Anesthesia Progress Volume 59: Issue 1

This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 10 anesthesiology training program directors was 9 of 10 or 90%. The response rate for the 79 pediatric dentistry training program directors was 46 of 79 or 58%. Thirty-seven percent of pediatric dentistry programs use clinic-based deep sedation/general anesthesia for dental treatment in addition to hospital-based deep sedation/general anesthesia. Eighty-eight percent of those programs use dentist anesthesiologists for administration of deep sedation/general anesthesia in a clinic-based setting. Pediatric dentistry residency directors perceive a future change in the need for deep sedation/general anesthesia services provided by dentist anesthesiologists to pediatric dentists: 64% anticipate an increase in need for dentist anesthesiologist services, while 36% anticipate no change. Dental anesthesiology directors compared to 2, 5, and 10 years ago have seen an increase in the requests for dentist anesthesiologist services by pediatric dentists reported by 56% of respondents (past 2 years), 63% of respondents (past 5 years), and 88% of respondents (past 10 years), respectively. Predicting the future need of dentist anesthesiologists is an uncertain task, but these results show pediatric dentistry directors and dental anesthesiology directors are considering the need, and they recognize a trend of increased need for dentist anesthesiologist services over the past decade.

The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available.

The purpose of this study was to examine how submucosal injection of a clinically relevant dose of a lidocaine hydrochloride solution containing epinephrine affects the muscle relaxant effects of rocuronium bromide. Sixteen patients scheduled for orthognathic surgery participated in this study. All patients were induced with fentanyl citrate, a target-controlled infusion of propofol and rocuronium bromide. Anesthesia was maintained by total intravenous anesthesia. After nasotracheal intubation, an infusion of rocuronium bromide was started at 7 µg/kg/min, and the infusion rate was then adjusted to maintain a train of four (TOF) ratio at 10 to 15%. The TOF ratio just prior to oral mucosal injection of a 1% lidocaine hydrochloride solution containing 10 µg/mL epinephrine (LE) was taken as the baseline. TOF ratio was observed for 20 minutes, with 1-minute intervals following the start of injection. Mean epinephrine dose was 85.6 ± 18.6 µg and mean infusion rate of rocuronium bromide was 6.3 ± 1.6 µg/kg/min. TOF ratio began to decrease 2 minutes after the injection of LE, reached the minimum value at 3.1 ± 3.6% 12 minutes after the injection, and then began to recover. We conclude that oral mucosal injection of LE enhances the muscle relaxant effects of rocuronium bromide.

Yutaka SHINOHE,

Division of Dental Anesthesiology, Department of Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University

Address correspondence to Yutaka SHINOHE, Division of Dental Anesthesiology, Department of Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, 1–3–27, Chuo-dori, Morioka 020–8505, Japan

Ken-ichi NABESHIMA,

Division of Dental Anesthesiology, Department of Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University

Chie ENDOU,

Division of Dental Anesthesiology, Department of Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University

Ken-ichi SATOH,

Division of Dental Anesthesiology, Department of Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University

SAKAMOTO

Limited Nasal Intubation Route After Pharyngeal Flap Surgery: A Case Report

Yuka MomotaDDS,

Takuya UchidaDDS, PhD,

Hazuki HiraDDS,

Mari NishimuraDDS,

Toshiko YanaseDDS, and

Yoshihiro MomotaDDS, PhD

What Else Can We Learn from the Anesthesia Specialty Application?

Demand in Pediatric Dentistry for Sedation and General Anesthesia by Dentist Anesthesiologists: A Survey of Directors of Dentist Anesthesiologist and Pediatric Dentistry Residencies

The Use of Office-Based Sedation and General Anesthesia by Board Certified Pediatric Dentists Practicing in the United States

Oral Mucosal Injection of a Local Anesthetic Solution Containing Epinephrine Enhances Muscle Relaxant Effects of Rocuronium

Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia

Pharmacodynamic Considerations for Moderate and Deep Sedation

Continuing Education Program

JDSA JOURNAL ABSTRACTS

Limited Nasal Intubation Route After Pharyngeal Flap Surgery: A Case Report

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

mRNA Expression Level of IL-1β in Labial Mucosa Following Surgical Insult After Administration of Dexmedetomidine

Perioperative Management of Patients With Seizure Disorders: Part I

Challenges in Developing an Effective Inferior Alveolar Nerve Block Guide