Anesthesia Progress Volume 52: Issue 1

Abstract

The aim of this study was to assess the need and demand for sedation or general anesthesia (GA) for dentistry in the Canadian adult population. A national telephone survey of 1101 Canadians found that 9.8% were somewhat afraid of dental treatment, with another 5.5% having a high level of fear. Fear or anxiety was the reason why 7.6% had ever missed, cancelled, or avoided a dental appointment. Of those with high fear, 49.2% had avoided a dental appointment at some point because of fear or anxiety as opposed to only 5.2% from the no or low fear group. Regarding demand, 12.4% were definitely interested in sedation or GA for their dentistry and 42.3% were interested depending on cost. Of those with high fear, 31.1% were definitely interested, with 54.1% interested depending on cost. In a hypothetical situation where endodontics was required because of a severe toothache, 12.7% reported high fear. This decreased to 5.4% if sedation or GA were available. For this procedure, 20.4% were definitely interested in sedation or GA, and another 46.1% were interested depending on cost. The prevalence of, and preference for, sedation or GA was assessed for specific dental procedures. The proportion of the population with a preference for sedation or GA was 7.2% for cleaning, 18% for fillings or crowns, 54.7% for endodontics, 68.2% for periodontal surgery, and 46.5% for extraction. For each procedure, the proportion expressing a preference for sedation or GA was significantly greater than the proportion having received treatment with sedation or GA (P < 0.001). In conclusion, this study demonstrates that there is significant need and demand for sedation and GA in the Canadian adult population.

Abstract

Progressive muscular dystrophy may produce abnormal reactions to several drugs. There is no consensus of opinion regarding the continuous infusion of propofol in patients with progressive muscular dystrophy. We successfully treated 2 patients with progressive muscular dystrophy who were anesthetized with a continuous infusion of propofol. In case 1, a 19-year-old, 59-kg man with Becker muscular dystrophy and mental retardation was scheduled for dental treatment under general anesthesia. General anesthesia was maintained by a continuous infusion of 6–10 mg/kg propofol per hour and an inhalational mixture of 67% nitrous oxide and 33% oxygen. No complications were observed during or after the operation. In case 2, a 5-year-old, 11-kg boy with Fukuyama type congenital muscular dystrophy and slight mental retardation was scheduled for dental treatment under general anesthesia. General anesthesia was maintained with a continuous infusion of 6–12 mg/kg propofol per hour and an inhalational mixture of 0.5–1.5% sevoflurane in 67% nitrous oxide and 33% oxygen. No complications were observed during or after the operation. It is speculated that a continuous infusion of propofol in progressive muscular dystrophy does not cause malignant hyperthermia because serum levels of creatine phosphokinase and myoglobin decreased after our anesthetic management. Furthermore, our observations suggest that sevoflurane may have some advantages in patients with progressive type muscular dystrophies other than Duchenne muscular dystrophy and Becker muscular dystrophy. In conclusion, our cases suggest that a continuous infusion of propofol for the patients with progressive muscular dystrophy is a safe component of our anesthetic strategy.

Abstract

A rare and unusual case of hallucinations following triazolam administration is reported. A review of the literature suggests that hallucinations following triazolam are rare; this is the first report of such a reaction when triazolam was used for oral conscious sedation in dentistry. A discussion of dental implications follows with emphasis on complete medical history evaluation before administering oral sedatives. We conclude that the proper selection of oral sedation candidates, coupled with recognition and management of adverse events, is essential.

Stanley F. Malamed, DDS

Elsevier Mosby, 2004

LOCAL ANESTHESIA ADMINISTRATION DVD

Stanley F. Malamed, DDS

2 disc DVD program, Elsevier Mosby, 2004

HANDBOOK OF NITROUS OXIDE AND OXYGEN SEDATION, 2ND EDITION

Morris S. Clark, DDS, FACD, and Ann Brunick, RDH, MS

Mosby, 2003

With the advent of the miracles of the digital age, newer editions of old favorites seem to appear almost monthly, and many of them are just higher priced versions of the original with a few expanded chapters but add little real value for the reader. We purchase them just to “keep up.” The following reviews of 2

Robert S. Locke—a Canadian Dental Anaesthesia Pioneer

Need and Demand for Sedation or General Anesthesia in Dentistry: A National Survey of the Canadian Population

Abstract

Continuous Infusion Propofol General Anesthesia for Dental Treatment in Patients With Progressive Muscular Dystrophy

Abstract

Hallucinations and Delirium in the Dental Office Following Triazolam Administration

Abstract

Postoperative Hyperthermia of Unknown Origin Treated With Dantrolene Sodium

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A Case Report of Malignant Hyperthermia in a Dental Clinic Operating Room

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Preemptive Analgesia and Local Anesthesia as a Supplement to General Anesthesia: A Review

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Handbook of Local Anesthesia, 5th Edition

LOCAL ANESTHESIA ADMINISTRATION DVD

HANDBOOK OF NITROUS OXIDE AND OXYGEN SEDATION, 2ND EDITION

Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple

Crises Management in Anesthesiology

Anaesthesia for the High Risk Patient

Managing Pain—the Canadian Healthcare Professional's Reference, 2nd Edition

Sedation: A Guide to Patient Management, 4th Edition

Mosby's Dental Drug Reference, 6th Edition

Clinical Anesthesia Procedures of the Massachusetts General Hospital, 6th Edition

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

A New ACLS Option for Anesthesia Providers

Single-Agent Total Intravenous Anesthesia With Remimazolam for an Elderly Man Undergoing Ambulatory Oral Surgery: A Case Report

General Anesthesia for a Child With a Living Donor Liver Transplant After Hepatoblastoma and Metastatic Lung Tumor Resection

Virtual Reality Distraction vs Nitrous Oxide for Reducing Anxiety and Injection Pain

Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery

Letter to the Editor

Monheim LM. Analgesia in dentistry now and in the future. Anesth Prog. 1971;18(5):100–106 and J Am Analg Soc. 1971:9:1(abstract).

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

Perfect Time for a Fresh Perspective