Anesthesia Progress Volume 68: Issue 1

Precooperative children and patients with intellectual disabilities often require intramuscular (IM) sedation prior to the induction of general anesthesia (GA). Ketamine is an effective preinduction sedative but can produce significant adverse side effects. Dexmedetomidine, a sedative with sympatholytic and analgesic properties, may provide advantages when used in combination with ketamine. This retrospective study evaluated the efficacy and safety of IM ketamine with dexmedetomidine for preoperative sedation. We conducted a chart review of all patients (n = 105) treated for dental rehabilitation who received either IM ketamine and dexmedetomidine (study group, n = 74) or IM ketamine and midazolam (control group, n = 31) prior to induction of GA. No significant difference (p = .14) was observed in the time interval from IM administration to operating room entry (median [interquartile range]) between the study and control groups (5 [4–8] vs 5 [2–7] minutes). Patients who received IM dexmedetomidine exhibited significantly lower mean arterial pressures throughout the induction (p = .004) and had lower heart rates (p = .01) throughout the intraoperative period compared with patients who did not receive dexmedetomidine. The combination of dexmedetomidine and ketamine may provide effective and safe IM sedation prior to the induction of GA.

The objectives of this research were to investigate (a) what was the most effective infusion rate of remifentanil and (b) the degree to which sympathomimetic effects were involved with cardiovascular stimulation by using a power spectral analysis of heart rate variability (HRV). A total of 63 healthy individuals scheduled for sagittal split ramus osteotomy were enrolled and randomly allocated to 1 of 3 groups: remifentanil infusion rate of 0.1, 0.2, or 0.4 μg/kg/min. Anesthesia was maintained with remifentanil and propofol. Before the surgical procedure, 2% lidocaine containing 12.5 μg/mL epinephrine was administered in the surgical field for local anesthesia. Systolic blood pressure (SBP), heart rate (HR), low-frequency (LF) and high-frequency (HF) components in HRV power spectral analysis, and the LF/HF ratio were analyzed. Increases in SBP and HR were observed after local anesthesia in all 3 groups, but no significant differences were observed between the groups. Remifentanil infusion at 0.1 μg/kg/min may be appropriate to minimize cardiovascular stimulation caused by exogenous epinephrine from local anesthesia. Although a rise in the LF/HF ratio was observed after local anesthesia in all groups, no relationship was observed between the cardiovascular changes and the increase in LF/HF ratio. This suggests that sympathomimetic effects are involved to a lesser extent with the cardiovascular stimulation caused by exogenous epinephrine.

The aim of this study was to analyze the use of dental local anesthetics in Germany compared with international data. The type and distribution of dental local anesthetics and added vasoconstrictors based on a representative sample of German dentists itemized over a period of 7 years (2011 to 2017) were evaluated and statistically analyzed. The results were compared with international dental local anesthetic consumption data published since 2005. With a consistent market share of nearly 98%, articaine was the first-line local dental anesthetic agent in Germany. During the investigation period, German dental local anesthetics with epinephrine 1:200,000 had ∼50% market shares, whereas formulations with epinephrine 1:100,000 had 40% to 45% market shares. Articaine, with market shares between 38% and 81%, was also the preferred anesthetic agent in various other countries, with the notable exceptions of the United Kingdom and the United States, where lidocaine was the preferred local anesthetic agent. Epinephrine was the preferred vasoconstrictor internationally, similar to Germany. The larger market share of higher concentrated epinephrine 1:100,000 was remarkable, considering the increasing number of medically compromised patients. Increased consideration for using agents with reduced dosages of epinephrine (1:200,000) is generally recommended.

Brown J, Gregson FKA, Shrimpton A, et al. A quantitative evaluation of aerosol generation during tracheal intubation and extubation.Anaesthesia. 2021;76(2):174–181. doi: 10.1111/anae.15292. PMID: 33022093; PMCID: PMC7675579.

In response to the COVID-19 pandemic, guidance issued from the World Health Organization and the Centers for Disease Control and Prevention recommend minimizing aerosol generating procedures (AGPs) and adopting personal protective equipment and engineering practices when AGPs must be performed. Tracheal intubation and extubation have been classified as AGPs; however, the underlying evidence for this classification is weak and based upon data from studies of other viral respiratory infections. Using mean airborne

Anaphylaxis After a Third Exposure to Sugammadex

Honoka IshiharaDDS,

Yukie NittaDDS, PhD,

Yoko KudoDDS, PhD, and

Kanta KidoDDS, PhD

IFDAS 2021 in Moscow, Russia

Retrospective Comparison of Intramuscular Admixtures of Ketamine and Dexmedetomidine Versus Ketamine and Midazolam for Preoperative Sedation

Effects of Remifentanil on Cardiovascular Stimulation Caused by Local Anesthetic With Epinephrine: A Power Spectral Analysis

Local Anesthetic Usage Among Dentists: German and International Data

Osteonecrosis of Bilateral Mandibular Tori After Direct Laryngoscopy

Accidental Intravascular Local Anesthetic Injection of the Facial Artery

Cardiovascular Considerations in Anesthetic Management for a Patient With Antiphospholipid Syndrome and Decreased Cardiac Function: A Case Study

Cardiac Arrest Upon Induction of General Anesthesia

Clinical Use of Preformed Microcuff® Pediatric Endotracheal Tubes in Japan

Difficult Airway Management in a Patient With Nicolaides-Baraitser Syndrome Who Had a Small Jaw and Limited Mouth Opening

Superior Laryngeal Nerve Block for Intubation in Patients With COVID-19

Anesthetic Management of the Pregnant Patient: Part 1

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

Brown J, Gregson FKA, Shrimpton A, et al. A quantitative evaluation of aerosol generation during tracheal intubation and extubation.Anaesthesia. 2021;76(2):174–181. doi: 10.1111/anae.15292. PMID: 33022093; PMCID: PMC7675579.

Anaphylaxis After a Third Exposure to Sugammadex

Use of Ultrasound-Guided Glossopharyngeal Nerve Block and Intravenous Sedation to Control a Gag Reflex

An Appropriate Setting for a Patient-Controlled Analgesia Pump for Continuous Local Anesthesia After Bimaxillary Osteotomy

Ramped Position Improves Oxygenation During Mechanical Ventilation for Patients With Severe Obesity

Commentary—Fasting Implications of GLP-1 Agonist Use in Pediatric Procedural Sedation