Anesthesia Progress Volume 63: Issue 2

Obstructive sleep apnea (OSA) is a recognized risk factor for complications during anesthesia during both the intraoperative and the postoperative periods. Unfortunately, only a small subset of patients who have OSA are formally diagnosed with the condition. There are many reasons, maybe chief among them being that the gold standard for testing is overnight polysomnography, which is expensive and inconvenient. The apnea-hypopnea index (AHI; number of apneas >10 seconds and hypopneas per hour) is frequently used to assess the severity of OSA. An AHI value ≥ 30 events/h reflects severe OSA. Moderate OSA is defined by the AHI as ranging

A randomized, nonblinded clinical trial compared the effectiveness of an application method of a fast-acting refrigerant topical agent to a 20% benzocaine gel topical. In a split-mouth design, right and left anterior middle superior alveolar injections (N = 30) were administered with a 27-gauge needle at least 24 hours apart with preinjection topicals. Using a cotton-tipped applicator, a refrigerant topical was applied for 5 seconds and 20% benzocaine gel for 2 minutes on opposite sides at 2 separate appointments. Subjects self-reported pain perception after each injection using a visual analog scale (VAS). The mean VAS ratings demonstrated no significant difference between the 5-second application of the refrigerant (M = 16.2, SD = 17.7) and the 2-minute application of 20% benzocaine topical gel anesthetic (M = 17.9, SD = 18.2). Fifty-seven percent of the subjects reported greater pain reduction with the refrigerant, 33% reported greater pain reduction with 20% benzocaine, and 10% reported no difference. Results suggest the described method of application of a refrigerant as an oral topical anesthetic has a faster onset and provides similar benefit in pain reduction compared with 20% benzocaine gel. The refrigerant was easy to accomplish and well received by subjects, indicating potential for routine use in dentistry.

The aim of this study was to investigate the correlation between basic life support skills in dentists who had completed the American Heart Association's Basic Life Support (BLS) Healthcare Provider qualification and time since course completion. Thirty-six dentists who had completed the 2005 BLS Healthcare Provider course participated in the study. We asked participants to perform 2 cycles of cardiopulmonary resuscitation on a mannequin and evaluated basic life support skills. Dentists who had previously completed the BLS Healthcare Provider course displayed both prolonged reaction times, and the quality of their basic life support skills deteriorated rapidly. There were no correlations between basic life support skills and time since course completion. Our results suggest that basic life support skills deteriorate rapidly for dentists who have completed the BLS Healthcare Provider. Newer guidelines stressing chest compressions over ventilation may help improve performance over time, allowing better cardiopulmonary resuscitation in dental office emergencies. Moreover, it may be effective to provide a more specialized version of the life support course to train the dentists, stressing issues that may be more likely to occur in the dental office.

Sedation may minimize physiologic and behavioral stress responses. In our facility, the infusion rate of propofol is adjusted according to the bispectral index (BIS) in all cases of implant-related surgery; multivariate analysis of retrospective data enabled us to extract independent factors that affect the dose of propofol in sedation that are considered useful indicators for achieving adequate sedation. The study population comprised all patients undergoing implant-related surgery under intravenous sedation in Okayama University Hospital from April 2009 to March 2013. The infusion rate of propofol was adjusted to maintain the BIS value at 70–80. The outcome was the average infusion rate of propofol, and potential predictor variables were age, sex, body weight, treatment time, and amount of midazolam. Independent variables that affected the average infusion rate of propofol were extracted with multiple regression analysis. One hundred twenty-five subjects were enrolled. In the multiple regression analysis, female sex was shown to be significantly associated with a higher average infusion rate of propofol. Females may require a higher infusion rate of propofol than males to achieve adequate sedation while undergoing implant-related surgery.

OBSTRUCTIVE SLEEP APNEA AND OFFICE-BASED SURGERY

Clinical Comparison: Fast-Acting and Traditional Topical Dental Anesthetic

Rapid Deterioration of Basic Life Support Skills in Dentists With Basic Life Support Healthcare Provider

Female Patients Require a Higher Propofol Infusion Rate for Sedation

Epinephrine Affects Pharmacokinetics of Ropivacaine Infiltrated Into Palate

Anesthetic Management of a Patient With Charcot-Marie-Tooth Disease

Variant Inferior Alveolar Nerves and Implications for Local Anesthesia

General Anesthesia for a Patient With Pelizaeus-Merzbacher Disease

Management of Patients With Cardiovascular Implantable Electronic Devices in Dental, Oral, and Maxillofacial Surgery

Clinical Comparison: Fast-Acting and Traditional Topical Dental Anesthetic

OBSTRUCTIVE SLEEP APNEA AND OFFICE-BASED SURGERY

Rapid Deterioration of Basic Life Support Skills in Dentists With Basic Life Support Healthcare Provider

Female Patients Require a Higher Propofol Infusion Rate for Sedation

Epinephrine Affects Pharmacokinetics of Ropivacaine Infiltrated Into Palate