Anesthesia Progress Volume 59: Issue 3

This study aimed to compare continuous intravenous infusion combinations of propofol-remifentanil and propofol-ketamine for deep sedation for surgical extraction of all 4 third molars. In a prospective, randomized, double-blinded controlled study, participants received 1 of 2 sedative combinations for deep sedation for the surgery. Both groups initially received midazolam 0.03 mg/kg for baseline sedation. The control group then received a combination of propofol-remifentanil in a ratio of 10 mg propofol to 5 μg of remifentanil per milliliter, and the experimental group received a combination of propofol-ketamine in a ratio of 10 mg of propofol to 2.5 mg of ketamine per milliliter; both were given at an initial propofol infusion rate of 100 μg/kg/min. Each group received an induction loading bolus of 500 μg/kg of the assigned propofol combination along with the appropriate continuous infusion combination . Measured outcomes included emergence and recovery times, various sedation parameters, hemodynamic and respiratory stability, patient and surgeon satisfaction, postoperative course, and associated drug costs. Thirty-seven participants were enrolled in the study. Both groups demonstrated similar sedation parameters and hemodynamic and respiratory stability; however, the ketamine group had prolonged emergence (13.6 ± 6.6 versus 7.1 ± 3.7 minutes, P = .0009) and recovery (42.9 ± 18.7 versus 24.7 ± 7.6 minutes, P = .0004) times. The prolonged recovery profile of continuously infused propofol-ketamine may limit its effectiveness as an alternative to propofol-remifentanil for deep sedation for third molar extraction and perhaps other short oral surgical procedures, especially in the ambulatory dental setting.

The goal of this study was to investigate the effect of an epinephrine continuous infusion on muscle blood flow in rabbits. Sixteen male Japan White rabbits were randomly allocated to 1 of 2 groups: epinephrine continuous infusion at 0.01 μg/kg/min (Ep-0.01 group, n = 8) and at 0.1 μg/kg/ min (Ep-0.1 group, n = 8). The observed variables were heart rate, femoral artery blood pressure, common carotid artery blood flow (CCBF), masseter muscle blood flow (MBF), and quadriceps muscle blood flow (QBF). In the Ep-0.01 group, CCBF, MBF, and QBF were increased by 14, 22, and 21% from respective control values. In contrast, in the Ep-0.1 group, CCBF, MBF and QBF were decreased by 10, 30, and 27% from respective control values. There were no differences in the percentage change between MBF and QBF during epinephrine continuous infusion. Positive correlations were observed between CCBF and MBF and between CCBF and QBF. In conclusion, skeletal muscle blood flow was increased during the small-dose epinephrine infusion, whereas it was decreased during large-dose infusion.

Bronchospasm and status asthmaticus are two of the most dreaded complications that a pediatric anesthesiologist may face. With the occurrence of severe bronchospasm and the inability to ventilate, children are particularly vulnerable to apnea and ensuing hypoxia because of their smaller airway size, smaller lung functional residual capacity, and higher oxygen consumption rates than adults. Nebulized medication delivery in intubated children is also more difficult because of smaller endotracheal tube internal diameters. This case demonstrates the potentially lifesaving use of a vibrating-mesh membrane nebulizer connected to the anesthesia circuit for treating bronchospasm.

In 1889, Ralph Waldo Emerson was quoted as saying: “If a man can write a better book, preach a better sermon, or make a better mousetrap than his neighbor, the world will beat a path to his door.” Dr Mason, by engaging a multispecialty international collaboration of medical/dental specialists, has compiled that better book, and clinicians who sedate children outside of the operating room will soon beat a path to her door. There are few reference texts that cover pediatric sedation, and this book, to my knowledge, is the first text totally dedicated to the sedation of children.

In 519

Local Anesthesia Part 2: Technical Considerations

Kenneth L. Reed DMD,

Stanley F. Malamed DDS, and

Andrea M. Fonner DDS

Prevention of Fire in the Dental Chair

Comparison of Propofol-Remifentanil Versus Propofol-Ketamine Deep Sedation for Third Molar Surgery

Large-Dose Epinephrine Reduces Skeletal Muscle Blood Flow Under General Anesthesia in Rabbits

Severe Intraoperative Bronchospasm Treated with a Vibrating-Mesh Nebulizer

Local Anesthesia Part 2: Technical Considerations

Continuing Education Program

PEDIATRIC SEDATION OUTSIDE OF THE OPERATING ROOM

Continuing Education Program

Local Anesthesia Part 2: Technical Considerations

PEDIATRIC SEDATION OUTSIDE OF THE OPERATING ROOM

Prevention of Fire in the Dental Chair

Comparison of Propofol-Remifentanil Versus Propofol-Ketamine Deep Sedation for Third Molar Surgery