Anesthesia Progress Volume 63: Issue 1

Over the past 10 years, checklists have been incorporated into the perioperative environment in increasing numbers. The concept appears to be a simple one: develop a simple list of critical items that need to be double-checked before, and in some cases after, any anesthetic or surgery. This has been extended to other phases of perioperative care such as patient handoffs to the PACU (Post-Anesthesia Care Unit) and placement of central lines, for instance. The World Health Organization's “Safe Surgery Saves Lives”¹ may be the best known of these instruments. Atul Gawande² popularized checklists in his book,

Effective pain control during local anesthetic injection is the cornerstone of behavior guidance in pediatric dentistry. The aim of this study was to evaluate the practical efficacy of a 2-stage injection technique in reducing injection pain in children. This was a split-mouth, randomized controlled crossover trial. One hundred cooperative children aged 7 to 13 years in need of bilateral local anesthetic injections (inferior alveolar nerve block, posterior superior alveolar nerve block, or maxillary and mandibular buccal infiltrations) for restorative, endodontic, and extraction treatments were recruited for the study. Children were randomly allocated to receive either the 2-stage injection technique or conventional technique at the first appointment. The other technique was used at the successive visit after 1 week. Subjective and objective evaluation of pain was done using the Wong–Baker FACES Pain Rating Scale (FPS) and Sound Eye Motor (SEM) scale, respectively. The comparison of pain scores was done by Wilcoxon sign-rank test. Both FPS and SEM scores were significantly lower when the 2-stage injection technique of local anesthetic nerve block/infiltration was used compared with the conventional technique. The 2-stage injection technique is a simple and effective means of reducing injection pain in children.

The aim of this study was to investigate the attitude of dentists in Kuwait toward the use of nitrous oxide sedation as a behavior management technique (BMT) for pediatric patients and assess their training in nitrous oxide sedation. In addition, we assessed parents' knowledge of and attitude toward the use of nitrous oxide as a BMT for their children. The objective was to determine if nitrous oxide sedation is being provided and utilized as a means to enhance dental care for pediatric patients. A cross-sectional survey was randomly distributed to both groups of interest: parents accompanying their children to the dentist and licensed dentists in Kuwait. Participants had to meet certain inclusion criteria to be included in the survey and had to complete the entire questionnaire to be part of the analysis. A total of 381 parents completed the questionnaires. The majority of parents responded that they were unaware of nitrous oxide sedation and were not aware of it as a BMT (79%). Two thirds of the parent would accept nitrous oxide sedation if recommended by a dentist treating their children. Two hundred and one dentists completed the survey and met the inclusion criteria. The majority (74.5%) of dentists were willing to use nitrous oxide as a BMT. However, only 6% were utilizing nitrous oxide sedation and providing it to their child patient if indicated. The main reasons for this huge gap are lack of facilities/equipment and lack of training as indicated by the dentists. This study showed that parents are accepting nitrous oxide sedation as a BMT for their children. It also showed the willingness of the dentists to provide such BMT to their patients. The lack of training and lack of equipment are the main barriers to providing such service to the patients. More training courses and more facilities should be provided to eliminate such barriers.

The vasoconstrictive effect due to the addition of epinephrine to local anesthetic has been clearly shown by measuring blood-flow volume or blood anesthetic concentration in oral mucosal tissue. However, there are no reports on the measurement of anesthetic concentration using samples directly taken from the jawbone and oral mucosal tissue. Consequently, in this study, the effect of lidocaine concentration in the jawbone and oral mucosal tissue by the addition of epinephrine to the local anesthetic lidocaine was considered by quantitatively measuring lidocaine concentration within the tissue. Japanese white male rabbits (n = 96) were used as test animals. General anesthesia was induced by sevoflurane and oxygen, and then cannulation to the femoral artery was performed while arterial pressure was constantly recorded. Infiltration anesthesia was achieved by 0.5 mL of 2% lidocaine containing 1 : 80,000 epinephrine in the upper jawbone (E⁺) and 0.5 mL of 2% of epinephrine additive–free lidocaine (E⁰) under the periosteum. At specified time increments (10, 20, 30, 40, 50, and 60 minutes), samples from the jawbone, oral mucosa, and blood were collected, and lidocaine concentration was directly measured by high-performance liquid chromatography. No significant differences in the change in blood pressure were observed either in E⁺ or E⁰. In both E⁺ and E⁰ groups, the serum lidocaine concentration peaked 10 minutes after local anesthesia and decreased thereafter. At all time increments, serum lidocaine concentration in E⁺ was significantly lower than that in E⁰. There were no significant differences in measured lidocaine concentration between jawbone and mucosa within either the E⁺ or the E⁰ groups at all time points, although the E⁰ group had significantly lower jawbone and mucosa concentrations than the E⁺ group at all time points when comparing the 2 groups to each other. Addition of epinephrine to the local anesthetic inhibited systemic absorption of local anesthetic into the blood such that a high concentration could be maintained in the tissue. Epinephrine-induced vasoconstrictive effect was observed not only in the oral mucosa but also in the jawbone.

Promoting a Culture of Safety

Evaluation of 2-Stage Injection Technique in Children

Dentists' and Parents' Attitude Toward Nitrous Oxide Use in Kuwait

Lidocaine Concentration in Oral Tissue by the Addition of Epinephrine

Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia

Anesthetic Management of a Patient With Takayasu Arteritis

Cardiovascular Collapse Associated With Irreversible Cardiomyopathy, Chronic Renal Failure, and Hypertension During Routine Dental Care

Potent Inhalational Anesthetics for Dentistry

Promoting a Culture of Safety

Lidocaine Concentration in Oral Tissue by the Addition of Epinephrine

Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia

Evaluation of 2-Stage Injection Technique in Children

Anesthetic Management of a Patient With Takayasu Arteritis