Anesthesia Progress Volume 67: Issue 2

Articaine is a low-toxicity local anesthetic that is widely used in dentistry. Typically, epinephrine is added to prolong the duration of articaine local anesthesia; however, epinephrine exhibits adverse effects. Low-dose dexmedetomidine (DEX), an α₂-adrenoreceptor agonist, reportedly prolongs local anesthesia without notable adverse cardiovascular effects. The purpose of this study was to assess whether a combination of low-dose DEX and articaine would provide a low-toxicity local anesthetic option for dental procedures without adverse cardiovascular effects. Thus, this study investigated whether DEX could prolong the local anesthetic effect of articaine using a rat model of pain. Adult male Wistar rats (N = 44; 11 per group) received a 50-μL subcutaneous injection into the plantar surface of the hind paws; injections were composed of either normal saline, 4% articaine (2 mg articaine), combined 5 μg/kg DEX and 4% articaine (1.25 μg DEX + 2 mg articaine), or combined epinephrine (1:100,000) and 4% articaine (0.9 μg epinephrine + 2 mg articaine). Subsequent acute pain perception was determined by paw withdrawal movement in response to infrared radiant heat stimulation of the plantar region. Paw withdrawal latency was tested at 5-minute intervals. Paw withdrawal latency values at 35 and 40 minutes were 3.83 ± 1.76 and 3.29 ± 1.43 seconds for articaine alone, 7.89 ± 2.72 and 7.25 ± 3.37 seconds for DEX and articaine, and 8.95 ± 2.28 and 8.17 ± 3.01 seconds for epinephrine and articaine. DEX prolonged the paw withdrawal latency of articaine for up to 35 minutes (p = .015) but not 40 minutes after injection (p = .052) when compared to articaine alone. The combination of DEX and articaine can provide effective local anesthesia for up to 35 minutes after injection.

This study investigated the effectiveness of subglottic irrigation (SI) with 100 mL of saline on reducing bacterial contamination in the subglottic space during oral surgery procedures without the use of throat packs. Subglottic lavage and irrigation were performed through the suction lumen located on specialized endotracheal tubes (ETTs) with capabilities of permitting evacuation from the subglottic space. Fifty-three patients who were scheduled for oral surgery procedures under general anesthesia while intubated with specialized ETTs at Kyushu Dental University Hospital were enrolled in this study. Subglottic irrigation was performed, and the sample fluid was collected through the ETT suction lumen for smear and culture bacterial examinations after 3 points in time: immediately after intubation, after completing the surgical procedure, and again after SI. Oral surgery without a throat pack significantly increased bacterial contamination in the subglottic lavage (p < .001), and SI decreased bacterial contamination (p < .001) similarly to levels found after tracheal intubation. Subglottic irrigation with 100 mL of saline was effective in reducing bacterial load in the subglottic space to levels similarly noted immediately after intubation for patients undergoing intraoral surgical procedures without the use of a throat pack.

Angiotensin receptor blockers (ARBs) are commonly used to treat hypertension. However, similar to angiotensin-converting enzyme inhibitors, ARBs can also cause refractory hypotension during general anesthesia. Therefore, it has been recommended that ARBs be withheld for 24 hours prior to the induction of anesthesia. This is a case report of refractory hypotension requiring the administration of potent vasopressors after the induction of general anesthesia despite withholding telmisartan for 24 hours. In the same patient undergoing a subsequent general anesthetic, telmisartan was withheld for 5 days before induction, leading to mild intraoperative hypotension that responded adequately to phenylephrine. The primary cause of refractory hypotension during the first general anesthetic was suspected to be an insufficient telmisartan washout period. Telmisartan's half-life of 24 hours is notably the longest of all ARBs in current use. This case report demonstrates that refractory hypotension during general anesthesia cannot always be avoided by withholding telmisartan for 24 hours before the induction of anesthesia. Therefore, a washout period greater than 24 hours is preferable for patients taking telmisartan.

Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: pacemakers and implantable cardioverter-defibrillators 2020: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients With Cardiac Implantable Electronic Devices. Anesthesiology. 2020;132:225–252.

Practice advisories are systematically developed reports that are intended to assist decision-making in areas of patient care. Advisories provide a synthesis of scientific literature and analysis of expert opinion, clinical feasibility data, open forum commentary, and consensus surveys. This updated advisory focuses on the perioperative management of the patient who has a pre-existing cardiac implantable electronic device

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

Yoshinari MorimotoDDS, PhD,

Megumi HayashiDDS, PhD,

Kanae TsukawakiDDS,

Kouji TakanoDDS, PhD,

Hiroko KuboDH, and

Eri IidaDH

The COVID-19 Pandemic and Its Impact on Dentistry

The History of the American Dental Board of Anesthesiology

THE EARLY YEARS OF DENTAL ANESTHESIOLOGY

Adding Dexmedetomidine to Articaine Increases the Latency of Thermal Antinociception in Rats

Impact of Subglottic Saline Irrigation on Reducing Bacterial Contamination for Oral Surgery Patients

Refractory Hypotension During General Anesthesia Despite Withholding Telmisartan

Medical Management of Epiglottitis

Mask Induction for an Intellectually Disabled Patient With Congenital Infiltrating Lipomatosis of the Face

Twin Block in Myogenous Orofacial Pain: Applied Anatomy, Technique Update, and Safety

General Anesthesia During Lip Repair and Palatoplasty After Glenn Surgery

Infection Control in Dental Anesthesiology: A Time for Preliminary Reconsideration of Current Practices

Literature Review for Office-Based Anesthesia

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

Commentary: Are Anesthesiologists Still “Darting” Their Patients?

Comparison of the Length and Shape of Various Preformed Nasotracheal Tubes

Virtual Reality Distraction vs Nitrous Oxide for Reducing Anxiety and Injection Pain

Single-Agent Total Intravenous Anesthesia With Remimazolam for an Elderly Man Undergoing Ambulatory Oral Surgery: A Case Report

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