Anesthesia Progress Volume 65: Issue 1

Surgical fires require an oxygen-enriched environment, a flammable substrate, and an ignition source. We hypothesized ambient oxygen concentration is proportional to the latency time to combustion and the incidence of surgical fires that are detected. We examined latency time and number of events, utilizing the VanCleave et al model of intraoral fire ignition under 60, 80, and 100% oxygen concentration and flow rates of 4 and 10 L/min. Results demonstrated that ambient oxygen concentration and flow rate correlated positively to the initiation of combustion. The number of combustion events with 60% oxygen was significantly lower than with both 80% (p = .0168) and 100% (p = .002). Likewise, the number of events with 80% oxygen was significantly lower than with 100% oxygen (p = .0019). Flow rate has a significant effect on the time to the first event (p = .0002), time to first audible pop (p = .0039), and time to first flash or fire (p < .0001). No combustion occurred at oxygen concentrations less than 60% or flows less than 4 L/min. We conclude that latency time to combustion is directly proportional to ambient oxygen concentration and flow rate. Minimum oxygen concentration and flow rate were identified in our model. Further research is indicated to determine the minimal clinical oxygen concentration and flow rate needed to support combustion of an intraoral fire in a patient.

This study provides trends in the discipline of dental anesthesiology. A questionnaire-based survey was sent to 338 members of the American Society of Dentist Anesthesiologists to evaluate practice patterns. One focus of the study was modality of sedation/anesthesia used for dentistry in North America. Age, gender, years in practice, and geographic region of practice were also obtained. Data gathered from the returned questionnaires were entered into an Excel spreadsheet and then imported into JMP Statistical Discovery Software (v12.2 Pro) for descriptive analysis. A total of 112 surveys were completed electronically and 102 surveys were returned via post, for a total response rate of 63.3% (N = 214). Data from this survey suggested a wide variation of therapeutic practices among dentist anesthesiologists in North America. Of the surveyed dentist anesthesiologists, 58.7% (SE = 4.2%) practice as mobile providers, 32.2% (SE = 3.1%) provide care in an academic environment, and 27.7% (SE = 2.8%) function as operator/anesthetists. The majority of anesthesia is provided for pediatric dentistry (47.0%, SE = 4.2%), oral and maxillofacial surgery (18.5%, SE = 3.9%), and special needs (16.7%, SE = 3.6%). Open-airway (58.7%, SE = 5.5%) sedation/anesthesia was the preferred modality of delivery, compared with the use of advanced airway (41.3%, SE = 4.6%). The demographics show diverse practice patterns of dentist anesthesiologists in multiple regions of the continent. Despite concerns regarding specialty recognition, reimbursement difficulties, and competition from alternative anesthesia providers, the overall perceptions of dentist anesthesiologists and the future of the field seem largely favorable.

The aim of this study was to provide an evidence-based answer to the question: “Is 3.6-mL volume of an anesthetic agent more effective than 1.8-mL volume in providing anesthesia for mandibular molars?” Following formulation of research question and keyword selection, a comprehensive search of the following databases was conducted: Cochrane library, PubMed, Scopus, Google Scholar, ProQuest, and Clinicaltrials.gov. Three-phase eligibility appraisal and quality assessment of the studies were carried out by 2 independent reviewers. To reduce clinical heterogeneity, the included studies were divided into 2 groups: studies on healthy teeth and studies on teeth with pulpitis. The data of included studies were statistically combined through meta-analysis using a fixed-effects model. A total of 20,778 records were initially retrieved from the search. Following screening and eligibility assessment, 8 studies met the eligibility criteria and were included for qualitative synthesis. Of those, 5 studies were qualified for meta-analysis. In the irreversible pulpitis group, increasing the volume of anesthetic agent from 1.8 to 3.6 mL significantly increased the success rate of inferior alveolar nerve block (risk ratio = 2.45, 95% CI: 1.67–3.59, p < .001). However, there was insufficient evidence to draw a conclusion regarding healthy teeth.

Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Shear TD, Deshur MA, Benson J, Newmark RL, Maher CE. Neostigmine administration after spontaneous recovery to a train-of-four ratio of 0.9 to 1.0: a randomized controlled trial of the effect on neuromuscular and clinical recovery. Anesthesiology. 2018;128:27–37.

When muscle relaxants are used to facilitate intubation, a significant amount of residual neuromuscular blockade remains when reversal drugs are not administered; however, routine reversal is not a universal practice. While most anesthesiologists routinely reverse neuromuscular blockade if muscular weakness is suspected at the time of extubation, others caution against the routine use

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

One More Checklist?

The Effects of Different Levels of Ambient Oxygen in an Oxygen-Enriched Surgical Environment and Production of Surgical Fires

Practice Patterns of Dentist Anesthesiologists in North America

Volume of Anesthetic Agents and IANB Success: A Systematic Review

A Comparative Study of Oral Analgesics for Postoperative Pain After Minor Oral Surgery

Electrophysiology of Muscle Fatigue in Cardiopulmonary Resuscitation on Manikin Model

Dexmedetomidine Enhances the Pulpal Anesthetic Effect of Lidocaine: A Pilot Study

Recurrent Coronary Artery Spasm Induced by Vasopressors During Two Operations in the Same Patient Under General Anesthesia

Airway Management for a Pediatric Patient With a Tracheal Bronchus

Facial Artery Pseudoaneurysm: Challenges of Airway Management

Challenges of Airway Management

A Case of Rocuronium-Induced Anaphylactic Shock in an Asthmatic Child

Anesthetic Considerations for Patients on Antidepressant Therapy – Part II

Literature Review for Office-Based Anesthesia

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

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

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

Effect of Thermomechanical Stimulation on Pain During IANB Injections

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