Abstract

The purpose of this randomized, double-blind clinical study was to evaluate the effectiveness of a larger-bore compared with a standard-bore dental local anesthetic needle of the same gauge in reducing pain during inferior alveolar (IA) and long buccal (LB) nerve block injections. Twenty active duty military or Department of Defense beneficiaries undergoing dental treatment were anesthetized using a split-mouth design with 4 anesthetic dental injections. Both sides of the mouth received IA nerve block and LB nerve injections, one using the 27-gauge large-bore Septoject XL needle and other using a 27-gauge standard-bore Septoject needle. Patients rated the pain experienced with each method using a visual analogue scale (VAS). The IA injection mean VAS score and standard deviation were 38.9 ± 22.7 mm and 37.1 ± 22.4 mm, respectively, for the larger and standard-bore needles. The LB injection mean VAS score and standard deviation were 33.5 ± 22.8 mm and 35.1 ± 19.6 mm, respectively, for the larger and standard-bore needles. The data were analyzed with a paired t test (α = .05). No significant difference was found between the IA (P = .70) or LB injections (P = .73). The use of a larger-bore 27-gauge needle did not reduce pain on injection compared with the standard-bore 27-gauge needle.

Abstract

Some patients with intellectual disabilities spend longer than others in emergence from ambulatory general anesthesia for dental treatment. Although antiepileptic drugs and anesthetics might be involved, an independent predictor for delay of the emergence remains unclear. Thus, a purpose of this study is to identify independent factors affecting the delay of emergence from general anesthesia. This was a retrospective cohort study in dental patients with intellectual disabilities. Patients in need of sedative premedication were removed from participants. The outcome was time until emergence from general anesthesia. Stepwise multivariate regression analysis was used to extract independent factors affecting the outcome. Antiepileptic drugs and anesthetic parameters were included as predictor variables. The study included 102 cases. Clobazam, clonazepam, and phenobarbital were shown to be independent determinants of emergence time. Parameters relating to anesthetics, patients' backgrounds, and dental treatment were not independent factors. Delay in emergence time in ambulatory general anesthesia is likely to be related to the antiepileptic drugs of benzodiazepine or barbiturates in patients with intellectual disability.

Abstract

Achieving adequate pulpal anesthesia in mandibular teeth is always a challenge. Supplementary injections and using drugs in combination are some methods implemented to overcome this hurdle. In this randomized clinical trial, use of meperidine in conjunction with lidocaine in intraligamentary injection did not exhibit significant improvement in anesthesia.

Reply

In response to the Letter to the Editor by Dr Stu Lieblich¹ in the latest publication of Anesthesia Progress (61/4), we would like to further expand on the processes that are likely to occur in the scenario described by Cooke and colleagues.²

It was postulated by Lieblich¹ that anaphylaxis could be included in the differential diagnosis of catastrophic cardiovascular collapse. Though this is a distinct possibility, the clinical scenario described by Cooke does not follow traditional manifestations of anaphylactic shock or severe anaphylactoid reaction under general anesthesia. Most scenarios of severe anaphylaxis

A Heartfelt Thank You to Dr Joel Weaver

Effect of Needle Design on Pain From Dental Local Anesthetic Injections

Abstract

Independent Predictors of Delay in Emergence From General Anesthesia

Abstract

Anesthetic Efficacy of Meperidine in Teeth With Symptomatic Irreversible Pulpitis

Abstract

Anesthetic Management by Laryngeal Mask Airway in a Patient With a History of Difficult Intubation Resulting in Dental Injuries

Abstract

Suspected Intraoperative Anaphylaxis to Gelatin Absorbable Hemostatic Sponge

Abstract

Dexmedetomidine, Ketamine, and Midazolam for Oral Rehabilitation: A Case Report

Abstract

Alpha-2 Adrenergic Receptor Agonists: A Review of Current Clinical Applications

Abstract

Continuing Education Program

Abstract

Reply

Reply

Announcement

14TH INTERNATIONAL DENTAL CONGRESS ON ANESTHESIA, SEDATION AND PAIN CONTROL
of the International Federation of Dental Anesthesia Societies
will be held in
BERLIN, GERMANY OCTOBER 8–10, 2015
For more information, see www.ifdas.org

Call for Proposals to Amend the IFDAS Constitution

Continuing Education Program

Announcement

A Heartfelt Thank You to Dr Joel Weaver

Anesthetic Efficacy of Meperidine in Teeth With Symptomatic Irreversible Pulpitis

Effect of Needle Design on Pain From Dental Local Anesthetic Injections