As a parent of 4 children and an owner/user of multiple handheld mobile electronic devices (iPad, iPhone, etc), I am undoubtedly no stranger to the ever-growing world of apps. As of the end of the first quarter in 2019, an estimated 2.6 and 2.2 million apps are available for Android and Apple devices, respectively. While there certainly are apps that have made positive impacts on our lives (thank you, iOS Maps), many end up failing to satisfy our expectations, ultimately being relegated to the infinite abyss of the interwebs following deletion from our respective devices. Often, it seems as though
The focus of this systematic review is to assess the efficacy of several commonly utilized anesthetic techniques for reducing pain during the placement of mini-implants. An electronic search was conducted in the databases PubMed, Scopus, Web of Science, Medline Complete, Cochrane, Trials Central, and Clinical Trials, without limitations on year of publication or language. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) were considered. Two reviewers of articles independently evaluated the results of the study, and the risk of bias of included articles was evaluated according to the Cochrane Scale. Five eligible articles (3 RCTs and 2 CCTs) were included. The quality of the body of evidence was considered low because of the presence of multiple methodological problems, high risks of bias, and heterogeneity in the articles included. There was evidence that the efficacy of the analgesia of infiltrative anesthesia was most effective in promoting a lower perception of pain compared to the other anesthetic agents, although an injection was required. Among topical anesthetics, compound topical anesthetics with 20% lidocaine were more effective than compound topical anesthetics with low lidocaine concentration and conventional topical anesthetic with 20% benzocaine.
We assessed the effect of 2% lidocaine with 1:80,000 adrenaline (L + AD) and 3% prilocaine with 0.03 IU/mL felypressin (P + FP) on blood pressure and heart rate in older adults with systemic diseases undergoing dental extraction. This double-blind, randomized crossover study included 22 elderly participants, aged over 65 years. The participants were administered L + AD for one dental extraction and P + FP for the other. Blood pressure and heart rate were recorded immediately, 5, and 10 minutes after local anesthetic administration and the data were analyzed. The systolic and diastolic blood pressures in the P + FP group increased at all measurement points (p < .001). In the L + AD group, the diastolic blood pressure decreased at 5 and 10 minutes after local anesthetic administration (p < .05), whereas the heart rate increased at all measured time points (p < .001). There were statistically significant differences in systolic blood pressure at 5 and 10 minutes after local anesthetic administration and in diastolic blood pressure and heart rate at all time points between the 2 groups. In older adults, P + FP administration increased the systolic and diastolic blood pressures. L + AD administration increased the heart rate and decreased the diastolic blood pressure.
Our objective was to estimate the prevalence of mortality and serious morbidity for office-based deep sedation and general anesthesia (DS/GA) for dentistry in Ontario from 1996 to 2015. Data were collected retrospectively in 2 phases. Phase I involved the review of incidents, and phase II involved a survey of DS/GA providers. In phase I, cases involving serious injury or death for dentistry under DS/GA, sourced from the Office of the Chief Coroner of Ontario and from the Royal College of Dental Surgeons of Ontario (RCDSO), were reviewed. Phase II involved a survey of all RCDSO-registered providers of DS/GA in which they were asked to estimate the number of DS/GAs administered in 2015 and the number of years in practice since 1996. Clinician data were pooled to establish an overall number of DS/GAs administered in dental offices in Ontario from 1996 to 2015. Prevalence was calculated using phase I (numerator) and phase II (denominator) findings. The estimated prevalence of mortality in the 20-year period from 1996 to 2015 was 3 deaths in 3,742,068 cases, with an adjusted mortality rate of 0.8 deaths per 1 million cases. The estimated prevalence of serious morbidity was 1 injury in 3,742,068 cases, which adjusts to a serious morbidity rate of 0.25 per 1 million cases. The mortality rate found in this study was slightly lower than those published by earlier studies conducted in Ontario. The risk of serious morbidity was found to be low and similar to other studies investigating morbidity in office-based dental anesthesia.
While anaphylaxis can occur at any time during general anesthesia, 90% of cases occur at induction of anesthesia. As several drugs are administered simultaneously at this time, it is difficult to identify the causative agent. However, it has been found that rocuronium is the most common drug associated with perioperative anaphylaxis. We treated 2 cases of patients who were administered sugammadex for anaphylactic symptoms thought to be caused by rocuronium, after which the anaphylactic symptoms disappeared. One of the most important aspects of treating anaphylactic shock is improving hemodynamics. If signs indicating circulatory collapse are observed, epinephrine should be administered immediately. However, because rocuronium was suspected of being the causative agent, and taking the patients' clinical course over time into consideration, sugammadex was initially administered. As a result, symptoms improved. Therefore, we believe that the administration of sugammadex may be effective for treating anaphylaxis caused by rocuronium and also help in identifying the causative agent.
Dravet syndrome (DS) is a rare and severe form of epilepsy that begins in infancy. This is particularly burdensome because repeated epileptic seizures lead to cognitive decline. We describe the case of a 12-year-old girl who was diagnosed with DS and was scheduled to have gingival reduction around her mandibular molars. Despite the patient being intellectually disabled, she was able to cooperate somewhat during medical procedures, including intravenous cannulation. Under the assumption that the major problem with anesthesia for DS would be the regulation of body temperature–induced seizures, we used body temperature management equipment to maintain the patient's body temperature during the procedure. We opted for intravenous sedation and administered a total dose of 4.5 mg midazolam throughout the procedure. Anesthesia was completed within 1 hour and 20 minutes without any adverse events. To the best of our knowledge, no previous studies have documented the anesthetic management of DS. In this case, no adverse events occurred perioperatively. However, the patient's temperature rose to that which indicated a slight fever despite the use of a standard cooling technique.
This is a case report of a 21-year-old male patient with Cornelia de Lange syndrome (CdL) and unrepaired tetralogy of Fallot scheduled for dental treatment under general anesthesia. Anticipated dental care consisted of restorative treatment and extractions. Surgical correction of the patient's congenital cardiac abnormalities had not occurred by the time of dental treatment. As such, the developed anesthetic plan included the following goals: prevention of any anoxic episodes or spell and preparation for difficult airway management due to micrognathia secondary to CdL. To help ensure adequacy of oxygenation during induction, the normal anesthetic face mask was specially modified with a hole to permit use of the fiberoptic scope during induction and intubation. With preoperative consultation involving a cardiologist as well as the use of the modified mask, general anesthesia was safely administered without any complications.
Medication Safety: Reducing Anesthesia Medication Errors and Adverse Drug Events in Dentistry Part 1
For decades, the dental profession has provided anesthesia services in office-based, ambulatory settings to alleviate pain and anxiety, ranging from local anesthesia to general anesthesia. However, despite a reported record of safety, complications occasionally occur. Two common contributing factors to general anesthesia and sedation complications are medication errors and adverse drug events. The prevention and early detection of these complications should be of paramount importance to all dental providers who administer or otherwise use anesthesia services. Unfortunately, there is a substantial lack of literature currently available regarding medication errors and adverse drug events involving anesthesia for dentistry. As a result, the profession is forced to look to the medical literature regarding these issues not only to assess the likely severity of the problem but also to develop preventive methods specific for general anesthesia and sedation as practiced within dentistry. Part 1 of this 2-part article will illuminate the problems of medication errors and adverse drug events, primarily as documented within medicine. Part 2 will focus on how these complications affect dentistry, discuss several of the methods that medicine has implemented to manage such problems, and introduce a method for addressing these issues with the dental anesthesia medication safety paradigm.
Midazolam has been shown to exacerbate motor dysfunction in patients with brain tumors in the eloquent cortex (ie, the frontotemporal and parietal cortex areas that are involved in speech). Some slowly infiltrative gliomas in these regions do not show any clinically detectable deficits under normal conditions but appear when sedation is administered. The mechanism of this “unmasking” by sedation is unclear. This study sought to determine if thisLin M, Han R, Hull X, Zhang K, Gelb A. Midazolam sedation induces upper limb coordination deficits that are reversed by flumazenil in patients with eloquent area gliomas. Anesthesiology. 2019;131:36–45.
There are a few individuals whom one meets throughout life who project auras that command respect, stimulate inquisitiveness, and induce profound reflection upon a legacy forged by firsthand experiences. Dr Harcourt M. Stebbins, a forefather of the American Dental Society of Anesthesiology (ADSA) and an original charter and founding member, was such an individual. Dr Stebbins received the Heidbrink Award, the highest honor of the ADSA, which is presented to the individual who has/had most significantly contributed to the advancement of anesthesiology in dentistry, at the 2010 Annual Session. Dr Stebbins was the first editor for Newsmonthly, the