Anesthesia Progress Volume 64: Issue 1

Remifentanil is reported to reduce oral tissue blood flow. We performed a retrospective investigation using logistic regression analysis of anesthesia records to investigate whether the use of remifentanil infusion in a balanced anesthesia technique was useful as a primary technique to reduce blood loss during orthognathic surgery. Subjects were 80 patients who underwent Le Fort I osteotomy and sagittal split ramus osteotomy of the mandible. The variables included gender, age, weight, type of maintenance anesthetic, type and dose or infusion rate of opioid, mean systolic blood pressure (SBP-mean), coefficient of variation of systolic blood pressure (CVSBP) during surgery, mean heart rate (HR-mean), duration of surgery, total blood loss, volume of infusion used, amount of local anesthetic used, body temperature, and urine output. Gender, type of maintenance anesthetic, type of opioid, SBP-mean, CVSBP, HR-mean, and duration of surgery were used as candidates for independent variables. Logistic regression analysis was performed for the selected independent variables with the total blood loss as the dependent variable. The factors associated with the reduction of blood loss were the use of remifentanil (odds ratio, 3.112; 95% CI, 1.166–8.307; P = .023) and smaller CVSBP (odds ratio, 2.747; 95% CI, 1.07–7.053; P = .036). Use of remifentanil and smaller CVSBP were associated with a reduction of blood loss during orthognathic surgery.

Two different anesthesia models were compared in terms of surgical duration, safer outcomes, and economic implications. Third molar surgeries performed with and without a separate dentist anesthesiologist were evaluated by a retrospective data analysis of the surgical operative times. For more difficult surgeries, substantially shorter operative times were observed with the dentist anesthesiologist model, leading to a more favorable surgical outcome. An example calculation is presented to demonstrate economic advantages of scheduling the participation of a dentist anesthesiologist for more difficult surgeries.

Little is known about implications of temperament for children who receive nitrous oxide inhalation sedation (N₂O/O₂) for dental care. The aim of this study was to investigate whether child temperament is associated with success in N₂O/O₂. Child-caregiver dyads were enrolled from patients aged 36–95 months receiving dental care with N₂O/O₂ at a university-based pediatric dental clinic. To assess child temperament, 48 caregivers completed the Children's Behavior Questionnaire Short Form. Patient behavior was abstracted from Frankl scores recorded in the patient's chart. The overall behavioral failure rate was 15% (n = 7/48). There was no significant difference in sedation outcome associated with sex, health, insurance status, or complexity of treatment provided. Sedation outcome was significantly associated with the broad temperament domain of Effortful Control and its subscales Attentional Focusing and Inhibitory Control. The Negative Affectivity subscales of Frustration, Sadness, and Soothability and the Extraversion/Surgency subscales Activity and Impulsivity were also significantly associated with sedation outcome. The results of this study suggest that Effortful Control is associated with behavior during dental treatment with N₂O/O₂. The subscales of Attention Focusing, Inhibitory Control, Frustration, Fear, Sadness, Soothability, Activity, and Impulsivity may also be important determinants of child behavior during dental treatment.

The editorial staff of Anesthesia Progress acknowledges all of our recent reviewers. We value your time and effort in ensuring the quality of the articles published in Anesthesia Progress.

Robert Bosack, DDS

Jason Brady, DDS

Jeffrey N. Brownstein, DDS

Brian Chanpong, DDS, MSc

Reny de Leeuw, DDS, PhD

Melissa Drum, DDS, MS

Ralph Epstein, DDS, MS

Rick Finder, DMD

James Fricton, DDS, MS

Mari Cynthia Fukami, DMD, MS

Joseph Giovannitti, DMD

Gino Gizzarelli, DDS, MSc

Josh Jackstien, DDS

Hiroyoshi Kawaii, DDS, PhD

Barry Krall, DDS

Kyle Joseph Kramer, DDS, MS

Anne Lemak, DMD

Stuart Lieblich,

Updates to Anesthesia Progress

Remifentanil Reduces Blood Loss During Orthognathic Surgery

Comparing the Efficiencies of Third Molar Surgeries With and Without a Dentist Anesthesiologist

Temperament as a Predictor of Nitrous Oxide Inhalation Sedation Success

Salivary Alpha Amylase, Dental Anxiety, and Extraction Pain: A Pilot Study

Cardiac Failure in a Trisomy 9 Patient Undergoing Anesthesia: A Case Report

Anesthetic Management of a Child With Unspecified Mitochondrial Disease in an Outpatient Dental Setting

Patients With Type 2 Diabetes: Anesthetic Management in the Ambulatory Setting: Part 2: Pharmacology and Guidelines for Perioperative Management

Reviewers

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

A New ACLS Option for Anesthesia Providers

Single-Agent Total Intravenous Anesthesia With Remimazolam for an Elderly Man Undergoing Ambulatory Oral Surgery: A Case Report

General Anesthesia for a Child With a Living Donor Liver Transplant After Hepatoblastoma and Metastatic Lung Tumor Resection

Virtual Reality Distraction vs Nitrous Oxide for Reducing Anxiety and Injection Pain

Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery

Letter to the Editor

Monheim LM. Analgesia in dentistry now and in the future. Anesth Prog. 1971;18(5):100–106 and J Am Analg Soc. 1971:9:1(abstract).

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

Perfect Time for a Fresh Perspective