Anesthesia Progress Volume 64: Issue 2

Nitrous oxide and midazolam have been used as sedative agents to decrease fear and anxiety associated with dental procedures. Although these agents have been widely used individually, the combination of the two is also commonly used. Four clinical trials were identified that compared the combination technique with the individual use of the drugs. The standardized mean difference (SMD) for each outcome measure was considered for final analysis. Three studies with 534 participants were included in the final meta-analysis, and the SMD [95% CI] was obtained as −0.15 [−0.32, 0.03] and was not statistically significant for cooperation scores. Two studies reported the dose of midazolam required for inducing sedation in 450 participants, and the pooled estimate of SMD [95% CI] was obtained as −0.29 [−0.48, −0.10] and was significant. Two studies with 450 participants reported the time taken to recover from sedation, and the pooled estimate of SMD [95% CI] was obtained as −0.20 [−0.39, −0.01] and favored the combination technique. To conclude, the combination technique combines the pros and cons of both drugs in causing fewer adverse effects due to midazolam by reducing the total dose and also helps to provide better acceptance of nitrous oxide inhalation.

Our aim was to characterize effectiveness and complications in children receiving oral midazolam alone, nasal midazolam alone, or oral midazolam with other sedatives. Children received oral midazolam alone, nasal midazolam, or oral midazolam in combination with other sedative medications. All subjects received a presedation history and physical examination and were sedated per protocol by any of 28 resident providers under attending supervision. Sedations were rated for success and complications by clinicians. Postoperative complications were assessed by trained staff up to 48 hours postoperatively. Seven hundred and one encounters, completed over 24 months, yielded 650 usable sedations. The majority of children were healthy (469; 68.2%) and 86% (532) weighed between 10 and 25 kg. Sedations were deemed successful in about 80% of cases. Planned treatment was completed in over 85% of encounters. Oral midazolam alone yielded the best behavior. Physical assessment factors of behavior and age were correlated (P = .035) with effectiveness. Hiccups and a positive medical history were significantly related (P = .049). Side effects of either nausea/vomiting, dysphoria, or hiccups occurred in less than 10% of cases. All 3 regimens were effective with minimal postoperative complications.

We analyzed trigeminal somatosensory evoked potentials (TSEP) to the alveolar mucosa to investigate the efficacy of an amide local anesthetic, 2% lidocaine hydrochloride with 12.5 μg/mL epinephrine (Lido treatment) as a topical anesthetic. Eighteen consenting healthy adult volunteers were enrolled. A volume of 0.06 mL of Lido, 0.06 g of 20% benzocaine, or 0.06 mL of physiological saline (control) was instilled onto a hemostatic adhesive patch, which was then applied to the alveolar mucosa at the maxillary right canine for 5 minutes. An electrical stimulus approximately 5 times that of the sensory threshold was applied using a surface stimulation electrode. The trigeminal somatosensory evoked potential was recorded immediately, 5 minutes, and 10 minutes after removal of the patch. Positive P125 and P310 peaks and negative N100 and N340 peaks were observed as a result of the electrical stimulation. A significant decrease in the percentage change in amplitude of N100-P125 was observed in the Lido treatment immediately, 5 minutes, and 10 minutes after patch removal. In the Lido treatment, trigeminal somatosensory evoked potential amplitude at N100-P125 decreased significantly, suggesting that topical anesthesia produced by an amide local anesthetic may have a topical anesthetic effect as potent as that produced by an ester local anesthetic.

This new section will provide a synopsis of articles from a wide range of anesthesiology journals that are applicable to office-based practice. Associate Editor Mark Saxen, DDS, PhD, of the Department of Oral Pathology, Medicine and Radiology at Indiana University will lead this effort. Dentist and physician leaders in office-based anesthesiology have graciously agreed to participate in this effort.

Chao Z, Jin HG, Cong Y. The effect of general anesthesia for the ambulatory dental treatment on children in Chongqing, Southwest China. Pediatr Anesthesiol. 2017;27:98–105.

The management of precooperative children for the treatment of early childhood caries is a

The FDA Warning on Anesthesia Drugs

Nitrous Oxide and Midazolam Sedation: A Systematic Review and Meta-Analysis

Safety and Efficacy of 3 Pediatric Midazolam Moderate Sedation Regimens

Effect of Topical Anesthesia Using an Adhesive Patch and Anesthetic Solution

Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery

Tension Pneumothorax After Percutaneous Tracheostomy

Dexmedetomidine Infusion for Routine Dental Management of an ASA IV Patient: A Case Report

Anesthetic Management of a Patient With Multiple Sclerosis

Anesthetic Management Using a Laryngeal Mask Airway in a Child With Congenital Bronchial Atresia

Risk Factors for Pressure Ulcers at the Ala of Nose in Oral Surgery

Hepatitis: Sedation and Anesthesia Implications

A Review of Scientific Literature of Interest to Office-Based Anesthesiology Practice

Chao Z, Jin HG, Cong Y. The effect of general anesthesia for the ambulatory dental treatment on children in Chongqing, Southwest China. Pediatr Anesthesiol. 2017;27:98–105.

Letter to the Editor

Reply

Editor:

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

Experience Using a New Gastric Tube Tip Localization System (Tumguide)

Anaphylaxis After a Third Exposure to Sugammadex

Effects of Remimazolam With or Without Remifentanil on Oral Tissue Blood Flow and Oxygen Tension in Rabbits

Limited Nasal Intubation Route After Pharyngeal Flap Surgery: A Case Report