Abstract

The purpose of this prospective, randomized, double-blind crossover study was to compare the anesthetic efficacy of 2% mepivacaine with 1 : 20,000 levonordefrin versus 2% lidocaine with 1 : 100,000 epinephrine in maxillary central incisors and first molars. Sixty subjects randomly received, in a double-blind manner, maxillary central incisor and first molar infiltrations of 1.8 mL of 2% mepivacaine with 1 : 20,000 levonordefrin and 1.8 mL of 2% lidocaine with 1 : 100,000 epinephrine at 2 separate appointments spaced at least 1 week apart. The teeth were electric pulp tested in 2-minute cycles for a total of 60 minutes. Anesthetic success (obtaining 2 consecutive 80 readings with the electric pulp tester within 10 minutes) was not significantly different between 2% mepivacaine with 1 : 20,000 levonordefrin and 2% lidocaine with 1 : 100,000 epinephrine for the central incisor and first molar. However, neither anesthetic agent provided an hour of pulpal anesthesia.

Abstract

We experience individual differences in pain and sensitivity to analgesics clinically. Genetic factors are known to influence individual difference. Polymorphisms in the human OPRM1 gene, which encodes the μ-opioid receptors, may be associated with the clinical effects of opioid analgesics. The purpose of this study was to determine whether any of the 5 common single-nucleotide polymorphisms (SNPs) of the OPRM1 gene could affect the antinociceptive effect of fentanyl. Fentanyl was less effective in subjects with the G allele of the OPRM1 A118G SNP than in those with the A allele, and subjects with the G allele required more fentanyl for adequate postoperative pain control than those with the A allele. In the future, identifying SNPs might give us information to modulate the analgesic dosage of opioid individually for better pain control. Factors underlying individual differences in sensitivity to pain other than genetic factors may include environmental and psychological factors. We therefore examined the effects of preoperative anxiety on the analgesic efficacy of fentanyl in patients undergoing sagittal split mandibular osteotomy (SSMO). From among the patients enrolled in the study, 60 patients (male/female: 18/42, age: 24.6 ± 6.7 years) who gave informed consent were examined for correlations between preoperative trait/state anxiety, as measured by the state-trait anxiety inventory (STAI) on the day before surgery, and postoperative consumption of patient-controlled analgesia (PCA) fentanyl and visual analog scale (VAS) assessment by patients. Levels of trait and state anxieties measured by the STAI were correlated with neither the consumption of PCA fentanyl nor postoperative VAS assessment. These findings suggest that psychological factors are unlikely to affect postoperative pain or the use of analgesics.

Abstract

Nausea, vomiting, and hiccups are troubling complications associated with sedation and general anesthesia. This article will review the basic pathophysiology of these events and current recommendations for their prevention and management.

Anatomical Study of the Stellate Ganglion Position, the Cervical Sympathetic Trunk, and the Surrounding Membrane Structures

Toshiyasu Kitayama, Toshiyuki Saito, Tomoe Iwabuchi, Takayoshi Miyaki*, Hanno Steinke**, Masahiro Ito* and Yoshiyuki Oi

2010;38(2):169–175.

Stellate ganglion block (SGB) is frequently used in pain clinics. SGB is useful for idiopathic facial palsy, Menière disease and many other applications. However, its success rate is not always satisfactory because the drug injection to the stellate ganglion is not easy. The stellate ganglion is located deep in the cervico-thoracic region, and is closely surrounded by vital organs. There are some reports of fatal complications due to

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

Kinnison EdmundsDDS, MS,

Melissa DrumDDS, MS,

Sara FowlerDMD, MS,

John NussteinDDS, MS, and

Al ReaderDDS, MS

The ADA's New Emergency Airway Course For Sedationists

A Prospective, Randomized, Double-Blind Comparison of 2% Mepivacaine With 1 : 20,000 Levonordefrin Versus 2% Lidocaine With 1 : 100,000 Epinephrine for Maxillary Infiltrations

Abstract

Diversity of Opioid Requirements for Postoperative Pain Control Following Oral Surgery—Is It Affected by Polymorphism of the μ-Opioid Receptor?

Abstract

Nausea, Vomiting, and Hiccups: A Review of Mechanisms and Treatment

Abstract

Continuing Education Program

JDSA ABSTRACTS

Anatomical Study of the Stellate Ganglion Position, the Cervical Sympathetic Trunk, and the Surrounding Membrane Structures

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

A New ACLS Option for Anesthesia Providers

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

Commentary: Are Anesthesiologists Still “Darting” Their Patients?

Tissue Blood Flow During Remifentanil Infusion With Carbon Dioxide Loading

Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery

Pulseless Ventricular Tachycardia During Office-Based Anesthetic in a Four-Year-Old Child

Partially Withdrawn Nasotracheal Tube: An Alternative to the Nasal Trumpet

Comparison of Insertion of the Modified i-gel Airway for Oral Surgery With the LMA Flexible: A Manikin Study