Abstract

The objective of this randomized double-blind investigation was to compare the anesthetic efficacy and injection discomfort of 3 volumes of 2% lidocaine with 1∶100,000 epinephrine for maxillary infiltration anesthesia. A total of 25 subjects received 0.6, 0.9, and 1.2 mL of the anesthetic buccal to an upper canine. Test teeth were assessed with electrical stimulation to determine onset and duration of pulpal anesthesia; soft tissue anesthesia and injection discomfort were assessed by pin-prick test and visual analog scale (VAS). Data were analyzed by 2-way analysis of variance (ANOVA), Friedman, and chi-square tests (α = 5%). The 1.2 mL dose induced faster onset of pulpal anesthesia, a higher success rate, and a longer duration of soft tissue/pulpal anesthesia than were achieved with the other doses (P < .05). No differences in injection discomfort were observed between treatments. It is concluded that maxillary infiltration anesthesia with lidocaine and epinephrine has a faster onset, a greater success rate, and a longer duration when a volume of 1.2 mL is used than when volumes less than 1.0 mL are used.

Abstract

The objectives of this study were to compare history and physical examinations (H&Ps) done by community-based physicians and dentist anesthesiologists for children undergoing general anesthesia for dental rehabilitation. One hundred sixty-eight records were evaluated from the Nationwide Children's Hospital Dental Surgery Center of patients anesthetized between June 2006 and March 2007. These patients had H&Ps completed by both a community-based physician and a dentist anesthesiologist prior to general anesthesia. H&P forms were reviewed by the 3 authors to identify missing data, American Society of Anesthesiologists (ASA) classification, and impact on care. There was a statistically significant difference with respect to 10 of 17 sections examined, with the community-based physicians' H&Ps tending to be incomplete more often. Over 20% of community-based physicians made no mention of the history of present illness. One third of all physician H&Ps were missing vital sign recordings. No significant difference was noted between the physicians' and dentist anesthesiologists' ratings of ASA status. The physician H&P altered course of anesthesia treatment in <1% of studied cases. Statistically significant deficiencies were noted in the physician H&P in 60% of categories.

Abstract

Phentolamine mesylate accelerates recovery from oral soft tissue anesthesia in patients who have received local anesthetic injections containing a vasoconstrictor. The proposed mechanism is that phentolamine, an alpha-adrenergic antagonist, blocks the vasoconstriction associated with the epinephrine used in dental anesthetic formulations, thus enhancing the systemic absorption of the local anesthetic from the injection site. Assessments of the pharmacokinetics of lidocaine and phentolamine, and the impact of phentolamine on the pharmacokinetics of lidocaine with epinephrine were performed to characterize this potentially valuable strategy. The blood levels of phentolamine were determined following its administration intraorally and intravenously. Additionally, the effects of phentolamine mesylate on the pharmacokinetics of intraoral injections of lidocaine with epinephrine were evaluated. Sixteen subjects were enrolled in this phase 1 trial, each receiving 4 drug treatments: 1 cartridge lidocaine/epinephrine followed after 30 minutes by 1 cartridge phentolamine (1L1P), 1 cartridge phentolamine administered intravenously (1Piv), 4 cartridges lidocaine/epinephrine followed after 30 minutes by 2 cartridges phentolamine (4L2P), and 4 cartridges lidocaine/epinephrine followed by no phentolamine (4L). Pharmacokinetic parameters estimated for phentolamine, lidocaine, and epinephrine included peak plasma concentration (C_max), time to peak plasma concentration (T_max), area under the plasma concentration-time curve from 0 to the last time point (AUC_last) or from time 0 to infinity (AUC_inf), elimination half-life (t_1/2), clearance (CL), and volume of distribution (Vd). The phentolamine T_max occurred earlier following the intravenous administration of 1Piv (7 minutes than following its submucosal administration in treatment 1L1P (15 minutes) or 4L2P (11 minutes). The phentolamine t1/2, CL, and Vd values were similar for 1L1P, 1Piv, and 4L2P. The T_max for lidocaine occurred later and the C_max for lidocaine was slightly higher when comparing the 4L2P treatment and the 4L treatment. The phentolamine-induced delay of the lidocaine T_max likely represents phentolamine's ability to accelerate the systemic absorption of lidocaine from oral tissues into the systemic circulation.

Effects of Dexmedetomidine Addition to Lidocaine on Hemodynamics and the Anesthetic Duration and Potency

Kaorie Yamashita and Katsuhisa Sunada, Department of Dental Anesthesiology, The Nippon Dental University, School of Life Dentistry at Tokyo (Chief : Prof. Katsuhisa SUNADA)

We studied the effect of dexmedetomidine (DEX) addition to lidocaine in reference to the anesthetic duration, potency, and hemodynamic changes by using somatosensory evoked potential (SEP) and arterial pressure measurements. In 24 Wistar rats, propofol was injected into the tail caudal vein to induce general anesthesia. A bipolar stimulating electrode was inserted into the tooth pulp of the right upper incisor. The

New Drugs on the Horizon May Improve the Quality and Safety of Anesthesia

Anesthetic Efficacy of 3 Volumes of Lidocaine With Epinephrine in Maxillary Infiltration Anesthesia

Abstract

Concordance and Contrast Between Community-Based Physicians' and Dentist Anesthesiologists' History and Physicals in Outpatient Pediatric Dental Surgery

Abstract

Pharmacokinetics of Lidocaine With Epinephrine Following Local Anesthesia Reversal With Phentolamine Mesylate

Abstract

Cardiovascular Drugs: Implications for Dental Practice Part 2—Antihyperlipidemics and Antithrombotics

Abstract

JDSA Abstracts

Effects of Dexmedetomidine Addition to Lidocaine on Hemodynamics and the Anesthetic Duration and Potency

Commentary: Are Anesthesiologists Still “Darting” Their Patients?

Difficulty Controlling Sedation Level Using Processed Electroencephalography Monitoring in a Patient With Intellectual Disability, Fontan Circulation, and a Severe Gag Reflex

Comparison of the Length and Shape of Various Preformed Nasotracheal Tubes

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

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

Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery

The Effect of Intraoral Suction on Oxygen-Enriched Surgical Environments: A Mechanism for Reducing the Risk of Surgical Fires

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