Select Issue

EDITORIAL

Why Are There So Many Drug Shortages?

DDS, PhD

In the past 10 years, an increasing number of drug shortages have resulted in tremendous frustration among practitioners who want only the best treatment for their patients but who cannot always depend that the best drugs for that treatment will be available when needed. Penicillin G, dexamethasone, fentanyl, ketamine, and propofol are only a few that have been back-ordered recently. Why does this occur, and how can it be fixed? Like cancer, the causes are multifactorial, and the cures may be just as elusive.

The propofol shortage resulted from 2 major problems. The first involved an unjust, ridiculous medical-legal verdict involving

Download PDF

SCIENTIFIC REPORTS

Assessing the Need for Anesthesia and Sedation Services in Kuwaiti Dental Practice

DMD, MPH,

DMD,

BS, RDH, and

DOI: 10.2344/0003-3006-57.3.91

Abstract

The objective of this study was to examine the public health relevance of the prevalence of dental fear in Kuwait and the resultant barrier that it creates regarding access to dental care. The study analysis demonstrated a high prevalence of dental fear and anxiety in the Kuwaiti population and a perceived need for anesthesia services by dental care providers. The telephone survey of the general population showed nearly 35% of respondents reported being somewhat nervous, very nervous, or terrified about going to the dentist. In addition, about 36% of the population postponed their dental treatment because of fear. Respondents showed a preference to receive sedation and anesthesia services as a means of anxiety relief, and they were willing to go to the dentist more often when such services were available. People with high fear and anxiety preferred to receive some type of medication to relieve their anxiety. In conclusion, the significance and importance of the need for anesthesia services to enhance the public health of dental patients in Kuwait has been demonstrated, and improvements are needed in anesthesia and sedation training of Kuwaiti dental care providers.

Download PDF

A Comparison of Intravenous Sedation With Two Doses of Dexmedetomidine: 0.2 µg/kg/hr Versus 0.4 µg/kg/hr

DDS, PhD,

DDS,

MD, PhD,

DMD, MS, and

DDS, PhD

DOI: 10.2344/0003-3006-57.3.96

Abstract

The present study investigated the physiologic and sedative effects between two different continuous infusion doses of dexmedetomidine (DEX). Thirteen subjects were separately sedated with DEX at a continuous infusion dose of 0.2 µg/kg/hr for 25 minutes after a loading dose of 6 µg/kg/hr for 5 minutes (0.2 group) and a continuous infusion dose of 0.4 µg/kg/hr for 25 minutes after a loading dose of 6 µg/kg/hr for 5 minutes (0.4 group). The recovery process was then observed for 60 minutes post infusion. The tidal volume, mean arterial pressure, and heart rate in both groups decreased significantly during infusion, but they were within a clinically acceptable level. A Trieger dot test plot error ratio in the 0.4 group was significantly higher than that in the 0.2 group until 15 minutes post infusion. Sedation appears to be safe at the infusion doses of DEX studied. However, increasing maintenance infusion doses of DEX from 0.2 µg/kg/hr to 0.4 µg/kg/hr delays some recovery parameters.

Download PDF

Effect of PaCO₂ and PaO₂ on Lidocaine and Articaine Toxicity

DDS, MSc, PhD,

MSc,

DDS, MSc, PhD,

DDS, MSc, PhD, and

DDS, PhD

DOI: 10.2344/0003-3006-57.3.104

Abstract

Alterations in arterial PaCO₂ can influence local anesthetic toxicity. The objective of this study was to evaluate the effect of stress-induced changes in PaCO₂ and PaO₂ on the seizure threshold of lidocaine and articaine. Lidocaine (2% with 1 ∶ 100,000 epinephrine) or articaine (4% with 1 ∶ 100,000 epinephrine) was administered intravenously under rest or stress conditions to 36 rats separated into 4 groups. Propranolol and prazosin were administered preoperatively to minimize cardiovascular effects of epinephrine. Mean arterial pressure (MAP), heart rate (HR), and arterial pH, PaCO₂, and PaO₂ were measured. Results showed no differences in MAP, HR, or pH. Stress significantly increased the latency period for the first tonic-clonic seizure induced by a toxic dose of both lidocaine and articaine (P < .05). Seizures were brought on more rapidly by articaine. No significant difference between toxic doses of lidocaine and articaine was noted. Stress raised the seizure threshold dose for both drugs and significantly (P < .01) increased arterial PaO₂ from 94.0 ± 1.90 mm Hg to 113.0 ± 2.20 mm Hg, and reduced PaCO₂ from 36.0 ± 0.77 mm Hg to 27.0 ± 0.98 mm Hg. In conclusion, reduction in PaCO₂ and/or increase in PaO₂ raised the seizure threshold of lidocaine and articaine. This study also confirmed that lidocaine and articaine have equipotent central nervous system toxicity.

Download PDF

CASE REPORT

General Anesthesia for a Child With Landau-Kleffner Syndrome, a Case Report

MD and

DDS

DOI: 10.2344/0003-3006-57.3.109

Abstract

Landau-Kleffner syndrome is a rare, epileptiform disorder with a pathognomonic sudden aphasia, epilepsy, and electroencephalographic abnormalities. It was first described in 1957. No case reports are included in the anesthesia literature. This case report describes a 9-year-old male who was treated for dental caries while under intubated general anesthesia. The case was successful and uneventful, with multiple precautions taken to prevent seizures or other complications. The authors hope that this report will provoke communication and additional case reports.

Download PDF

ANESTHETIC TECHNIQUE

Application of Gum Elastic Bougie to Nasal Intubation

MD, DDS, PhD,

MD, PhD,

DDS, PhD,

DDS,

MD, PhD, and

DDS, PhD

DOI: 10.2344/0003-3006-57.3.112

Abstract

Gum elastic bougie (GEB), a useful device for difficult airway management, has seldom been used for nasotracheal intubation. Among 632 patients undergoing dental procedures or oral surgery, GEB was used successfully in 16 patients in whom conventional nasal intubation had failed because of anatomical problems or maldirection of the tip of the tracheal tube. We recommend that GEB should be applied from the first attempt for nasal intubation in patients with difficult airways.

Download PDF

CONTINUING EDUCATION

DEPARTMENTS

Continuing Education Program

DOI: 10.2344/0003-3006-57.3.120

Please see the pdf version for the Continuing Education Program Answer Sheet.

Download PDF

JDSA Abstracts

DOI: 10.2344/0003-3006-57.3.121

Changes in Body Temperature and Urine Output during General Anesthesia Combined with Remifentanil in Oral and Maxillofacial Surgery: Comparison of Sevoflurane vs Propofol Anesthesia

Yoko Hakumoto, Shingo Sugioka, Kayoko Hashimoto, Yuki Kan, Hideyuki Matsui,Yoko Nunotani, Naotaka Kishimoto,Yasushi Sakuma,Yoshihiro Momota, Yasuhiko Kato and Junichiro Kotani 2010;38(1):1–5.

Remifentanil is a selective μ-opioid receptor agonist. Due to its short-acting effect and is rapid elimination from the body, it has been considered effective for relatively short surgical procedures. Although there have been many reports on the efficacy and safety of remifentanil for general anesthesia, there are few reports related to

Download PDF

ADSA/NDBA Abstracts

DOI: 10.2344/0003-3006-57.3.129

ABSTRACT/POSTER #001 Calculating Maximum Local Anesthetic Dose in Cartridges for the Pediatric Population

Ahmed M, Martinez HR

This poster presents a new graph that easily allows the dental practitioner to determine the child's maximum local anesthetic dosage in milliliters (cartridges) based on his or her weight. Local anesthesia is used daily in dentistry to manage pain, and different kinds of agents available in the market may be selected, depending on the strength and duration of anesthesia required. Each anesthetic agent has a maximum recommended dose, and it is very important to calculate the maximum recommended dose, especially in children. This

Download PDF