidine, and hydroxyzine. Chloral hydrate is no longer commercially available and is on formulary at only some compounding pharmacies in the United States (US). Dosing recommendations are 50 to 100 mg/kg; however, deaths have occurred even within this range. BENZODIAZEPINES

assess the quality and confidence in the main results of pooled data, 2 review authors (J.P. and M.Z.) used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment tool (GRADEpro GDT, McMaster University, 2015; developed by Evidence Prime, Inc; available from gradepro.org). Five domains of study limitations—risk of bias, inconsistency, indirectness, imprecision, publication bias, and overall certainty of bias—were evaluated. Each domain's risk level was judged as very severe, severe, or no concerns. This either downgraded or upgraded

in Patients With Acute Hemolysis SUMMARY The most effective management strategy is to prevent hemolysis by avoiding oxidative stressors. Therefore, management for pain and anxiety should include medications that are safe and have not been shown to cause hemolytic crises, such as benzodiazepines, codeine/codeine derviatives, propofol, fentanyl, and ketamine. In conclusion, the authors of this article make 5 particular recommendations. First, anyone suspected of G6PD deficiency, with a family history of

all health care practitioners regarding best practices for health care–related infection control. 1 These guidelines are almost always incorporated into the latest accreditation standards for hospitals and ASCs. Many states also mandate these recommendations in state rules and regulations that apply to all health care settings, including the dental office. The CDC reiterates, albeit briefly, many of its recommendations regarding the use of parenteral medications in its specific dental office guidelines. 2 I was in an office recently that was using a needled system

search, evidence levels, and recommendation levels are described, as follows. We clarified the clinical questions (CQs) regarding intravenous conscious sedation that are performed at present and searched the literature concerning each CQ. To select relevant references, working group members were divided to perform searches of the literature, mainly using Igaku Chuo Zasshi (ICHUSHI) and PubMed. Independently collected papers were also used as references. The evidence levels and recommendations extracted from