Anesthesia Progress Volume 59: Issue 2

The entire dental profession mourns the loss of John A. Yagiela, DDS, PhD, an internationally recognized authority on pain and anxiety control in dentistry, who died suddenly on February 22, 2012. John was one of the most brilliant men whom your editor has ever known. We first met soon after the Journal of the American Dental Association published my review of his first pharmacology textbook in 1980, and we subsequently became life-long friends. We traveled with our spouses all over the world to places including Scotland, Germany, France, Israel, New Zealand, Japan, Australia, and South Africa. John was

The aim of this present study was to evaluate the irritative potential of 2 topical anesthetics used in intrapocket anesthesia for periodontal scaling/root planing when applied in subcutaneous tissue of rats. Sixty animals were divided into 4 groups: group 1, saline solution (control); group 2, poloxamer gel (thermosetting vehicle); group 3, lidocaine and prilocaine poloxamer thermosetting gel; group 4: EMLA, a lidocaine and prilocaine dermatological cream. Injections of 2% Evans blue were administrated intravenously into the lateral caudal vein. In order to analyze vascular permeability, the tested substances were injected intradermally. The rats were sacrificed 3, 6, and 9 hours after injection of the substances. The dorsal skin was dissected and removed. The vascular permeability was evaluated by the measurement of area of dye extravasation and the dye was subsequently extracted after immersion in formamide. Statistical analyses were made by ANOVA with Bonferroni's post hoc test and Pearson correlation. The 2 methods to analyze the exudative phase of the inflammatory process showed statistically significant difference among the groups and periods of evaluation (P < .05). Both methods had a significant correlation (P < .0001). Under the tested conditions, the anesthetic agents showed mild initial inflammatory response when implanted in subcutaneous connective tissue.

Dexmedetomidine (DEX) has a minimal respiratory depressive effect, which is beneficial for dentistry; however, it has the disadvantage of permitting an intraoperative arousal response such that the patient appears to be suddenly no longer sedated, and it has a variable amnestic effect. Since midazolam (MDZ) in an appropriate dose has a profound amnesic effect, we investigated whether additional MDZ compensates for the disadvantage of DEX and enables a better quality of sedation. Forty-three subjects were randomly divided into 4 groups. In group 1, MDZ (0.02 mg/kg) was administered intravenously, followed by a dose of 0.01 mg/kg every 45 minutes. After the first dose of MDZ, preloading with DEX (2 µg/kg/h for 10 minutes) was started and maintained with a dosage of 0.5 µg/kg/h. In group 2, MDZ was infused in the same manner as in group 1, followed by preloading with DEX (1 µg/kg/h for 10 minutes) and maintenance (0.3 µg/kg/h). In group 3, MDZ was infused 0.03 mg/kg, and a dose of 0.01 mg/kg was given every 30 minutes; DEX was administered at the same as in group 2. In group 4, DEX was infused using the same method as in group 1 without MDZ. The sedation levels, amnesia, and patient satisfaction were also investigated. Group 2 had a lower sedation level and a poor evaluation during the first half of the operation. Group 4 did not exhibit an amnesic effect at the beginning of the operation. An evaluation of the degree of patient satisfaction did not reveal any differences among the groups. Optimal sedation was achieved through the combined use of MDZ (0.02 mg/kg with the addition of 0.01 mg/kg every 45 minutes) and DEX (2 µg/kg/h for 10 minutes followed by 0.5 µg/kg/h).

We audited the recovery characteristics of 51 patients who had undergone orthognathic maxillofacial surgery at a single center. Patients whose anesthesia had been maintained with intravenous propofol and remifentanil (n = 21) had significantly higher pain scores during the first 4 hours after surgery than those whose anesthesia was maintained with volatile inhalational agents and longer-acting opioids (n = 30) (P = .016). There was a nonsignificant trend towards shorter recovery times in the former group, while there were no differences in early postoperative opioid usage, hemodynamic parameters, or postoperative nausea and vomiting . Given that our data were collected retrospectively and without the ability to control for potential confounders, we interpret the results with caution. Notwithstanding these limitations, we believe this is the first report comparing the effects of different opioid-based anesthetic regimens on early recovery from orthognathic surgery, and we believe this report may be used as the starting point for a controlled study.

A Case in Which the Hole in the Inflation Line Was Not Closed at the Tip of the Tracheal Tube

Yoshinari MorimotoDDS, PhD,

Megumi HayashiDDS, PhD,

Kanae TsukawakiDDS,

Kouji TakanoDDS, PhD,

Hiroko KuboDH, and

Eri IidaDH

John A. Yagiela, D.D.S., Ph.D.- A Dental Anesthesia Giant 1947–2012

Effect of Lidocaine- and Prilocaine-Based Topical Anesthetics on the Inflammatory Exudates in Subcutaneous Tissue of Rats

A Comparison of Dexmedetomidine Sedation With and Without Midazolam for Dental Implant Surgery

The Effect of Anesthetic Technique on Recovery After Orthognathic Surgery: A Retrospective Audit

The Local Pharmacokinetics of ³H-Ropivacaine and ¹⁴C-Lidocaine After Maxillary Infiltration Anesthesia in Rats

Complicated Airway Due to Unexpected Lingual Tonsil Hypertrophy

Dual Bougie Technique for Nasotracheal Intubation

Anesthetic Considerations for Masticatory Muscle Tendon-Aponeurosis Hyperplasia: A Report of 24 Cases

Local Anesthetics: Review of Pharmacological Considerations

Continuing Education Program

A Case in Which the Hole in the Inflation Line Was Not Closed at the Tip of the Tracheal Tube

Comparison of the Length and Shape of Various Preformed Nasotracheal Tubes

Commentary: Are Anesthesiologists Still “Darting” Their Patients?

Immunohistochemical Analysis of Maxillary Nerve Distribution in Rats

Difficulty Controlling Sedation Level Using Processed Electroencephalography Monitoring in a Patient With Intellectual Disability, Fontan Circulation, and a Severe Gag Reflex

Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery

The Effect of Intraoral Suction on Oxygen-Enriched Surgical Environments: A Mechanism for Reducing the Risk of Surgical Fires

Letter to the Editor

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).

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