Anesthesia Progress Volume 64: Issue 4

Additional studies are needed to evaluate intraseptal anesthesia in the mandibular first molar. The purpose of this study was to compare the anesthetic efficacy of a primary intraseptal injection of articaine and lidocaine, administered with a computer-controlled local anesthetic delivery (CCLAD) system, in asymptomatic mandibular first molars. Using a crossover design, 100 subjects randomly received intraseptal injections of 1.4 mL of 4% articaine and 2% lidocaine, both with 1:100,000 epinephrine, at 2 separate appointments. Injections were given in the interdental papillae, mesial (0.7 mL) and distal (0.7 mL) to the first molar. An electric pulp tester was used to test for pulpal anesthesia. Pain of injection, postoperative pain, and pulse rate were also evaluated. Data were statistically analyzed. Anesthetic success rate for the mandibular first molar was 32% for articaine and 30% for lidocaine, with no statistically significant difference (p = .8689) between the two. No significant differences were found between formulations for pain of injection. The intraseptal injection did not cause a clinically meaningful increase in pulse rate. Postoperative pain decreased each day with no significant differences between formulations. In conclusion, a primary intraseptal injection does not achieve a high success rate of pulpal anesthesia in the mandibular first molar.

Few studies have examined the practice characteristics of dentist anesthesiologists and compared them to other anesthesia providers. Using outcomes from the National Anesthesia Clinical Outcomes Registry and the Society for Ambulatory Anesthesia Clinical Outcomes Registry for dental/oral surgery procedures, we compared 7133 predominantly office-based anesthetics by dentist anesthesiologists to 106,420 predominantly operating room anesthetics performed by physician anesthesia providers. These encounters were contrasted with 34,191 previously published encounters from the practices of oral and maxillofacial surgeons. Children younger than 6 years received the greatest proportion of general anesthetic services rendered by both dentist anesthesiologists and hospital-based anesthesia providers. These general anesthesia services were primarily provided for complete dental rehabilitation for early childhood caries. Overall treatment time for complete dental rehabilitation in the office-based setting by dentist anesthesiologists was significantly shorter than comparable care provided in the hospital operating room and surgery centers. The anesthesia care provided by dentist anesthesiologists was found to be separate and distinct from anesthesia care provided by oral and maxillofacial surgeons, which was primarily administered to adults for very brief surgical procedures. Cases performed by dentist anesthesiologists and hospital-based anesthesia providers were for much younger patients and of significantly longer duration when compared with anesthesia administered by oral and maxillofacial surgeons. Despite the limited descriptive power of the current registries, office-based anesthesia rendered by dentist anesthesiologists is clearly a unique and efficient mode of anesthesia care for dentistry.

Hypertensive patients receiving nonselective β-adrenergic antagonists are vulnerable to hypertension and bradycardia when injected with dental local anesthetic formulations containing epinephrine. Dexmedetomidine (DEX), an α₂-adrenergic agonist, has been reported to prolong and enhance the local anesthetic effects of lidocaine. The cardiovascular effects of the DEX-lidocaine combination have not yet been investigated in the presence of nonselective β-adrenergic antagonists. Therefore, we assessed the cardiovascular effects of the DEX-lidocaine combination in spontaneously hypertensive rats (SHR) treated with a nonselective β-adrenergic antagonist (propranolol). We injected propranolol-treated rats with various concentrations of DEX alone, 100 μg/kg epinephrine alone, or 5 μg/kg DEX combined with 2% lidocaine and measured their blood pressure (BP) and heart rates (HR) to assess the cardiovascular effects. The BP of propranolol-treated SHR was significantly increased by treatment with 100 μg/kg epinephrine alone. The BP and HR of propranolol-treated SHR were not significantly changed by treatment with low concentrations of DEX, but they were significantly decreased by treatment with a high concentration of DEX (50 μg/kg). Moreover, there was no significant difference in the BP and HR of propranolol-treated SHR after the injection of a combination of 5 μg/kg DEX and 2% lidocaine. Thus, the DEX-lidocaine combination may be an acceptable addition to dental local anesthetic solutions from a cardiovascular standpoint for hypertensive patients receiving nonselective β-adrenergic antagonists.

Addiction, 178

Adhesive patch, 73

Adrenaline, 165

Airway, 168

Airway management, 153

Ala of nose, 104

Allergic disease, 173

Alpha amylase, 22

Analgesic, 178

Adrenergic, 253

Anesthesia, 33

Anesthetic management, 244

Antidepressants, 253

Antidiabetic medication, 39

Arrhythmia, 165

Articaine, 80, 203

Atrioventricular node, 165

Belching, 244

Benzocaine, 73

Blood loss, 3

Body fluid, 226

Bupivacaine, 127

Capnography, 168

Cardiac failure, 29

Cardiomyopathy, 29

Child, 17

Complications, 66

Congenital bronchial atresia, 102

Congenital disorder, 235

Congenital heart disease, 162

Conscious sedation, 168

Conservative treatment, 248

Demyelinating encephalomyelitis, 97

Dental anxiety, 22, 59

Dental extraction, 22

Dental rehabilitation, 212

Dentist anesthesiologist, 8,

Difficulty Controlling Sedation Level Using Processed Electroencephalography Monitoring in a Patient With Intellectual Disability, Fontan Circulation, and a Severe Gag Reflex

Riko UmemotoDDS,

Satoshi TachikawaDDS, PhD,

Daisuke KikuchiDDS,

Aoi OoshioDDS,

Risa KajiwaraDDS, PhD,

Rie NishidaDDS, PhD,

Asuka TaguchiDDS, PhD,

Takehiko IijimaDDS, DMSc, and

Rikuo MasudaDDS, PhD

Have Our Sterility Practices Kept Up With the Tremendous Advances in Sedation and Surgical Techniques?

Anesthetic Efficacy of Articaine and Lidocaine in a Primary Intraseptal Injection: A Prospective, Randomized Double-Blind Study

Comparison of Anesthesia for Dental/Oral Surgery by Office-based Dentist Anesthesiologists versus Operating Room-based Physician Anesthesiologists

A Combination of Dexmedetomidine and Lidocaine Is a Cardiovascularly Safe Dental Local Anesthetic for Hypertensive Rats Treated With a Nonselective β-Adrenergic Antagonist

Influence of Fasting Duration on Body Fluid and Hemodynamics

Dexmedetomidine Increases the Latency of Thermal Antinociception in Rats

Anesthetic Management in Mitochondrial Encephalomyopathy: A Case Report

Retropharyngeal Dissection by Parker Flex-Tip Nasal Endotracheal Tube

Anesthesia for a Patient With Excessive Supragastric Belching

A Case of Laryngeal Granuloma Likely Caused by Laryngopharyngeal Reflux Disease Following a Sagittal Split Ramus Osteotomy

Anesthetic Management of a Patient With a History of Rhabdomyolysis for Dental Treatment

Anesthetic Considerations for Patients on Antidepressant Therapy—Part I

Literature Review for Office-Based Anesthesia

Itagaki T, Oto J, Burns SM, Jiang Y, Kacmarek RM, Mountjoy JR. The effect of head rotation on efficiency of face mask ventilation in anaesthetized apnoeic adults. Eur J Anaesthesiol . 2017;34:432–440.

Author Index

Subject Index

Difficulty Controlling Sedation Level Using Processed Electroencephalography Monitoring in a Patient With Intellectual Disability, Fontan Circulation, and a Severe Gag Reflex

Comparison of the Length and Shape of Various Preformed Nasotracheal Tubes

Commentary: Are Anesthesiologists Still “Darting” Their Patients?

A Case in Which the Hole in the Inflation Line Was Not Closed at the Tip of the Tracheal Tube

Immunohistochemical Analysis of Maxillary Nerve Distribution in Rats

Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery

The Effect of Intraoral Suction on Oxygen-Enriched Surgical Environments: A Mechanism for Reducing the Risk of Surgical Fires

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