The aftermath of the massive earthquake that destroyed the homes of millions of Haitians was broadcast by television networks worldwide. Newscasts focused on citizens pulling victims from the rubble and on volunteer doctors and nurses treating the severely injured in open courtyards because most of the hospitals and clinics were destroyed. With minimal sterile instruments and supplies, these heroic health care workers sometimes had no alternative other than to amputate gangrenous limbs of victims without anesthesia, just as it was done for centuries before Horace Wells and William T.G. Morton discovered general anesthesia. One heart-breaking newscast showed a screaming child
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EDITORIAL
DDS, PhD
SCIENTIFIC REPORTS
DDS, MS,
DDS, MS,
DDS, MS,
DDS, MS, and
DDS, MA
Abstract
The purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 2% lidocaine with 1 : 100,000 epinephrine, 4% prilocaine with 1 : 200,000 epinephrine, and 4% prilocaine in maxillary lateral incisors and first molars. Sixty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of 1.8 mL of 2% lidocaine with 1 : 100,000 epinephrine, 1.8 mL of 4% prilocaine with 1 : 200,000 epinephrine, and 1.8 mL of 4% prilocaine, at 3 separate appointments spaced at least 1 week apart. The teeth were pulp-tested in 3-minute cycles for a total of 60 minutes. Anesthetic success (ie, obtaining 2 consecutive 80 readings with the electric pulp tester) and onset of pulpal anesthesia were not significantly different between 2% lidocaine with 1 : 100,000 epinephrine, 4% prilocaine with 1 : 200,000 epinephrine, and 4% prilocaine for the lateral incisor and first molar. For both lateral incisor and first molar, 4% prilocaine with 1 : 200,000 epinephrine and 2% lidocaine with 1 : 100,000 epinephrine were equivalent for incidence of pulpal anesthesia. However, neither anesthetic agent provided an hour of pulpal anesthesia. For both lateral incisor and first molar, 4% prilocaine provided a significantly shorter duration of pulpal anesthesia compared with 2% lidocaine with 1 : 100,000 epinephrine and 4% prilocaine with 1 : 200,000 epinephrine.
DMD,
DMD, PhD, MPH,
, and
RHD, BS
Abstract
General descriptions or “snapshots” of sedation/general anesthesia practices during dental care are very limited in reviewed literature. The objective of this study was to determine commonalities in dental sedation/anesthesia practices, as well as to accumulate subjective information pertaining to sedation/anesthesia care within the dental profession. This questionnaire-based survey was completed by participating anesthesia providers in the United States. A standardized questionnaire was sent via facsimile, or was delivered by mail, to 1500 anesthesia providers from a randomized list using an online database. Data from the returned questionnaires were entered onto an Excel spreadsheet and were imported into a JMP Statistical Discovery Software program for analyses. Quantitative evaluations were confined to summation of variables, an estimation of means, and a valid percent for identified variables. A total of 717 questionnaires were entered for data analysis (N = 717). Data from this study demonstrate the wide variation that exists in sedation/anesthesia care and those providing its administration during dental treatment in the United States. The demographics of this randomized population show anesthesia providers involved in all disciplines of the dental profession, as well as significant variation in the types of modalities used for sedation/anesthesia care. Data from this study reveal wide variation in sedation/anesthesia care during dental treatment. These distinctions include representation of sedation/anesthesia providers across all disciplines of the dental profession, as well as variations in the techniques used for sedation/anesthesia care.
DDS, MS,
DDS, MS,
DDS, MS,
DDS, MS, and
DDS, MA
Abstract
The authors, using a crossover design, randomly administered, in a double-blind manner, inferior alveolar nerve (IAN) blocks using a buffered 2% lidocaine with 1 : 100,000 epinephrine/sodium bicarbonate formulation and an unbuffered 2% lidocaine with 1 : 100,000 epinephrine formulation at 2 separate appointments spaced at least 1 week apart. An electric pulp tester was used in 4-minute cycles for 60 minutes to test for anesthesia of the first and second molars, premolars, and lateral and central incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes, and the 80 reading was continuously sustained for 60 minutes. For the buffered 2% lidocaine with 1 : 100,000 epinephrine/sodium bicarbonate formulation, successful pulpal anesthesia ranged from 10–71%. For the unbuffered 2% lidocaine with 1 : 100,000 epinephrine formulation, successful pulpal anesthesia ranged from 10–72%. No significant differences between the 2 anesthetic formulations were noted. The buffered lidocaine formulation did not statistically result in faster onset of pulpal anesthesia or less pain during injection than did the unbuffered lidocaine formulation. We concluded that buffering a 2% lidocaine with 1 : 100,000 epinephrine with sodium bicarbonate, as was formulated in the current study, did not statistically increase anesthetic success, provide faster onset, or result in less pain of injection when compared with unbuffered 2% lidocaine with 1 : 100,000 epinephrine for an IAN block.
CONTINUING EDUCATION
DDS
Abstract
Safe and effective management of acute dental pain can be accomplished with nonopioid and opioid analgesics. To formulate regimens properly, it is essential to appreciate basic pharmacological principles and appropriate dosage strategies for each of the available analgesic classes. This article will review the basic pharmacology of analgesic drug classes, including their relative efficacy for dental pain, and will suggest appropriate regimens based on pain intensity. Management of chronic pain will be addressed in the second part of this series.
DEPARTMENTS
Please see the pdf version for the Continuing Education Program Answer Sheet.
Statistical Analysis of Lidocaine and Dexmedetomidine Interaction with Isobologram
YukakoTsutsui, Satoko Hoshiai and Katsuhisa Sunada
2009;37(5):543–547.
It has been recently reported that dexmedetomidine (DEX), an alpha-2 adrenergic receptor agonist, enhanced local anesthetic effect of lidocaine on peripheral nerve. We previously reported that the combination of lidocaine and DEX decreased the action potential (AP) amplitude of the sciatic nerve in rats. These reports suggested that combination of lidocaine and DEX could be more effective for increasing pain threshold. Although recent reports have described the effect of DEX for lidocaine, to our knowledge, the pharmacological relationship of lidocaine and DEX has not
Mortality and Morbidity Associated With Out-of-Hospital Deep Sedation and General Anesthesia for Dental Treatment: A 36-Year Retrospective Study in British Columbia, Canada (1984-2019)
Paul AzzopardiDDS, MSc,
Carlos QuiñonezDMD, MSc, PhD,
Daniel A. HaasDDS, PhD, and
Carilynne YarascavitchDDS, MSc
Does Propofol-based or Remimazolam-based Anesthesia Impact the Incidence of Postoperative Nausea and Vomiting When Used In Combination With Prophylactic Dexamethasone and Ondansetron?
Ai NakakukiDDS,
Kyotaro KoshikaDDS, PhD,
Masanari NakazawaDDS,
Momoka NishinoDDS,
Rika NomuraDDS,
Mariko IimuraDDS, PhD,
Natsuki SaitoDDS, PhD,
Kaori YoshidaDDS, PhD,
Toshiyuki HandaDDS, PhD, and
Tatsuya IchinoheDDS, PhD
Comparing Etizolam and Music Distraction on Inferior Alveolar Nerve Block Success in Patients With Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial
Rakesh SinglaMDS,
Gurdeep Singh GillMDS,
Himani SheoranMDS,
Namita JainMDS, and
Suraj AroraMDS
Is Direct Laryngoscopy Antiquated and Irrelevant Today?
Kyle J. KramerDDS, MS
Anesthetic Management of a Dental Patient With Familial Mediterranean Fever
Aki KawauchiDDS, PhD,
Shin SatoMD, PhD,
Ayumi NakayamaDDS,
Masami HasegawaDDS, and
Shigeru MaedaDDS, PhD
Letter to the Editor
Stuart LieblichDMD
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).
Joseph A. Giovannitti JrDMD,
Morton B. RosenbergDMD, and
James C. PheroDMD
A Review of Current Literature of Interest to the Office-Based Anesthesiologist
Mark A. SaxenDDS, PhD
Perfect Time for a Fresh Perspective
Kyle J. KramerDDS, MS
The Cost of Learning From Our Mistakes
Joel M. WeaverDDS, PhD
eISSN: 1878-7177
ISSN: 0003-3006
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