Anesthesia Progress Volume 68: Issue 3

Objective:

The primary aim of this study was to determine the cardiovascular safety of topical racemic epinephrine pellets by measuring heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure in children receiving dental care under general anesthesia. The secondary aim was to assess clinical efficacy by measuring time to reach adequate hemostasis.

Methods:

For this pilot study utilizing a split-mouth randomized design, 13 patients requiring prefabricated zirconia crowns on both primary maxillary first molars were recruited. Patients received continuous infusions of propofol and remifentanil with 50–70% inhaled nitrous oxide and oxygen. After randomization and tooth preparation, either saline pellets (control) or racemic epinephrine pellets (experimental) were applied directly to gingival tissue. Vital signs were recorded for 5 minutes. The procedure was repeated on the contralateral side using the alternative (control or experimental) treatment.

Results:

Topical racemic epinephrine compared to saline produced a significantly larger decrease in mean diastolic blood pressure (−11.1% vs −3.9%; P < .01) and mean arterial pressure (−8.1% vs −2.1%; P < .01), although all noted decreases in cardiovascular variables were clinically insignificant. All experimental treatment teeth achieved adequate hemostasis after 2.2 minutes. Only 5 of the 13 control treatment teeth achieved adequate hemostasis during the 5-minute observation period (1.6 vs 4.2 minutes; P = .01).

Conclusion:

Overall, we conclude that use of topical racemic epinephrine pellets did not result in adverse cardiovascular effects and hemostasis was reached more quickly and predictably compared to saline pellets.

Objective:

Antipsychotic drugs exhibit α-1 adrenergic receptor-blocking activity. When epinephrine and antipsychotic drugs are administered in combination, β-2 adrenergic effects are thought to predominate and induce hypotension. This study aimed to assess hemodynamic parameters in patients regularly taking antipsychotics who were administered epinephrine-containing lidocaine under general anesthesia in a dental setting.

Methods:

Thirty patients taking typical and/or atypical antipsychotics and scheduled for dental procedures under general anesthesia were enrolled. Five minutes after tracheal intubation, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and percutaneous oxygen saturation (SpO₂) measurements were taken. The SBP, DBP, HR, and SpO₂ measurements were repeated 2, 4, 6, 8, and 10 minutes after the injection of 1.8 mL of 2% lidocaine (36 mg) with 1:80,000 epinephrine (22.5 mcg) via buccal infiltration.

Results:

Differences between the baseline measurements and those of each time point were analyzed using Dunnett test, and no statistically significant changes were observed.

Conclusions:

Our findings demonstrate that the use of epinephrine at a clinically relevant dose of 22.5 mcg for dental treatment under general anesthesia is unlikely to affect the hemodynamic parameters of patients taking antipsychotic medications.

Kawasaki disease (KD) is an acute vasculitis of childhood and is the leading cause of acquired heart disease in children in developed countries. Failure to quickly diagnose and treat patients with KD can result in severe cardiac sequelae, especially coronary artery aneurysms (CAAs). Patients with a prior diagnosis of KD who require general anesthesia (GA) may present unique challenges depending on the severity of any cardiovascular sequelae. This case report describes the perioperative management of a 5-year-old male patient previously diagnosed with incomplete KD approximately 1 year before presenting to Stony Brook University Hospital for full mouth dental rehabilitation under GA. Most uniquely, the patient was at high risk for coronary artery thrombosis due to a giant CAA of his right coronary artery and a small CAA of his left anterior descending artery. The discussion also includes the implications of dental treatment under GA for patients with a history of KD.

Warner M, Meyerhoff K, Posner K, Stephens L, Domino, K. Pulmonary aspiration of gastric contents: a closed claims analysis. Anesthesiology. 2021;135(2):284–291. doi:10.1097/ALN.0000000000003831.

Perioperative pulmonary aspiration of gastric contents has been, and continues to be, associated with severe morbidity and death despite recent advances in relevant guidelines and airway management. In this closed claim analysis, 115 cases of pulmonary aspiration were retrieved from the Anesthesia Closed Claims Database for the period between 2000 and 2015. Anesthesia malpractice claims associated with surgical, procedural, or obstetric anesthesia care were included, whereas claims associated with acute or chronic pain management were excluded. Death occurred

A Culture of Safety: Why Reinvent the Wheel?

Cardiovascular Safety and Hemostatic Efficacy of Topical Epinephrine in Children Receiving Zirconia Crowns

Objective:

Methods:

Results:

Conclusion:

Hemodynamic Impact of Drug Interactions With Epinephrine and Antipsychotics Under General Anesthesia With Propofol

Objective:

Methods:

Results:

Conclusions:

Kawasaki Disease and General Anesthesia for Dental Treatment: A Case Report

Unexpected Anesthetic Circuit Leak Attributed to Improper Use of a Tube Holder: A Case Report

Anesthetic Management of a Patient With Citrullinemia Type I During Dental Treatment

Anesthetic Management of a Rett Syndrome Patient at High Risk for Respiratory Complications

A Retrospective Case Series of Anesthetic Patients With Epiglottic Cysts

Anesthetic Management of a Patient With Ring 18 Syndrome

Review of Modern Insulin Pumps and the Perioperative Management of the Type 1 Diabetic Patient for Ambulatory Dental Surgery

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

Warner M, Meyerhoff K, Posner K, Stephens L, Domino, K. Pulmonary aspiration of gastric contents: a closed claims analysis. Anesthesiology. 2021;135(2):284–291. doi:10.1097/ALN.0000000000003831.

A Culture of Safety: Why Reinvent the Wheel?

Cardiovascular Safety and Hemostatic Efficacy of Topical Epinephrine in Children Receiving Zirconia Crowns

Hemodynamic Impact of Drug Interactions With Epinephrine and Antipsychotics Under General Anesthesia With Propofol

Kawasaki Disease and General Anesthesia for Dental Treatment: A Case Report

Unexpected Anesthetic Circuit Leak Attributed to Improper Use of a Tube Holder: A Case Report