Abstract

This double-blind, placebo-controlled, randomized cross-over clinical experimental study tested the reliability, validity, and sensitivity to change of punctuate pain thresholds and self-reported pain on needle penetration. Female subjects without orofacial pain were tested in 2 sessions at 1- to 2-week intervals. The test site was the mucobuccal fold adjacent to the first upper right premolar. Active lidocaine hydrochloride 2% (Dynexan) or placebo gel was applied for 5 minutes, and sensory testing was performed before and after application. The standardized quantitative sensory test protocol included mechanical pain threshold (MPT), pressure pain threshold (PPT), mechanical pain sensitivity (MPS), and needle penetration sensitivity (NPS) assessments. Twenty-nine subjects, mean (SD) age 29.0 (10.2) years, completed the study. Test-retest reliability intraclass correlation coefficient at 10-minute intervals between examinations was MPT 0.69, PPT 0.79, MPS 0.72, and NPS 0.86. A high correlation was found between NPS and MPS (r = 0.84; P < .001), whereas NPS and PPT were not significantly correlated. The study found good to excellent test-retest reliability for all measures. None of the sensory measures detected changes in sensitivity following lidocaine 2% or placebo gel. Electronic von Frey assessments of MPT/MPS on oral mucosa have good validity.

Abstract

We previously modified the i-gel airway to enable its use in the field of oral and maxillofacial surgery and reported its fabrication methods. In general, the standard i-gel airway is quick to insert and has a high success rate, but the modified i-gel airway has yet to be assessed for these attributes. We, therefore, set out to compare the ease of insertion of the modified i-gel airway with the LMA Flexible to investigate the usefulness of the modified i-gel airway. The study participants, who included 20 new interns with no experience using either the LMA Flexible or the modified i-gel airway, inserted each device 3 times into an intubation practice manikin. The variables measured in this study were insertion time and rate of successful insertions. Mean insertion time over 3 attempts was significantly shorter for the modified i-gel™ airway (18.9 ± 4.7 seconds) than the LMA Flexible (24.9 ± 5.1 seconds, P < .001). The rate of successful insertions as a total of all 3 attempts was significantly higher for the modified i-gel airway (56/60 times, 93.3%) than the LMA Flexible (45/60 times, 75%; P = .012). When used by an inexperienced operator, the modified i-gel™ airway is faster and has a higher success rate than the LMA Flexible, suggesting that it can be easily manipulated during insertion.

Abstract

Adrenaline (epinephrine) is included in dental local anesthesia for the purpose of vasoconstriction. In Japan, adrenaline is contraindicated for use in patients receiving antipsychotic therapy, because the combination of adrenaline and an antipsychotic is considered to cause severe hypotension; however, there is insufficient evidence supporting this claim. The purpose of the present study was to clarify the changes in hemodynamics caused by drug interaction between adrenaline and an antipsychotic and to evaluate the safety of the combined use of adrenaline and an antipsychotic in an animal study. Male Sprague-Dawley rats were anesthetized with sodium pentobarbital. A catheter was inserted into the femoral artery to measure blood pressure and pulse rate. Rats were pretreated by intraperitoneal injection of chlorpromazine or chlorpromazine and propranolol, and after 20 minutes, saline or 1 of 3 different doses of adrenaline was administered by intraperitoneal injection. Changes in the ratio of mean arterial blood pressure and pulse rate were measured after the injection of adrenaline. Significant hypotension and tachycardia were observed after the injection of adrenaline in the chlorpromazine-pretreated rats. These effects were in a dose-dependent manner, and 100 μg/kg adrenaline induced significant hemodynamic changes. Furthermore, in the chlorpromazine and propranolol–pretreated rats, modest hypertension was induced by adrenaline, but hypotension and tachycardia were not significantly shown. Hypotension was caused by a drug interaction between adrenaline and chlorpromazine through the activation of the β-adrenergic receptor and showed a dose-dependent effect. Low-dose adrenaline similar to what might be used in human dental treatment did not result in a significant homodynamic change.

Acute angle-closure glaucoma, 155

Adrenal hypoplasia, 158

Adrenaline, 150

Adverse drug reactions, 26

Airway fire, 21

Airway management, 78, 113, 162

Anesthesia, 63, 164

Anesthesiology, 3

Anti-emetic prophylaxis, 18

Antipsychotics, 150

Appropriate head position, 47

ATP, 95

Bolus infusion, 18

Calcium channel antagonist, 18

Cavity, 111

Central adenosine receptors, 95

Cerebrovascular event, 73

Complication, 73

Complications, 164

Cuffed oropharyngeal airway, 107

Deliberate hypotension, 18

Dental, 111

Dental anesthesiology, 18

Dental rehabilitation, 158

Dental treatment, 21

Dentistry, 21, 26, 73

Devices, 78, 113

Dexmedetomidine, 3

Difficult airway management, 107

Drug interaction, 150

Drug side effects, 26

Epinephrine, 150

Equipment, 78

Facemask,

Anaphylaxis After a Third Exposure to Sugammadex

Honoka IshiharaDDS,

Yukie NittaDDS, PhD,

Yoko KudoDDS, PhD, and

Kanta KidoDDS, PhD

The Importance of Anesthesia Progress to Dental Anesthesiology

A New Protocol to Evaluate the Effect of Topical Anesthesia

Abstract

Comparison of Insertion of the Modified i-gel Airway for Oral Surgery With the LMA Flexible: A Manikin Study

Abstract

Hemodynamic Changes by Drug Interaction of Adrenaline With Chlorpromazine

Abstract

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

Abstract

Acute Angle-Closure Glaucoma After General Anesthesia for Bone Grafting

Abstract

Anesthetic and Dental Management of a Child With IMAGe Syndrome

Abstract

Upside-Down Mask Ventilation Technique for a Patient With a Long and Narrow Mandible

Abstract

Emergency Drug Kits: Pharmacological and Technical Considerations

Abstract

Continuing Education Program

Letter to the Editor

Differential Diagnosis of Acute Hypotension Under Anesthesia

Announcement

Laureate of the History of Anesthesia

Author Index, Volume 61

Subject Index, Volume 61

Anaphylaxis After a Third Exposure to Sugammadex

Use of Ultrasound-Guided Glossopharyngeal Nerve Block and Intravenous Sedation to Control a Gag Reflex

An Appropriate Setting for a Patient-Controlled Analgesia Pump for Continuous Local Anesthesia After Bimaxillary Osteotomy

Ramped Position Improves Oxygenation During Mechanical Ventilation for Patients With Severe Obesity

Commentary—Fasting Implications of GLP-1 Agonist Use in Pediatric Procedural Sedation