Editorial Type: DEPARTMENTS
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Online Publication Date: 01 Jan 2013

JDSA Journal Abstracts

Article Category: Other
Page Range: 125 – 138
DOI: 10.2344/0003-3006-60.3.125
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Aya Masawaki,
Address correspondence to: Aya Masawaki, Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan.
 Hiroshi Hanamoto Fumi Kitamoto Tomotaka Ohnuki Shigeko Murakami Mika Inoue Chiho Kudo Hitoshi Niwa

Uncuffed Tracheal Tube Size in Pediatric Patients Aged below 2 Years

J Jpn Dent Soc Anesthesiol 2012;40:587–591.

Cole's formula (tube size = 0.25 × age + 4) is usually used to calculate uncuffed endotracheal tube (ETT) size in pediatric patients aged above 2 years, but is not applicable for younger patients. The purpose of this study was to investigate the relationship between ETT size and patients' age and/or body weight in patients aged below 2 years.

A total of 1,035 patients, aged from 1 month to 2 years, with ASA physical status 1 or 2, who received oral surgery in Osaka University Dental Hospital between February 2003 and June 2011 were enrolled in this study. Patients who were born prematurely or whose trachea had structural anomalies were excluded. The outer diameter of uncuffed ETT (mm), type of ETT, age in days, and body weight (kg) were investigated retrospectively. If there was an audible leak when the lungs were inflated to a pressure of less than 15 cmH2O, the ETT was exchanged for one that was 0.5 mm larger. Univariate linear regression was used to assess the relationship between tube size (dependent variable) and age in days or body weight (independent variable). Multiple regression analysis was performed to assess the relationship between tube size and age in days and body weight.

Univariate and multiple regression analyses demonstrated a statistically significant correlation between tube size and age and body weight (p<0.001). The following regression equations and coefficients of determination were obtained.

Tube size (mm) = 0.00223 × age (days) + 4.88, R2 = 0.511. Tube size (mm) = 0.201 × weight (kg) + 3.96, R2 = 0.474. Tube size (mm) = 0.00144 × age (days) + 0.0866 × weight (kg) + 4.43, R2 = 0.534.

Tube size was correlated with age in days rather than with body weight. Therefore, an age-based formula is more reliable for prediction of the ideal tube size in patients aged below 2 years. When conventional uncuffed ETTs (e. g. Portex® regular ETTs) are used, inner diameters (IDs) of 4.0 mm and 4.5 mm are suitable in patients aged 9 months and 19 months, respectively. Thus, a formula based on age in days is useful in patients aged below 2 years.

Figure 1. Relationship between outer diameter of uncuffed tracheal tubes and age. / OD : outer diameterFigure 1. Relationship between outer diameter of uncuffed tracheal tubes and age. / OD : outer diameterFigure 1. Relationship between outer diameter of uncuffed tracheal tubes and age. / OD : outer diameter
Figure 1. Relationship between outer diameter of uncuffed tracheal tubes and age OD : outer diameter

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Figure 2. Relationship between outer diameter of uncuffed tracheal tubes and body weight. / OD : outer diameterFigure 2. Relationship between outer diameter of uncuffed tracheal tubes and body weight. / OD : outer diameterFigure 2. Relationship between outer diameter of uncuffed tracheal tubes and body weight. / OD : outer diameter
Figure 2. Relationship between outer diameter of uncuffed tracheal tubes and body weight OD : outer diameter

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Table 1. Outer diameter of uncuffed tracheal tubes according to the inner diameter of tracheal tubes supplied by different manufacturers
Table 1.
Hiroki Shibata,
Address correspondence to: Hiroki Shibata, Department of Anesthesiology, Osaka Dental University, 1-5-17, Otemae, Chuoku, Osaka 540-00008, Japan.
 Kayoko Ando Naoko Yamamoto Tomomi Kohara Junichiro Kotani

Results of a Six-year Survey of In-Hospital Emergency Cases Concerning Dental Anesthesiology at Osaka Dental University Hospital

J Jpn Dent Soc Anesthesiol 2012;40:592–597.

We investigated in-hospital emergency cases over the last 6 years at our hospital to review the current emergency management system in use. We studied the anesthesia records of 93 emergency cases handled by the Department of Dental Anesthesiology during the 6-year period between April 2006 and March 2012 to obtain information about time of occurrence, place of occurrence, emergency situation, and outcomes. The 93 cases comprised 87 outpatients, 2 inpatients, 3 students/staff, and a family member of a patient. A total of 1,500,790 outpatient emergency cases were handled nationally during the same period, which gives an occurrence rate for our emergency cases of 0.0058%. Our cases occurred most frequently in an examination room before treatment at around 11 am, and the most common accidental symptom was vasovagal reflex. At our hospital, the Department of Dental Anesthesiology handles dental emergencies; other emergency cases are referred to the Department of Internal Medicine at another hospital. No patterns were observed in terms of the place and time of occurrence, suggesting that it is not possible to predict when and where medical emergencies may occur. Pain and stress from invasive treatment are factors associated with local anesthesia. It took relatively longer for an attending dentist to obtain patients' medical history because our hospital is not an advanced treatment hospital. Some patients were later transferred to other hospitals due to unfavorable outcomes, suggesting that, in order to handle a variety of emergency cases and unexpected events, it is necessary to collaborate with other general hospitals. Because the number of emergency cases has been increasing in recent years, we incorporated a basic life support (BLS) course for students and staff into our curriculum in August 2004 and also installed an automated external defibrillator on each floor. We believe this heightened awareness of emergency events at our institution, which has led to an increased number of emergency cases reported at our hospital. We have been able to produce reports of near-miss cases using our electronic medical record system since May 2012. This system also enables us to review incidents that have never been reported previously and to use the information to strengthen our emergency management system.

Figure 1. Medical emergencies classified by age and gender (n = 87). / There were more female than male cases. Their ages ranged between 16 and 93 years old.Figure 1. Medical emergencies classified by age and gender (n = 87). / There were more female than male cases. Their ages ranged between 16 and 93 years old.Figure 1. Medical emergencies classified by age and gender (n = 87). / There were more female than male cases. Their ages ranged between 16 and 93 years old.
Figure 1. Medical emergencies classified by age and gender (n = 87) There were more female than male cases. Their ages ranged between 16 and 93 years old.

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Figure 2. Treatment contents (n = 87). / Most of the treatment contents were conservative dentistry and prosthodontics.Figure 2. Treatment contents (n = 87). / Most of the treatment contents were conservative dentistry and prosthodontics.Figure 2. Treatment contents (n = 87). / Most of the treatment contents were conservative dentistry and prosthodontics.
Figure 2. Treatment contents (n = 87) Most of the treatment contents were conservative dentistry and prosthodontics.

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Figure 3. Situations when medical emergencies occurred (n = 87). / More than 70% of medical emergencies occurred before and during dental treatment.Figure 3. Situations when medical emergencies occurred (n = 87). / More than 70% of medical emergencies occurred before and during dental treatment.Figure 3. Situations when medical emergencies occurred (n = 87). / More than 70% of medical emergencies occurred before and during dental treatment.
Figure 3. Situations when medical emergencies occurred (n = 87) More than 70% of medical emergencies occurred before and during dental treatment.

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Table 1. Number of medical emergencies in Osaka Dental University Hospital from April 2006 to March 2012
Table 1.
Manabu Soya Hirokazu Kukidome Hidetaka Kuroda Shun Nakamura Nobuyuki Matsuura Tatsuya Ichinohe

Comparison of Various Preformed Nasotracheal Intubation Tubes

J Jpn Dent Soc Anesthesiol 2012;40:598–601.

Nasotracheal intubation is commonly chosen in oral and maxillofacial surgery under general anesthesia for securing a sufficient surgical field and airway management. We experienced a case in which a nasotracheal tube was used for the first operation without trouble and another nasotracheal tube with the same internal diameter (ID) purchased from a different company used for the second surgery was too short for the cuff to go well into the trachea beyond the glottis. In this study, therefore, we compared four kinds (three sizes each) of preformed nasotracheal tubes. Measurement items were length between proximal edge of cuff and tube tip, length between flexion point and proximal edge of cuff, and cuff length. Variability was detected in each measurement site of the tube. In a nasotracheal tube of 7.5 mm ID, there was a difference of up to 37 mm between the Portex®Polar™ tube and Parker Flex-Tip® tube in length from the flexion point to the proximal edge of the cuff. There was also a difference of up to 15 mm between the Mallinckrodt®RAE™ tube and Parker Flex-Tip® tube in length from the proximal edge of the cuff to the tube tip in 7.0 mm ID. These results indicate that the length between the flexion point and tube tip may be short in the second operation, because the distance between the external nostril and glottis could be longer after jaw deformity surgery in which the maxillary bone was moved forward. This event might cause serious complications such as glottis edema because of compression on the vocal cord. Accordingly, if the distance between the external nostril and glottis is expected to be longer after the first maxillofacial surgery, we should choose a nasotracheal tube having a sufficiently long distance from the flexion point to the proximal edge of the cuff. For safe and secure airway management, we should understand the features of each preformed nasotracheal tube, and select a nasotracheal tube in consideration of gender, body type and surgical procedure.

Figure 1. Measurements of nasotracheal tube. / A : length between proximal edge of cuff and tube tip, B : length between flexion point and proximal edge of cuff.Figure 1. Measurements of nasotracheal tube. / A : length between proximal edge of cuff and tube tip, B : length between flexion point and proximal edge of cuff.Figure 1. Measurements of nasotracheal tube. / A : length between proximal edge of cuff and tube tip, B : length between flexion point and proximal edge of cuff.
Figure 1. Measurements of nasotracheal tube A : length between proximal edge of cuff and tube tip, B : length between flexion point and proximal edge of cuff.

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Figure 2. Comparison of cuff of nasotracheal tubes (cuff inflated to 20 cm H2O cuff pressure). / C : cuff length (a) Rusch AGT nasal preformed cuffed endotracheal tube, (b) Parker Flex-Tip®PFNC, (c) Portex® Polar™ preformed tracheal tube, (d) Mallinckrodt® RAE™ preformed tracheal tube, nasal cuffed..Figure 2. Comparison of cuff of nasotracheal tubes (cuff inflated to 20 cm H2O cuff pressure). / C : cuff length (a) Rusch AGT nasal preformed cuffed endotracheal tube, (b) Parker Flex-Tip®PFNC, (c) Portex® Polar™ preformed tracheal tube, (d) Mallinckrodt® RAE™ preformed tracheal tube, nasal cuffed..Figure 2. Comparison of cuff of nasotracheal tubes (cuff inflated to 20 cm H2O cuff pressure). / C : cuff length (a) Rusch AGT nasal preformed cuffed endotracheal tube, (b) Parker Flex-Tip®PFNC, (c) Portex® Polar™ preformed tracheal tube, (d) Mallinckrodt® RAE™ preformed tracheal tube, nasal cuffed..
Figure 2. Comparison of cuff of nasotracheal tubes (cuff inflated to 20 cm H2O cuff pressure) C : cuff length (a) Rusch AGT nasal preformed cuffed endotracheal tube, (b) Parker Flex-Tip®PFNC, (c) Portex® Polar™ preformed tracheal tube, (d) Mallinckrodt® RAE™ preformed tracheal tube, nasal cuffed..

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Table 1. Measurements of four nasotracheal tubes
Table 1.
Kaori Yoshida,
Address correspondence to Kaori Yoshida, Department of Clinical Health and Oral Sciences, Division of Dental Anesthesiology (Seudobashi Hospital Dental Anesthesia/Orofacial Pain Center), Tokyo Dental College, 2-9-18, Misakicho, Chiyoda-ku, Tokyo 101-0061, Japan.
 Mariko Nomura Junko Hayashi Ken-ichi Fukuda Yoshihiko Kohkita Keita Ohkushi Toshiyuki Handa Ayako Sugiyama Satoshi Ito Tatsuya Ichinohe

Infusion Rate of Remifentanil Necessary for Flexible Laryngeal Mask Airway Insertion during Propofol Anesthesia

J Jpn Dent Soc Anesthesiol 2013;41:15–20.

Successful insertion of the flexible laryngeal mask airway (FLMA) requires adequate jaw relaxation and suppression of the upper airway reflexes. Propofol is a commonly-used anesthetic for LMA insertion because of its inhibitory effects on the airway reflexes. However, successful insertion with propofol alone needs a high bolus dose or target controlled infusion rate, which may result in hemodynamic depression. Several studies have demonstrated that the addition of opioid during propofol anesthesia facilitates LMA insertion with minimal hemodynamic changes. In particular, remifentanil is suitable for FLMA insertion because it provides better jaw relaxation and the attenuation of strong noxious stimuli. This study was designed to determine the effective infusion rate (EIR) of remifentanil for the successful insertion of FLMA during a target-controlled infusion of propofol.

Seventy-five unpremedicated patients undergoing removal of the plates of the mandible were included in this study. Patients were randomly allocated to one of the following five groups according to the infusion rate of remifentanil: 0.02, 0.06, 0.125, 0.25 and 0.5 μg/kg/min. Following an intravenous bolus of 1 μg/kg remifentanil administered over 60 sec, anesthesia was induced by infusion of propofol at a target blood concentration of 3.0 μg/ml and remifentanil at a predetermined infusion rate. In case of cessation of spontaneous respiration during induction, ventilation was controlled manually to maintain a concentration of end-tidal CO2 35–45 mmHg. A size-3 FLMA was used for the female and a size-4 FLMA for the male. FLMA insertion was attempted 15 min after equilibrium was reached between plasma and effect-site concentration of propofol. The conditions of FLMA insertion were classified as success or failure based on the patient's responses. Failure was defined as coughing, gagging, difficult mouth-opening or purposeful body movement when insertion was attempted. The results were as follows. 1. Spontaneous respiration was maintained in all the patients in the 0.02 insertion group (Table 2). 2. Mean arterial pressure immediately before FLMA insertion in the 0.02, 0.06 and 0.125 infusion groups was significantly higher than those in the 0.25 and 0.5 groups (Table 3). 3. Mean arterial pressure, heart rate and bispectral index (BIS) values did not differ before and after successful insertion (Table 4). 4. From the probit analysis, the EIR50 and EIR95 of remifentanil for successful insertion of FLMA were 0.08 μg/kg/min (95% confidence interval [CI] 0.02–0.13 μg/kg/min) and 0.29 μg/kg/min (95% CI 0.21–0.52 μg/kg/min), respectively (Table 5).

This study suggests that propofol anesthesia at EC of 3.0 μg/ml in combination with an infusion rate of remifentanil of 0.29 μg/kg/min provide good conditions for inserting FLMA without hemodynamic and BIS changes in 95% of patients.

Figure 1. The infusion rate of remifentanil and response curve from the probit analysis. The EIR50 and EIR95 were 0.08 and 0.29 μg/kg/min, respectively.Figure 1. The infusion rate of remifentanil and response curve from the probit analysis. The EIR50 and EIR95 were 0.08 and 0.29 μg/kg/min, respectively.Figure 1. The infusion rate of remifentanil and response curve from the probit analysis. The EIR50 and EIR95 were 0.08 and 0.29 μg/kg/min, respectively.
Figure 1 The infusion rate of remifentanil and response curve from the probit analysis. The EIR50 and EIR95 were 0.08 and 0.29 μg/kg/min, respectively.

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Table 1. Characteristics of patients
Table 1.
Table 2. Anesthetic characteristics during anesthesia induction
Table 2.
Table 3. Hemodynamic and BIS values immediately before FLMA insertion
Table 3.
Table 4. Changes in hemodynamics and BIS values before and after successful insertion
Table 4.
Table 5. Rate of successful insertion
Table 5.
Yuka Honda,
Address correspondence to Yuka Honda, Department of Dental Anesthesiology and Special Care Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama 700-8525, Japan.
 Shigeru Maeda Hitoshi Higuchi Yumiko Tomoyasu Minako Ishii Tomoko Hayashi Kazuo Mukae Ayaka Yamane Akiko Yabuki Takuya Miyawaki

A Retrospective Study on the Risk Factors for Emergence Agitation following General Anesthesia

J Jpn Dent Soc Anesthesiol 2013;41:21–25.

We performed a retrospective study on the risk factors for emergence agitation following general anesthesia in patients undergoing oral surgery in Okayama University Hospital between June 2011 and March 2012.

This study was performed after approval by the Ethics Committee of the Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences. One hundred and eighty one patients aged more than 16 years old were enrolled. We used the Richmond Agitation and Sedation Scale (RASS, Table 1), which was developed to assess the level of agitation and sedation following general anesthesia. The patients were divided into two groups: non-agitated patients (RASS score: −5 to 0) and agitated patients (RASS score: 1 to 4). The results were statistically analyzed using JMP 9.0.0 (SAS Institute, Cary, USA). In the univariate analysis, Fisher's exact test and the χ2 test were used to compare groups. A multivariable analysis was performed using stepwise logistic regression to separately determine risk factors of agitation.

Of the 181 patients, emergence agitation occurred in 30 patients (16.6%). Agitation of level 1, 2, 3 or 4 of excitement according to the RASS was observed in 25, 4, 1, and 0 patients, respectively. Table 2 shows the risk factors of emergence agitation using univariate analysis. Emergence agitation was not correlated with age, BMI, duration of operation, postoperative pain, amount of opioid during the operation, or kind of postoperative analgesics, but was more common in males than females (p = 0.039) and also in patients who received general inhalational anesthesia than patients who received total intravenous anesthesia (p = 0.011). Table 3 shows the risk factors of emergence agitation using multivariate analysis by stepwise logistic regression. One variable was associated with emergence agitation. Inhalational anesthesia was the highest risk factor (odds ratio [OR] = 3.24; 95% confidence interval [CI] = 1.23–10.17; p = 0.015).

In conclusion, the results suggest that inhalational anesthesia was the highest risk factor of emergence agitation.

Table 1. RASS (Richmond Agitation and Sedation Scale)6)
Table 1.
Table 2. Univariate analysis: risk factors of postoperative agitation
Table 2.
Table 3. Multivariate analysis (Logistic regression): risk factors of agitation
Table 3.
Rie Iwamoto,
Address correspondence to Rie Iwamoto, Department of Dental Anesthesiology, Graduate School of Dental Medicine, Hokkaido University, Kita-ku, Kita 13, Nishi 6, Sapporo 060-8586, Japan.
 Yukie Nitta Shigeru Takuma Makiko Shibuya Yukifumi Kimura Nobuhito Kamekura Toshiaki Fujisawa

Intravenous Sedation Using BIS Monitor for a Dental Patient with Frontotemporal Dementia

J Jpn Dent Soc Anesthesiol 2013;41:34–37.

Frontotemporal dementia (FTD) is a disease that presents localized cerebral degeneration and atrophy in the frontal and temporal lobes of the brain. A patient with FTD has a high chance of being indicated for intravenous sedation in dental treatment from a relatively early stage due to being easily distracted and communication difficulty (Table 1). However, there are no reports on intravenous sedation management or management with BIS monitor for patients with FTD, although there have been some reports on intravenous sedation using the BIS monitor for dementia patients.

Recently, we experienced intravenous sedation management using the BIS monitor for a patient with moderate or severe-stage FTD. MRI and SPECT of this patient are shown in Fig. 1. The electrode of the BIS monitor (Fig. 2) was attached to the right side of the forehead where there was less atrophy and diminished cerebral blood flow. The target dental treatment was completed under conscious sedation level with propofol at a continuous infusion speed of 1.5–3.5 mg/kg/h. The control value of BIS Index showed a normal level of 97 and the values during sedation management were in the low 80s. As a result, all values of BIS Index were consistent with clinical findings from the beginning to the end.

The electroencephalographic views vary with the type of dementia and its period. In general, normal brain waves or decreased alpha and beta activities are seen in the incipient period, and theta waves, which are a slow wave, are dominant in the middle period in Alzheimer's disease (AD). Meanwhile, normal brain waves are seen in the incipient and middle periods, and decreased alpha and beta activities are seen in the last period in FTD. Therefore, the BIS monitor appears to be useful for evaluating sedation level in patients with FTD till the middle period, unlike patients with AD.

Figure 1. Brain images of (A) magnetic resonance imaging (MRI) and (B) single-photon emission computed tomography (SPECT) Marked atrophy and diminished cerebral blood flow are seen in the left frontal and temporal lobes. (B) Arrows show diminished blood flow.Figure 1. Brain images of (A) magnetic resonance imaging (MRI) and (B) single-photon emission computed tomography (SPECT) Marked atrophy and diminished cerebral blood flow are seen in the left frontal and temporal lobes. (B) Arrows show diminished blood flow.Figure 1. Brain images of (A) magnetic resonance imaging (MRI) and (B) single-photon emission computed tomography (SPECT) Marked atrophy and diminished cerebral blood flow are seen in the left frontal and temporal lobes. (B) Arrows show diminished blood flow.
Figure 1 Brain images of (A) magnetic resonance imaging (MRI) and (B) single-photon emission computed tomography (SPECT) Marked atrophy and diminished cerebral blood flow are seen in the left frontal and temporal lobes. (B) Arrows show diminished blood flow.

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Figure 2. BIS monitor electrode Electrical potential difference between electrodes 1 and 3, and between 1 and 4, are reflected in the BIS Index. Electrode 2 is a reference electrode.Figure 2. BIS monitor electrode Electrical potential difference between electrodes 1 and 3, and between 1 and 4, are reflected in the BIS Index. Electrode 2 is a reference electrode.Figure 2. BIS monitor electrode Electrical potential difference between electrodes 1 and 3, and between 1 and 4, are reflected in the BIS Index. Electrode 2 is a reference electrode.
Figure 2 BIS monitor electrode Electrical potential difference between electrodes 1 and 3, and between 1 and 4, are reflected in the BIS Index. Electrode 2 is a reference electrode.

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Table 1. Positive and negative symptoms of FTD2,4)
Table 1.
Eiji Kitagawa,
Address correspondence to Eiji Kitagawa, Department of Dentistry, Oral and Maxillofacial Surgery, Hokuto Hospital, 7–5, Kisenn, Inadacho, Obihiro, Hokkaido 080-0833, Japan.

A Comparison of Intravenous Sedation in Patients with and without Profound Phobia of Dental Treatment

J Jpn Dent Soc Anesthesiol 2013;41:38–46.

Intravenous sedation (IVS) is frequently used in patients with a profound phobia of dental treatment The present study examined whether IVS actually relieved patient fears, as well as the level of sedation, frequency of procedural accidents and the hemodynamics of phobic patients compared to non-phobic patients.

A total of 1,834 patients underwent impacted tooth extraction under IVS in our department between 2000 and 2008. Sixty-four patients who admitted to having considerable tenseness, fear and anxiety before the treatment in a questionnaire survey were assigned to the “dental phobia” (DP) group, while the 340 patients who responded that they did not have any tenseness, fear and anxiety. The results were then compared retrospectively between the two groups.

No significant differences were found in procedure duration, recovery time, local anesthesia effect, amnesic effect, incidence of respiratory depression, incidence of procedural accidents or patient impressions (pain, recollection of the procedure, drowsiness) (Table 1, 2, 3). Dose of propofol was significantly higher in the DP group, because a larger dose was deemed necessary to achieve optimal sedation. No significant intergroup differences in level of sedation at induction or during surgery were seen, but many patients in the DP group were heavily sedated at the end of the procedure. Hemodynamically, mean BP and HR remained significantly elevated in the DP group before and during the procedure (Fig. 1, 2). There was no significant difference in min Sp02 (Fig. 3). Fifty-nine of 64 patients in the DP group showed a diminished score of tenseness, fear and anxiety during sedation (Fig. 4). Postoperative patient impressions were virtually the same in both groups, with more than 95% of patients indicating no experience of any discomfort during the procedure and approximately 100% in the DP group stating that they would prefer IVS if undergoing the same procedure again.

These study findings suggest that intravenous sedation enables a good level of sedation, safety and patient satisfaction, even in patients with dental phobia.

Figure 1. Changes in mean blood pressure Mean blood pressure remained significantly elevated on B, C, D, E and Min BP in the DP group. A: preoperative examination, B: on entry to operating room, C: pre-induction, D post-induction, E: after local anesthesia, F: leaving operating room, G: dischargeFigure 1. Changes in mean blood pressure Mean blood pressure remained significantly elevated on B, C, D, E and Min BP in the DP group. A: preoperative examination, B: on entry to operating room, C: pre-induction, D post-induction, E: after local anesthesia, F: leaving operating room, G: dischargeFigure 1. Changes in mean blood pressure Mean blood pressure remained significantly elevated on B, C, D, E and Min BP in the DP group. A: preoperative examination, B: on entry to operating room, C: pre-induction, D post-induction, E: after local anesthesia, F: leaving operating room, G: discharge
Figure 1 Changes in mean blood pressure Mean blood pressure remained significantly elevated on B, C, D, E and Min BP in the DP group. A: preoperative examination, B: on entry to operating room, C: pre-induction, D post-induction, E: after local anesthesia, F: leaving operating room, G: discharge

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Figure 2. Changes in heart rate Heart rate remained significantly elevated on B, C, D, E, Max HR and Min HR in the DP group. A: preoperative examination, B: on entry to operating room, C: pre-induction, D: post-induction, E: after local anesthesia, F: leaving operating room, G: dischargeFigure 2. Changes in heart rate Heart rate remained significantly elevated on B, C, D, E, Max HR and Min HR in the DP group. A: preoperative examination, B: on entry to operating room, C: pre-induction, D: post-induction, E: after local anesthesia, F: leaving operating room, G: dischargeFigure 2. Changes in heart rate Heart rate remained significantly elevated on B, C, D, E, Max HR and Min HR in the DP group. A: preoperative examination, B: on entry to operating room, C: pre-induction, D: post-induction, E: after local anesthesia, F: leaving operating room, G: discharge
Figure 2 Changes in heart rate Heart rate remained significantly elevated on B, C, D, E, Max HR and Min HR in the DP group. A: preoperative examination, B: on entry to operating room, C: pre-induction, D: post-induction, E: after local anesthesia, F: leaving operating room, G: discharge

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Figure 3. Changes in SpO2 The DP group was significantly higher than the nonDP group on entry to OR, but there was no significant difference in Min SpO2 on leaving OR.Figure 3. Changes in SpO2 The DP group was significantly higher than the nonDP group on entry to OR, but there was no significant difference in Min SpO2 on leaving OR.Figure 3. Changes in SpO2 The DP group was significantly higher than the nonDP group on entry to OR, but there was no significant difference in Min SpO2 on leaving OR.
Figure 3 Changes in SpO2 The DP group was significantly higher than the nonDP group on entry to OR, but there was no significant difference in Min SpO2 on leaving OR.

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Figure 4. Changes in tenseness, fear and anxiety score 59 of 64 patients in the DP group showed diminished tenseness, fear and anxiety score during treatment 333 of 340 patients in the nonDP group showed no change in score 0 during treatment.Figure 4. Changes in tenseness, fear and anxiety score 59 of 64 patients in the DP group showed diminished tenseness, fear and anxiety score during treatment 333 of 340 patients in the nonDP group showed no change in score 0 during treatment.Figure 4. Changes in tenseness, fear and anxiety score 59 of 64 patients in the DP group showed diminished tenseness, fear and anxiety score during treatment 333 of 340 patients in the nonDP group showed no change in score 0 during treatment.
Figure 4 Changes in tenseness, fear and anxiety score 59 of 64 patients in the DP group showed diminished tenseness, fear and anxiety score during treatment 333 of 340 patients in the nonDP group showed no change in score 0 during treatment.

Citation: Anesthesia Progress 60, 3; 10.2344/0003-3006-60.3.125

Table 1. Question for patients who received intravenous sedation
Table 1.
Table 2. Profiles and results of the two groups
Table 2.
Table 3. Complications and adverse reactions
Table 3.
Table 4. Results of questionnaire
Table 4.
Copyright: 2013
<bold>Figure 1</bold> .
Figure 1 .

Relationship between outer diameter of uncuffed tracheal tubes and age

OD : outer diameter

<bold>Figure 2</bold> .
Figure 2 .

Relationship between outer diameter of uncuffed tracheal tubes and body weight

OD : outer diameter

<bold>Figure 1</bold> .
Figure 1 .

Medical emergencies classified by age and gender (n = 87)

There were more female than male cases. Their ages ranged between 16 and 93 years old.

<bold>Figure 2</bold> .
Figure 2 .

Treatment contents (n = 87)

Most of the treatment contents were conservative dentistry and prosthodontics.

<bold>Figure 3</bold> .
Figure 3 .

Situations when medical emergencies occurred (n = 87)

More than 70% of medical emergencies occurred before and during dental treatment.

<bold>Figure 1</bold> .
Figure 1 .

Measurements of nasotracheal tube

A : length between proximal edge of cuff and tube tip, B : length between flexion point and proximal edge of cuff.

<bold>Figure 2</bold> .
Figure 2 .

Comparison of cuff of nasotracheal tubes (cuff inflated to 20 cm H2O cuff pressure)

C : cuff length (a) Rusch AGT nasal preformed cuffed endotracheal tube, (b) Parker Flex-Tip®PFNC, (c) Portex® Polar™ preformed tracheal tube, (d) Mallinckrodt® RAE™ preformed tracheal tube, nasal cuffed..

<bold>Figure 1</bold>
Figure 1

The infusion rate of remifentanil and response curve from the probit analysis. The EIR50 and EIR95 were 0.08 and 0.29 μg/kg/min, respectively.

<bold>Figure 1</bold>
Figure 1

Brain images of (A) magnetic resonance imaging (MRI) and (B) single-photon emission computed tomography (SPECT) Marked atrophy and diminished cerebral blood flow are seen in the left frontal and temporal lobes. (B) Arrows show diminished blood flow.

<bold>Figure 2</bold>
Figure 2

BIS monitor electrode Electrical potential difference between electrodes 1 and 3, and between 1 and 4, are reflected in the BIS Index. Electrode 2 is a reference electrode.

<bold>Figure 1</bold>
Figure 1

Changes in mean blood pressure Mean blood pressure remained significantly elevated on B, C, D, E and Min BP in the DP group. A: preoperative examination, B: on entry to operating room, C: pre-induction, D post-induction, E: after local anesthesia, F: leaving operating room, G: discharge

<bold>Figure 2</bold>
Figure 2

Changes in heart rate Heart rate remained significantly elevated on B, C, D, E, Max HR and Min HR in the DP group. A: preoperative examination, B: on entry to operating room, C: pre-induction, D: post-induction, E: after local anesthesia, F: leaving operating room, G: discharge

<bold>Figure 3</bold>
Figure 3

Changes in SpO2 The DP group was significantly higher than the nonDP group on entry to OR, but there was no significant difference in Min SpO2 on leaving OR.

<bold>Figure 4</bold>
Figure 4

Changes in tenseness, fear and anxiety score 59 of 64 patients in the DP group showed diminished tenseness, fear and anxiety score during treatment 333 of 340 patients in the nonDP group showed no change in score 0 during treatment.

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