Anesthesia Progress Volume 66: Issue 1

The aim of this study was to compare the efficacy of articaine versus lidocaine, both containing epinephrine, using a single buccal infiltration for extraction of primary molars.A total of 100 children requiring primary molar extraction received buccal infiltration using either 4% articaine or 2% lidocaine, both with epinephrine, with 50 children in each group. The Wong-Baker Facial Pain Scale (FPS) was used to evaluate pain perception subjectively. The heart rate and the blood pressure values were assessed objectively as an indirect measure of physiological pain perception. The Wilcoxon-Mann-Whitney test was used for comparing mean pain scores, heart rate, and blood pressure in both the groups. Single buccal infiltration with articaine was sufficient for achieving palatal or lingual anesthesia in all the children receiving it while all children in the lidocaine group required supplemental anesthesia. The mean FPS value was found to be higher in lidocaine group and was statistically significant. The mean heart rate recorded during the intervention was less than the mean baseline values in the articaine group, which was found to be statistically significant. For pediatric patients age 7 to 12 years, single buccal infiltration with 4% articaine with 1:100,000 epinephrine is more effective compared to 2% lidocaine with 1:80,000 epinephrine for primarly molar extraction.

An estimation of the appropriate tubing depth for fixation is helpful to prevent inadvertent endobronchial intubation and prolapse of cuff from the vocal cord. A feasible estimation formula should be established. We measured the anatomical length of the upper-airway tract through the oral and nasal pathways on cephalometric radiographs and tried to establish the estimation formula from the height of the patient. The oral upper-airway tract was measured from the tip of the incisor to the vocal cord. The nasal upper-airway tract was measured from the tip of the nostril to the vocal cord. The tracts were smoothly traced by using software. The length of the oral upper-airway tract was 13.2 ± 0.8 cm, and the nasal upper-airway tract was 16.1 ± 0.9 cm. We found no gender difference (p > .05). The correlations between the patients' height and the length of the oral and nasal upper-airway tracts were 0.692 and 0.760, respectively. We found that the formulas (height/10) − 3 (in cm) for oral upper-airway and (height/10) + 1 (in cm) for nasal upper-airway tract are the simple fit estimation formulas. The average error and standard deviation of the estimated values from the measured values were 0.50 ± 0.66 cm for the oral tract and 0.39 ± 0.63 cm for the nasal tract. Thus, considering the length of the intubation marker of each product (DM), we would like to propose the length of tube fixation as (height/10) + 1 + DM for nasal intubation and (height/10) − 3 + DM for oral intubation. In conclusion, the estimation formulas of (height/10) − 3 + DM and (height/10) + 1 + DM for oral and nasal intubation, respectively, are within almost 1 cm error in most cases.

The purpose of this study was to determine anesthetic success in adjacent teeth following a primary infiltration of the maxillary lateral incisor and first molar using 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Three hundred eight asymptomatic subjects received an infiltration of a cartridge of 2% lidocaine with 1:100,000 epinephrine over the maxillary lateral incisor (163 subjects) or first molar (145 subjects). Pulpal anesthesia of the injected tooth and adjacent mesial and distal teeth was monitored with the electric pulp tester in 2-minute cycles for a total of 60 minutes. No response from the subject at the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Comparisons of the odds of pulpal anesthesia (defined as an 80/80 response to electric pulp testing over 60 minutes) between the experimentally injected tooth and adjacent teeth were analyzed using mixed-models, repeated-measures logistic regression. When compared with the lateral incisor infiltration, the adjacent mesial tooth (central incisor) and distal tooth (canine) achieved statistically lower anesthetic success. When compared with the first molar, the mesial tooth (second premolar) did not differ statistically. However, significant differences were shown between the first molar and the second molar, with the distal tooth (second molar) achieving a statistically higher rate of pulpal anesthesia, which was related to a better duration of anesthesia. For asymptomatic patients, local anesthesia of the adjacent mesial (central incisor) and distal (canine) teeth to the infiltrated lateral incisor had lower pulpal anesthetic success. Because standard infiltration anesthesia of the lateral incisor is of short duration, repeating the infiltration at 30 minutes will result in a high incidence of pulpal anesthesia for 60 minutes. Local anesthesia of the adjacent distal tooth to the first molar (second molar) had a statistically higher rate of total pulpal anesthesia than the infiltrated first molar due to the longer duration of pulpal anesthesia. However, if pulpal anesthesia is required for 60 minutes in the first and second molars, the clinician may need to add an additional infiltration to ensure anesthesia.

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment. Larach MG, Klumpner TT, Brandon BW, Vaughn MT, et al. on behalf of the Multicenter Perioperative Outcomes Group. Anesthesiol. 2019;130:41–54.

Dantrolene is an effective treatment for malignant hyperthermia (MH). Succinylcholine and volatile anesthetic agents are potential triggers for inducing MH; however, discrepant recommendations for emergency preparedness exist regarding the availability of dantrolene during general anesthesia. The Malignant Hyperthermia Association of the United States (MHAUS) guidelines state dantrolene must be available within 10 minutes of the decision to treat MH whenever volatile agents or succinylcholine are administered. ¹ In

Comparison of the Length and Shape of Various Preformed Nasotracheal Tubes

Naotaro NakamuraDDS,

Natsuki KobayashiDDS,

Ryohei OkazawaDDS,

Manabu MikiDDS,

Takeshi OhnoDDS, PhD,

Mutsumi NonakaDDS, PhD, and

Kentaro OuchiDDS, PhD

Large Shoes to Fill

Anesthetic Efficacy of Buccal Infiltration Articaine versus Lidocaine for Extraction of Primary Molar Teeth

A Formula for Estimating the Appropriate Tube Depth for Intubation

Pulpal Anesthesia of Adjacent Teeth Following Infiltration of 2% Lidocaine With 1:100,000 Epinephrine in the Maxillary Lateral Incisor and First Molar

Panoramic Radiographic Relationship of the Mandibular Foramen to the Anterior Border of the Ramus and Occlusal Plane as an Aid in Inferior Alveolar Nerve Block

Efficacy of Topical Benzocaine in Maxilla: A Randomized Controlled Trial

Anesthetic Management of a Patient With Hereditary Angioedema for Oral Surgery

A Case of Cardiac Arrest for 31 Seconds During Recovery After Intravenous Sedation

Intravenous Sedation in Arnold-Chiari Malformation With Respiratory Failure

Endotracheal Intubation Complicated by a Palatal Tooth in a Patient With Treacher Collins Syndrome

Office-Based Sedation/General Anesthesia for COPD Patients, Part II

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

Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment. Larach MG, Klumpner TT, Brandon BW, Vaughn MT, et al. on behalf of the Multicenter Perioperative Outcomes Group. Anesthesiol. 2019;130:41–54.

Comparison of the Length and Shape of Various Preformed Nasotracheal Tubes

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

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