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Sugammadex: Efficacy and Practicality in the Dental Office
Stephen Goetz DMD,
 Benjamin Pritts DMD, and
 Bryant Cornelius. DDS MBA, MPH
Article Category: Research Article
Volume/Issue: Volume 65: Issue 2
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-65-03-03
Page Range: 113 – 118

(Bridion) for the reversal of neuromuscular blockade induced by rocuronium or vecuronium. Sugammadex is a gamma cyclodextrin ring made up of 8 conjoined sugar molecules. It works by encapsulating a neuromuscular blocking drug (NMBD) in a 1:1 ratio. This encapsulation of the NMBD by sugammadex renders the NMBD unable to bind to acetylcholine nicotinic receptors. As plasma levels of the NMBD decrease, a rapid shift in the concentration gradient causes remaining NMBD to diffuse away from the neuromuscular junction. If enough sugammadex is used, a complete reversal of

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Reversal Agents in Sedation and Anesthesia Practice for Dentistry
Michelle Wong DDS, MSc, EdD
Article Category: Research Article
Volume/Issue: Volume 69: Issue 1
Online Publication Date: Apr 04, 2022
DOI: 10.2344/anpr-69-01-09
Page Range: 49 – 58

Knowledge of reversal agents, or pharmacologic antagonists, is essential for all providers of sedation and general anesthesia. Reversal agents are defined as any drug used to counter the pharmacologic effects of another drug. 1 This article reviews common reversal agents used in contemporary sedation and anesthesia practice for dentistry, specifically flumazenil, naloxone, neostigmine, sugammadex, and phentolamine, and discusses their use in emergency management and routine practice. This article also reviews safety considerations and

Atrio-ventricular Block Following Neostigmine-Glycopyrrolate Reversal in Non-heart Transplant Patients: Case Report
Njinkeng J. Nkemngu MD, PhD and
 Joel N. Tochie MD
Article Category: Case Report
Volume/Issue: Volume 65: Issue 3
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-65-03-10
Page Range: 187 – 191

Following the use of nondepolarizing neuromuscular blocking drugs (NDMB), appropriate reversal of the effect of these drugs at the neuromuscular junction (NMJ) is essential after reversibility has been established to avoid adverse patient outcomes. An anticholinergic drug is usually administered followed by a cholinesterase inhibitor or both are given concurrently. The cholinesterase inhibitor prevents the breakdown of acetylcholine, thus increasing its competitiveness on the post synaptic acetylcholine receptors in caparison to the NDMB

Effect of Flumazenil on Disturbance of Equilibrium Function Induced by Midazolam
S. Maeda DDS, PhD,
 T. Miyawaki DDS, PhD,
 H. Higuchi DDS, PhD, and
 M. Shimada DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 55: Issue 3
Online Publication Date: Jan 01, 2008
DOI: 10.2344/0003-3006-55.3.73
Page Range: 73 – 77

1990 . 45 : 445 – 448 . 17 Sanders , L. D. , S. E. Piggott , P. A. Isaac , et al . Reversal of benzodiazepine sedation with the antagonist flumazenil. Br J Anaesth 1991 . 66 : 445 – 453 . 18 Pratila , M. G. , M. E. Fischer , R. Alagesan , R. A. Reinsel , and D. Pratilas . Propofol versus midazolam for monitored sedation: a comparison of intraoperative and recovery parameters. J Clin Anesth 1993 . 5

Pharmacokinetics of Lidocaine With Epinephrine Following Local Anesthesia Reversal With Phentolamine Mesylate
Paul A. Moore DMD, PhD, MPH,
 Elliot V. Hersh DMD, MS, PhD,
 Athena S. Papas DMD, PhD,
 J. Max Goodson DDS, PhD,
 John A. Yagiela DDS, PhD,
 Bruce Rutherford DDS, PhD,
 Seigried Rogy PhD, and
 Laura Navalta MS
Article Category: Research Article
Volume/Issue: Volume 55: Issue 2
Online Publication Date: Jan 01, 2008
DOI: 10.2344/0003-3006(2008)55[40:POLWEF]2.0.CO;2
Page Range: 40 – 48

of the pharmacokinetics of lidocaine and phentolamine was performed. This article describes the pharmacokinetics of phentolamine following administration of intraoral and intravenous injections. Additionally, the effects of phentolamine mesylate reversal on the pharmacokinetics of lidocaine with epinephrine when administered for maxillary and mandibular local anesthesia were evaluated. Methods This was a single-center, open-label, 4-treatment, phase 1 crossover study designed and statistically powered to evaluate the pharmacokinetics of

Figure 1.; Initial appearance of arrhythmia on the anesthesia monitor. Patient's baseline normal sinus rhythm converting to wide-complex rhythm with a rate in the 90s. This occurred after administration of neuromuscular blockade reversal agents.
Jonathan D. Rizner,
 Heather L. Bartlett, and
 Robert E. Shaw
Figure 1.
Figure 1.

Initial appearance of arrhythmia on the anesthesia monitor. Patient's baseline normal sinus rhythm converting to wide-complex rhythm with a rate in the 90s. This occurred after administration of neuromuscular blockade reversal agents.

Figure 1; Gravicorder GS10. As shown in this picture, subjects stood on the platform in the heel position with feet spread at an angle of approximately 30°.
S. Maeda,
 T. Miyawaki,
 H. Higuchi, and
 M. Shimada
Figure 1
Figure 1

Gravicorder GS10. As shown in this picture, subjects stood on the platform in the heel position with feet spread at an angle of approximately 30°.

Figure 2; Changes in the sedation level. The results are expressed as the mean ± SE (n  =  8). Midazolam 0.075 mg/kg was administered intravenously, and 30 minutes later, the test drug (flumazenil 0.5 mg or 1.0 mg) was administered. The sedation level was assessed on a 4-point scale as follows: 0 - awake and alert; 1 - drowsy; 2 - sedated, arousable when spoken to; 3 - sedated, not arousable. (a) Effects of 0.5 mg of flumazenil. (b) Effects of 1.0 mg of flumazenil. C indicates control; before, before an injection of flumazenil. ** Significantly different from the control values, P < .01.
S. Maeda,
 T. Miyawaki,
 H. Higuchi, and
 M. Shimada
Figure 2
Figure 2

Changes in the sedation level. The results are expressed as the mean ± SE (n  =  8). Midazolam 0.075 mg/kg was administered intravenously, and 30 minutes later, the test drug (flumazenil 0.5 mg or 1.0 mg) was administered. The sedation level was assessed on a 4-point scale as follows: 0 - awake and alert; 1 - drowsy; 2 - sedated, arousable when spoken to; 3 - sedated, not arousable. (a) Effects of 0.5 mg of flumazenil. (b) Effects of 1.0 mg of flumazenil. C indicates control; before, before an injection of flumazenil. ** Significantly different from the control values, P < .01.

Figure 3; Changes in the area of CG (center of gravity). The results are expressed as the mean ± SE (n  =  8). Measurement of the area of CG was performed just after the assessment of the sedation level. Subjects stood on the platform with their eyes open for 1 minute. The values were automatically calculated by the platform. (a) Effects of 0.5 mg of flumazenil. (b) Effects of 1.0 mg of flumazenil. C indicates control; before an injection of flumazenil. * Significantly different from the control values, P < .05, ** P < .01.
S. Maeda,
 T. Miyawaki,
 H. Higuchi, and
 M. Shimada
Figure 3
Figure 3

Changes in the area of CG (center of gravity). The results are expressed as the mean ± SE (n  =  8). Measurement of the area of CG was performed just after the assessment of the sedation level. Subjects stood on the platform with their eyes open for 1 minute. The values were automatically calculated by the platform. (a) Effects of 0.5 mg of flumazenil. (b) Effects of 1.0 mg of flumazenil. C indicates control; before an injection of flumazenil. * Significantly different from the control values, P < .05, ** P < .01.

New-Onset Accelerated Idioventricular Rhythm During Dental Rehabilitation
Jonathan D. Rizner BA,
 Heather L. Bartlett MD, and
 Robert E. Shaw MD
Article Category: Case Report
Volume/Issue: Volume 69: Issue 4
Online Publication Date: Dec 19, 2022
DOI: 10.2344/anpr-69-02-13
Page Range: 32 – 36

, beta-adrenergic agonists, volatile anesthetics 5 (e.g., desflurane, halothane, isoflurane, and sevoflurane), and illicit drugs, including cocaine. 1 We describe the case of an 8-year-old boy with asymptomatic AIVR that manifested after neuromuscular blockade reversal with neostigmine and glycopyrrolate. Informed consent was obtained for publication of this case from the patient's legal guardian. CASE PRESENTATION Our 8-year-old male patient (height 146 cm; weight 61 kg; body mass index 28.6 kg/m 2 ) had a history of attention