Abstract

The purpose of this prospective randomized, single blind study was to determine the anesthetic efficacy of 68.8 mg of lidocaine with 50 μg epinephrine compared to 68.8 mg lidocaine with 50 μg epinephrine plus 0.9 M mannitol in inferior alveolar nerve (IAN) blocks. Forty subjects randomly received 2 IAN blocks consisting of a 1.72-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine and a 5-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine (1.72 mL) plus 0.9 M mannitol (3.28 mL) in 2 separate appointments spaced at least 1 week apart. Mandibular anterior and posterior teeth were blindly electric pulp tested at 4-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all the times of pulpal anesthesia (80 readings), for each tooth, over the 60 minutes. One hundred percent of the subjects had profound lip numbness with both inferior alveolar nerve blocks. The results demonstrated that the 5 mL-formulation of 68.8 mg lidocaine with 50 μg epinephrine plus 0.9 M mannitol was significantly better than the 1.72-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine for all teeth, except the lateral incisor. We concluded that adding 0.9 M mannitol to a lidocaine with epinephrine formulation was significantly more effective in achieving a greater percentage of total pulpal anesthesia (as defined in this study) than a lidocaine formulation without mannitol. However, the 0.9 M mannitol/lidocaine formulation would not provide 100% pulpal anesthesia for all the mandibular teeth.

Abstract

The purpose of this study was to identify the risk factors associated with low peripheral oxygen saturation (SpO₂) and delayed recovery of dental patients with disabilities after intravenous sedation. A total of 1213 patients with disabilities were retrospectively investigated with respect to demographic parameters and sedation conditions. Multivariate logistic analyses were conducted for patients with an SpO₂ <90% and a recovery period of >60 minutes to identify the risk factors for poor sedation conditions. A significant odds ratio related to decreased SpO₂ was observed for age, sex, midazolam and propofol levels, concurrent use of nitrous oxide, cerebral palsy, Down syndrome, and mental retardation. The most problematic patients were those diagnosed with Down syndrome (odds ratio, 3.003–7.978; 95% confidence interval; P < .001). Decision tree analysis showed an increased risk of decreased SpO₂ in males with Down syndrome or after administration of >0.493 mg/kg propofol in combination with midazolam. An increased risk of delayed awakening was seen in patients aged less than 21 years and in males administered >0.032 mg/kg of midazolam. Intravenous sedation for dental patients with disabilities, particularly those with cerebral palsy, Down syndrome, or mental retardation, increases the risk of decreased SpO₂. In addition, delayed recovery is expected after midazolam administration.

Abstract

Moderate intravenous (IV) sedation combined with local anesthesia is common for outpatient oral surgery procedures. An ideal sedative agent must be safe and well tolerated by patients and practitioners. This study evaluated fospropofol, a relatively new sedative/hypnotic, in comparison to midazolam, a commonly used benzodiazepine, for IV moderate sedation during oral and maxillofacial surgery. Sixty patients were randomly assigned to either the fospropofol or the midazolam group. Each participant received 1 μg/kg of fentanyl prior to administration of the selected sedative. Those in the fospropofol group received an initial dose of 6.5 mg/kg, with 1.6 mg/kg supplemental doses as needed. Those in the midazolam group received initial doses of 0.05 mg/kg, followed by 0.02 mg/kg supplemental doses. The quality of sedation in each patient was evaluated with regard to (a) onset of sedation, maintenance, and recovery profile; (b) patient and surgeon satisfaction; and (c) hemodynamic stability and adverse effects. The fospropofol group demonstrated shorter physical recovery times than midazolam patients, taking a mean of 11.6 minutes versus 18.4 minutes for physical recovery (P = .007). Cognitive recovery comparison did not find any difference with a mean of 7.5 minutes versus 8.8 minutes between the 2 drug groups (P = .123). The fospropofol group had a higher rate of local anesthetic injection recall (90.5 vs 44.4%, P = .004). Other parameters of recall were comparable. Two adverse effects demonstrated significance, with more patients in the midazolam group experiencing tachycardia (48.2 vs 9.4%, P = .001), and more patients in the fospropofol group experiencing perineal discomfort (40.6 vs 0, P < .001). No significant difference was found in any other measures of sedation safety, maintenance, or satisfaction. Fospropofol, when administered intravenously by a dentist anesthesiologist at the indicated dose in this study, appears to be a safe, well-tolerated alternative to midazolam for intravenous moderate sedation during minor oral surgery procedures.

Adverse events, 54

Agitation, 67

Analgesics, 178

Antibiotic prophylaxis, 111

Antibiotics, 111

Anticoagulants, 72

Antifungals, 111

Antiplatelet drugs, 72

Articaine, 42

Benzodiazepine, 162

Children, 54, 60

Continuous veno-venous hemofiltration, 21

Cut nasotracheal tube, 11

Delayed recovery, 153

Delirium, 67

Dental anesthesia sonophoresis device, 37

Dental anxiety, 46

Dental Anxiety Scale, 46

Dental infections, 111

Dental pulp anesthesia, 15

Dental sedation, 153

Dental treatment, 72

Dentistry, 25, 188

Developmental disability patients, 60

Diclofenac potassium soft gelatin capsules, 178

Drug allergy, 188

Drug interactions, 72

Drug side effects, 72, 188

Epinephrine, 3, 42

Fospropofol, 162

General anesthesia, 11, 60

Glucocorticosteroid, 25

Inferior

New Evidence of Enhanced Safety of Nitrous Oxide in General Anesthesia

Anesthetic Efficacy of a Combination of 0.9 M Mannitol Plus 68.8 mg of Lidocaine With 50 μg Epinephrine in Inferior Alveolar Nerve Blocks: A Prospective Randomized, Single Blind Study

Abstract

Risk Factors With Intravenous Sedation for Patients With Disabilities

Abstract

A Comparison of Fospropofol to Midazolam for Moderate Sedation During Outpatient Dental Procedures

Abstract

Three Newly Approved Analgesics: An Update

Abstract

Drug Allergies and Implications for Dental Practice

Abstract

Continuing Education Program

JDSA Journal Abstracts

Medical Emergencies Experienced in the Nihon University School of Dentistry Dental Hospital

J Jpn Dent Soc Anesthesiol 2013;41:153–159

Author Index, Volume 60

Subject Index, Volume 60

Continuing Education Program

Author Index, Volume 60

Subject Index, Volume 60

New Evidence of Enhanced Safety of Nitrous Oxide in General Anesthesia

Anesthetic Efficacy of a Combination of 0.9 M Mannitol Plus 68.8 mg of Lidocaine With 50 μg Epinephrine in Inferior Alveolar Nerve Blocks: A Prospective Randomized, Single Blind Study