Anesthesia Progress Volume 68: Issue 2

I'll start with a simple premise—the current IV anesthetic agents available for sedation and anesthesia in dentistry are quite good, even excellent. In fact, they are the best yet and only continue to improve as the march toward anesthesia nirvana, an instantaneous pharmacologic on/off switch, persists. The advent of remifentanil with its plasma esterase–based metabolism has blown the door open for a whole new generation of ultra–short-acting agents. Remimazolam, a similarly metabolized benzodiazepine, is the newest arrival. These drugs have extremely short clinical durations of action and context-sensitive half-times (≤8 minutes) attributed to lightning-fast terminal half-lives and lack of active

The inferior alveolar nerve block (IANB) does not always result in successful pulpal anesthesia. Nitrous oxide may increase the success of the IANB. The purpose of this investigation was to study the effect of nitrous oxide/oxygen (N₂O/O₂) on IANB injection pain and mandibular pulpal anesthesia in asymptomatic subjects. One hundred five asymptomatic subjects received an IANB after the administration of N₂O/O₂ or room air/oxygen (air/O₂) at 2 separate appointments. After the IANB, subjects rated their level of pain for each phase of the injection (needle insertion, needle placement, and solution deposition) using a Heft Parker visual analog scale. Pulpal anesthesia was evaluated with an electric pulp tester for 60 minutes. The mean pain rating for all 3 injection phases showed a statistically significant reduction in pain when N₂O/O₂ was used compared with Air/O₂ (P < .05). Odds ratios demonstrated a statistically significant increase in IANB success for the N₂O/O₂ group compared with the air/O₂ group. N₂O/O₂ administration statistically decreased pain for all 3 injection phases of the IANB. In addition, nitrous oxide statistically increased the likelihood of pulpal anesthesia for posterior mandibular teeth. However, the incidence of pulpal anesthesia was not 100%.

In the event of a medical emergency in the dental office, the dentist must be able to identify a patient in distress, assess the situation, and institute proper management. This study assessed the impact of a simulation-based medical emergency preparedness curriculum on a resident's ability to manage medical emergencies. This interventional and pre-post educational pilot study included 8 participants who completed a standard curriculum and 8 who completed a modified curriculum (N = 16). The intervention consisted of a comprehensive medical emergency preparedness curriculum that replaced lecture sessions in a standard curriculum. Participants completed performance assessments using scenario-based objective structured clinical examinations (OSCEs) that were recorded and evaluated by calibrated faculty reviewers using a customized scoring grid. The intervention group performed significantly better than the control group on their summative OSCEs, averaging 90.9 versus 61.2 points out of 128 (p = .0009). All participants from the intervention group passed their summative OSCE with scores >60%, while none from the control group received passing scores. Completion of a simulation-based medical emergency preparedness curriculum significantly improved resident performance during simulated medical emergencies.

This study aimed to investigate the characteristics of chest compressions performed in dental chairs (DCs) with 2 different structural support designs and on the floor. This randomized prospective study was conducted to compare the effectiveness of chest compressions (rate and depth) using a feedback device and a manikin reporting system. The mean anterior chest wall motion measurements captured using the feedback device were significantly increased in the DCs than on the floor, whereas the percentage of net chest compression depths ≥5 cm as measured using the manikin reporting system were significantly decreased in the DCs than on the floor. These findings suggest that cardiopulmonary resuscitation performed in a DC without the use of a supporting stool or stiff backboard is not likely to be effective even if a DC design that incorporates a supportive steel column is utilized.

Hussain N, Brull R, Sheehy B, et al. Perineural liposomal bupivacaine is not superior to non-liposomal bupivacaine for peripheral nerve block analgesia: a systematic review and meta-analysis. Anesthesiology . 2021;134:147–164.

Perineural infiltration is a technique in which local anesthetic is continuously administered through a fixed catheter over nerves at or near the surgical site. Sustained analgesia is achieved when bupivacaine encapsulated in liposomes is slowly released, causing conduction blockade in the peripheral nerve. When used for local infiltration and field blocks, liposomal bupivacaine is predicted to provide prolonged postoperative analgesia up to 72 hours following a variety of surgeries. However,

Modified Retrograde Nasal Intubation: A New Airway Technique and Devices

Vernon H. Vivian MBChB,

Dip Anaes (SA),

Tyson L. Pardon MD, and

Andre A. J. Van Zundert MD, PhD, EDRA

So Good It Hurts?

Nitrous Oxide/Oxygen Effect on IANB Injection Pain and Mandibular Pulpal Anesthesia in Asymptomatic Subjects

Medical Emergency Management in the Dental Office (MEMDO): A Pilot Study Assessing a Simulation-Based Training Curriculum for Dentists

Efficacy of Chest Compressions Performed on Patients in Dental Chairs Versus on the Floor

Nasogastric Tube Knotted Around a Nasal Endotracheal Tube in the Nasopharynx: Possible Cause

A Case of Laryngeal Granulomas After Oral and Maxillofacial Surgery With Prolonged Intubation

Ambulatory Anesthesia for a Case of Idiopathic Bronchiolitis Obliterans

Modified Retrograde Nasal Intubation: A New Airway Technique and Devices

A Case of Childhood-Onset Basedow–Graves' Disease Diagnosed as a Result of the Fourth Time of General Anesthesia for Oral and Maxillofacial Surgery

Anesthetic Management of a Juvenile Hyaline Fibromatosis Patient With Trismus and Cervical Movement Limitation

Anesthetic Management of the Pregnant Patient: Part 2

Literature Review for Office-Based Anesthesia

Hussain N, Brull R, Sheehy B, et al. Perineural liposomal bupivacaine is not superior to non-liposomal bupivacaine for peripheral nerve block analgesia: a systematic review and meta-analysis. Anesthesiology . 2021;134:147–164.

Modified Retrograde Nasal Intubation: A New Airway Technique and Devices

A Case of Childhood-Onset Basedow–Graves' Disease Diagnosed as a Result of the Fourth Time of General Anesthesia for Oral and Maxillofacial Surgery

Anesthetic Management of a Juvenile Hyaline Fibromatosis Patient With Trismus and Cervical Movement Limitation

Anesthetic Management of the Pregnant Patient: Part 2

Literature Review for Office-Based Anesthesia