Anesthesia Progress Volume 63: Issue 4

The purpose of this study was to determine which anesthetic was preferable for ambulatory anesthesia: propofol alone or sevoflurane alone. A crossover study was performed to compare the recovery profile and patient satisfaction after 2 anesthesia methods. Twenty healthy patients with severe anxiety toward dental treatment undergoing 2 sessions of day-case dental treatment received either propofol or sevoflurane anesthesia. The order of these methods was randomized. The depths of anesthesia were kept constant using bispectral index (BIS) monitoring. Observations on recovery profiles were performed in the emergence phase, in the recovery phase, and 24 hours after discharge. Patient satisfaction and preference were obtained by a questionnaire. Most of the recovery profiles in the emergence phase such as time to eye opening to respond to verbal command, time to BIS ≥ 75, and time to extubation were shorter in the sevoflurane group than in the propofol group. All recovery profiles in the recovery phase showed no differences between the 2 groups. Based on the subject's satisfaction and preference, propofol was evaluated as a better anesthetic for ambulatory anesthesia than sevoflurane. Higher patient satisfaction and a greater preference for future dental treatment were revealed for propofol anesthesia. Propofol may be more suitable for ambulatory anesthesia for dental treatment.

The purpose of this study was to compare the effectiveness of various concentrations of N₂O/O₂ on obtunding a hypersensitive gag reflex. We hypothesized that the administration of nitrous oxide and oxygen would obtund a hypersensitive gag reflex enough to allow a patient to tolerate the placement and holding of a digital x-ray sensor long enough to obtain a dental radiograph. Volunteers claiming to have a hypersensitive gag reflex were first screened to validate their claim and then tested by placing a size 2 digital x-ray sensor in the position for a periapical radiograph of the right mandibular molar area and holding it in place for 10 seconds. Subjects were first tested using room air only, then 30%, 50%, or 70% nitrous oxide until they were able to tolerate the sensor without gagging or discomfort. A visual analog scale was used for subjective responses, and other statistical tests were used to analyze the results. We found that for some subjects, 30% nitrous oxide was sufficient; for others, 50% was needed; and for the remainder of the subjects, 70% was sufficient to tolerate the test. Using a combination of 70% nitrous oxide and 30% oxygen allowed all patients claiming to have a hypersensitive gag reflex to tolerate the placement and holding of a digital x-ray sensor long enough to take a periapical radiograph.

During dental sedation, control of the cough reflex is crucial for a safe and smooth procedure. Accumulated saliva is one of the predisposing factors for coughing. Body movements during dental sedation appear to enhance salivation. Therefore, the aim of this study was to investigate the difference in salivary secretion between the with-movements state and the without-movements state during sedation. Salivary weight for 1 min was measured 3 times in 27 patients with intellectual disability during dental treatment under deep sedation with midazolam and propofol. The observed variables were body movements, bispectral index (BIS), and predicted propofol effect-site concentration. A total of 81 measurements were classified into the with-movements state (n = 39; ie, measurements during which body movements were observed) or the without-movements state (n = 42; ie, measurements during which no body movements were observed). The median salivary weight was significantly smaller in the without-movements state compared with the with-movements state (0.03 vs 0.11 g, P < .0001). The BIS was significantly lower in the without-movements state. There was no significant difference in the predicted propofol effect-site concentration between the 2 states. Significant correlation was observed between salivary weight and BIS in the with-movements state (r = 0.44, P = .004). The findings indicate that salivary secretion decreased according to deep sedation. Furthermore, immobility also reduced salivary secretion. We concluded that one reason that immobility is beneficial is because of the resulting decreased salivary secretion during dental treatment under deep sedation.

Ambulatory, 42

Ambulatory anesthesia, 116, 175

Anaphylactoid reactions, 160

Anaphylaxis, 160

Anatomical variation, 84

Anesthesia, 197

Anesthesia induction, 42

Anesthetic cost, 116

Anesthetic management, 31

Apex locator, 95

Asystole, 197

Benzocaine, 55

Benzodiazepine allergy, 160

BIS, 91

Bispectral index, 185

Body movements, 185

Body temperature, 91

Bradycardia, 95

Buccal infiltration, 3

Cardiac arrest, 34

Cardiopulmonary resuscitation, 62

Cardiorenal syndrome, 34

Cauterization, 95

Charcot-Marie-Tooth disease, 80

CIED, 95

Congenital heart disease, 201

Congestive heart failure, 34

Conscious sedation, 25

Coronary artery steal, 42

Cough reflex, 185

Deep sedation, 185

Defibrillation, 95

Dental anesthesia, 84, 116, 139, 192

Dental education, 62

Dental

New and Emerging Medications

Recovery Profile and Patient Satisfaction After Ambulatory Anesthesia for Dental Treatment—A Crossover Comparison Between Propofol and Sevoflurane

The Effect of Various Concentrations of Nitrous Oxide and Oxygen on the Hypersensitive Gag Reflex

Correlation Between Body Movements and Salivary Secretion During Sedation

Preliminary Evidence Supports Modification of Retraction Technique to Prevent Needlestick Injuries

Asystole From Direct Laryngoscopy: A Case Report and Literature Review

Anesthetic Management of a Patient With Emanuel Syndrome

Anesthetic Management of a Patient With Ehlers-Danlos Syndrome

Patients With Type 2 Diabetes: Anesthetic Management in the Ambulatory Setting. Part 1: Pathophysiology and Associated Disease States

Author Index

Subject Index

Erratum

In Memoriam: Dr James K. Grainger

New and Emerging Medications

Recovery Profile and Patient Satisfaction After Ambulatory Anesthesia for Dental Treatment—A Crossover Comparison Between Propofol and Sevoflurane

The Effect of Various Concentrations of Nitrous Oxide and Oxygen on the Hypersensitive Gag Reflex

Correlation Between Body Movements and Salivary Secretion During Sedation

Preliminary Evidence Supports Modification of Retraction Technique to Prevent Needlestick Injuries