How long has it been since you updated your preanesthetic medical history form? Most busy dentists are happy with their history form and perceive no reason to change it. However, an antiquated and/or incompletely filled out preanesthetic medical history form can be a very costly mistake. Lack of documentation of critically important information cannot only alter patient outcome but can place the dentist in a totally defenseless position if an untoward incident were to occur. The plaintiff's attorney will ask, “Why didn't you obtain a medical consultation?” The defense attorney will hope that the answers are documented in the dentist's
To test the Italian translation of Corah's Dental Anxiety Scale (DAS) and to check the relationship between dental anxiety and the American Society of Anesthesiologists (ASA) physical status classification (ASA-PS), the DAS was translated into Italian and administered to 1072 Italian patients (620 male and 452 female patients, ages 14–85 years) undergoing oral surgery. Patients' conditions were checked and rated according to the ASA-PS. The DAS ranged from 4 to 20 (modus = 8, median = 10); 59.5% of patients had a DAS of 7–12, 26.1% had a DAS >12, and 10.3% had a DAS >15. The mean DAS was 10.29 (95% confidence limit = 0.19); female patients were more anxious than male patients (P < .001), while patients older than 60 years showed a significant decrease in the level of anxiety. Five hundred two patients were rated as ASA-PS class P1, 502 as ASA-PS class P2, and 68 as ASA-PS class P3, with a mean DAS score of 9.69, 10.78, and 11.09, respectively: the DAS difference between groups was significant (P < .001).Abstract
An abstract of this study was presented at the American Association for Dental Research (AADR) Dental Anesthesiology Research Group in Honolulu, Hawaii, in March of 2004. This study was conducted to correlate the intraoperative and postoperative morbidity associated with moderate and deep sedation, also known as monitored anesthesia care (MAC), provided in a General Practice Residency (GPR) clinic under the supervision of a dentist anesthesiologist. After internal review board approval was obtained, 100 parenteral moderate and deep sedation cases performed by the same dentist anesthesiologist in collaboration with second year GPR residents were randomly selected and reviewed by 2 independent evaluators. Eleven morbidity criteria were assessed and were correlated with patient age, gender, American Society of Anesthesiology Physical Status Classification (ASAPS), duration of procedure, and anesthetic protocol. A total of 39 males and 61 females were evaluated. Patients' ASAPS were classified as I, II, and III, with the average ASAPS of 1.61 and the standard deviation (STDEV) of 0.584. No ASPS IV or V was noted. Average patient age was 33.8 years (STDEV, 14.57), and the average duration of procedure was 97.5 minutes (STDEV, 42.39). Three incidents of postoperative nausea and vomiting were reported. All 3 incidents involved the ketamine-midazolam-propofol anesthetic combination. All patients were treated and were well controlled with ondansetron. One incident of tongue biting in an autistic child was regarded as an effect of local anesthesia. One patient demonstrated intermittent premature atrial contractions (PACs) intraoperatively but was stable. Moderate and deep sedation, also known as MAC, is safe and beneficial in an outpatient GPR setting with proper personnel and monitoring. This study did not demonstrate a correlation between length of procedure and morbidity. Ketamine was associated with all reported nausea and vomiting incidents because propofol and midazolam are rarely associated with such events.Abstract
The high risks associated with general anesthesia in obstructive sleep apnea syndrome (OSAS) patients have been reported. Many authors have suggested that the intraoperative administration of opioids and sedatives should be limited or avoided because these drugs selectively impair muscle activity in the upper airway. We report the case of an OSAS patient who was managed with nasal continuous positive airway pressure (NCPAP) and treated safely in spite of the use of conventional anesthetic and analgesic agents typically used for patients without OSAS. She had little pain during the perioperative period. It is suggested that NCPAP is an effective treatment for not only preventing airway obstructive apnea but for allowing the administration of anesthetic and analgesic drugs without major complications.Abstract
Nitrous oxide is the most commonly used inhalation anesthetic in dentistry and is commonly used in emergency centers and ambulatory surgery centers as well. When used alone, it is incapable of producing general anesthesia reliably, but it may be combined with other inhalation and/or intravenous agents in deep sedative/general anesthestic techniques. However, as a single agent, it has impressive safety and is excellent for providing minimal and moderate sedation for apprehensive dental patients. To gain a full appreciation of the pharmacology, physiologic influences, and proper use of nitrous oxide, one must compare it with other inhalation anesthetics. The purpose of this CE article is to provide an overview of inhalation anesthetics in general and to address nitrous oxide more specifically in comparison.Abstract
The Council of the International Federation of Dental Anesthesiology Societies (IFDAS) met in Puerto Rico on April 29, 2008. The Council of IFDAS is composed of the following members: Prof Yuzuru Kaneko (Japan), President Dr James Grainger (Australia), Secretary General Dr Wolfgang Jakobs (Germany), Treasurer Dr Chris Holden (UK), Past President Associate Prof Douglas Stewart (Australia), President-Elect Dr Joel Weaver (USA), Editor Dr John Yagiela (USA), American Rep Prof Eliezer Kaufman (Israel), European Rep Dr Greg Mahoney (Australia), Asian Pacific Rep In attendance also were the following individuals: Dr James Phero (USA), Immediate Past-President ADSA Dr Karen Crowley (USA), President-Elect
Kanta Kido, Atsuko Aoi, Toshihiro Konno, Makoto Yasuda, Minoru Sato, Hajime Shimoda, Toshiro Igari and Masahiko Takahashi, Division of Anesthesia and Pain Management, Tohoku University Hospital (Chief: Prof. Masahiko TAKAHASHI) The use of opioids in general anesthesia is a key component in the current notion of “balanced anesthesia”. However, concern over opioid side effects can cause practitioners to hesitate to use opioids. Fentanyl is a commonly used opioid in perioperative management, because it allows smooth emergence from anesthesia without coughingBalance Anesthesia Using Sevoflurane and Fentanyl Based on Site Concentration Model Compared to Sevoflurane/N2O Anesthesia for Oral Surgery