Abstract

In this study, by measuring bispectral index (BIS), we tested the hypothesis that intravenous adenosine 5′-triphosphate (ATP) infusion would deepen the level of midazolam-induced sedation. Ten healthy volunteers underwent 2 experiments with at least 2 weeks' interval: immediately after intravenous bolus administration of midazolam (0.04 mg/kg), they received continuous infusion of either ATP infusion (100 μg/kg/min) or placebo (saline) for 40 minutes in a double-blind, randomized, crossover manner. Changes in BIS values and responsiveness to verbal command as well as cardiorespiratory variables were observed throughout the study periods. Administration of midazolam alone reduced BIS value from control: 97 ± 1 to 68 ± 18 at 25 minutes, which was accompanied by significant cardiopulmonary depressant effects, while maintaining responsiveness to verbal command (consciousness) throughout the study period. Coadministration of ATP with midazolam further reduced BIS value to 51 ± 13, associated with complete loss of consciousness without adverse effect on the cardiorespiratory systems. We conclude that the addition of ATP infusion to midazolam significantly enhances midazolam sedation without disturbing cardiorespiratory functions.

Abstract

This was judged to be the first place winning submission for the American Dental Society of Anesthesiology Student Essay Award.

Acetaminophen is an old drug that is now available in an intravenous formulation. Its advantages and disadvantages are reviewed, including its potential role in multimodal postoperative pain therapy.

Abstract

Klippel-Feil syndrome (KFS) is a rare disease characterized by a classic triad comprising a short neck, a low posterior hairline, and restricted motion of the neck due to fused cervical vertebrae. We report repeated anesthetic management for orthognathic surgeries for a KFS patient with micrognathia. Because KFS can be associated with a number of other anomalies, we therefore performed a careful preoperative evaluation to exclude them. The patient had an extremely small mandible, significant retrognathia, and severe limitation of cervical mobility due to cervical vertebral fusion. As difficult intubation was predicted, awake nasal endotracheal intubation with a fiberoptic bronchoscope was our first choice for gaining control of the patient's airway. Moreover, the possibility of respiratory distress due to postoperative laryngeal edema was considered because of the surgeries on the mandible. In the operating room, tracheotomy equipment was always kept ready if a perioperative surgical airway control was required. Three orthognathic surgeries and their associated anesthetics were completed without a fatal outcome, although once the patient was transferred to the intensive care unit for precautionary postoperative airway management and observation. Careful preoperative examination and preparation for difficult airway management are important for KFS patients with micrognathia.

Tatsuya Ichinohe ,

Address correspondence to Tatsuya Ichinohe, Department of Dental Anesthesiology, Tokyo Dental College, 1-2-2, Masago, Mihama-ku, Chiba 261-8502, Japan.

Masahiko Shimada*

A Questionnaire Survey Regarding the Administration of Lidocaine Hydrochloride Solution Containing Adrenaline for Dental Use in Regular Users of Antipsychotics

J Jpan Dent Soc Anesthesiol 2014;42(2):190–195

Severe hypotension can be induced when antipsychotics, such as chlorpromazine, haloperidol or risperidone, are concomitantly used with adrenaline, since these two agents can interact through α-adrenergic receptors. As a result, cautions have been issued against the administration of lidocaine hydrochloride solution containing adrenaline for dental use in regular users of

Repeated Anesthetic Management for a Patient With Klippel-Feil Syndrome

Yuri HasePhD,

Nobuhito KamekuraPhD,

Toshiaki FujisawaPhD, and

Kazuaki FukushimaPhD

Confirmed Transmission of Hepatitis C in an Oral Surgery Office

IV ATP Potentiates Midazolam Sedation as Assessed by Bispectral Index

Abstract

OFIRMEV: An Old Drug Becomes New Again

Abstract

Repeated Anesthetic Management for a Patient With Klippel-Feil Syndrome

Abstract

Cuffed Oropharyngeal Airway for Difficult Airway Management

Abstract

Hair Tourniquet Syndrome in the Dental Patient

Abstract

Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways

Abstract

Continuing Education Program

JDSA JOURNAL ABSTRACTS

A Questionnaire Survey Regarding the Administration of Lidocaine Hydrochloride Solution Containing Adrenaline for Dental Use in Regular Users of Antipsychotics

J Jpan Dent Soc Anesthesiol 2014;42(2):190–195

Continuing Education Program

Repeated Anesthetic Management for a Patient With Klippel-Feil Syndrome

Cuffed Oropharyngeal Airway for Difficult Airway Management

Hair Tourniquet Syndrome in the Dental Patient

Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways