Anesthesia Progress Volume 68: Issue 4

Objective:

Serious airway complications can occur with inadequate airway management during general anesthesia (GA). This meta-analysis investigated randomized controlled trials that compared perioperative technique failures and airway complications, including hypoxia, during GA for dentistry using endotracheal intubation or a laryngeal mask airway (LMA) for airway management.

Methods:

A systematic search of electronic databases and gray literature was completed. Independent reviewers assessed eligibility, performed data extraction, completed risk of bias assessment, and judged the quality of results through Grading of Recommendations, Assessment, Development, and Evaluation. Risk ratios (RRs) for airway complications, with 95% CIs, were calculated. Heterogeneity was quantified using the I ² statistic. Sensitivity and age-subgroup analyses were explored.

Results:

Six trials were deemed eligible from a total of 9076 identified reports. The airway management intervention for these trials was LMA. Technique failures or effect differences in airway complications were not detected except for postoperative hypoxia, where LMA use had a decreased risk (RR, 0.22; 95% CI, 0.06-0.77; I ² = 0%; moderate quality). A similar effect was seen in the pediatric analysis (RR, 0.10; 95% CI, 0.01-0.84; I ² = 0%; moderate quality). Additionally, LMA use reduced pediatric sore throat risk (RR, 0.08; 95% CI, 0.04-0.15; I ² = 0%; moderate quality).

Conclusion:

Use of an LMA in dentistry may have the potential to reduce the risk of postoperative hypoxia, particularly in pediatric patients, although further study is required.

Objective:

This randomized, prospective, blinded study compared pain in children following dental treatment under general anesthesia (GA) using 1 of 2 established analgesia methods.

Methods:

Patients age 4 to 7 years were randomly assigned to a control group (intravenous [IV] analgesics) or experimental group (IV analgesics and intrapapillary local anesthetic infiltrations) between July 2017 and February 2018. During recovery from surgery, Faces, Legs, Activity, Cry, and Consolability (FLACC) scores were recorded upon regaining consciousness and reassessed every 15 minutes until discharge. Overall pain occurrence (FLACC ≥1) and moderate/severe pain occurrence (FLACC ≥4) were analyzed using mixed effects logistic regression (N = 88).

Results:

The experimental group had a 17% lower overall pain occurrence than the control group (16 vs 33%; p = .02). Moderate/severe pain occurrence between the groups was not significant (9 vs 22%; p = .23). The dental treatment subjects received (number of completed stainless steel crowns, extractions, and/or pulpotomies) did not significantly affect pain occurrence.

Conclusion:

Local anesthesia intrapapillary infiltrations around stainless steel crowns decrease overall pain occurrence but not moderate/severe pain occurrence following dental treatment under GA in pediatric patients.

Objective:

The aim of this study was to investigate the changes in pulpal blood flow (PBF) and pulpal oxygen tension (P_pulpO₂) after injecting local anesthetics with vasoconstrictors.

Methods:

Under general anesthesia, male Japanese White rabbits were injected with 0.6 mL of 2% lidocaine with 1:80,000 epinephrine (LE) or 3% propitocaine (prilocaine) with 0.03 IU felypressin (PF) at the apical area of the lower incisor.

Results:

Relative to baseline, PBF and P_pulpO₂ significantly decreased 5 minutes after LE or PF injection as compared with saline. The decrease in PBF was significantly lower in the LE group than in the PF group. Although the LE group had a larger decrease in P_pulpO₂ relative to baseline than the PF group did, that difference was not significant. PBF and P_pulpO₂ recovered to baseline faster in the PF group than in the LE group.

Conclusion:

The injection of local anesthetic solutions containing vasoconstrictors (LE or PF) transiently caused significant decreases in PBF that resulted in significant decreases in P_pulpO₂. The recovery of P_pulpO₂ was faster than PBF regardless of the vasoconstrictor used.

“How do you get to Carnegie Hall?

Practice! Practice! Practice!”

Anonymous

A simulator is a device or software program that is designed to reproduce or represent effects simulating phenomena likely to occur in reality. Perhaps the most familiar simulator is the flight simulator, which accurately replicates the look and feel of an airplane cockpit. Using a flight simulator, a pilot may practice takeoffs, landings, navigation procedures, and critical incidents without risk to passengers, crew, or expensive aircraft. Simulation technology has become an important educational tool in many complex, high-risk, dynamic environments such as the nuclear power and petroleum industries, the

**Meethil AP, Saraswat S, Chaudhary PP, Dabdoub SM, Kumar PS. Sources of SARS-CoV-2 and other microorganisms in dental aerosols. J Dent Res. 2021;100(8):817–823.**

The COVID-19 pandemic has generated a high degree of concern about aerosols generated during dental procedures and the potential for transmission of respiratory pathogens harbored in saliva. Current knowledge of the pathogens found in dental aerosols is mostly gleaned from case reports and poorly controlled studies. A 2020 review found several studies described the radius of contamination following aerosol-generating dental procedures in the operatory; however, few characterized the type of organisms found, and none identified

Curious Case of the Pretracheal Stethoscope

Airway Complications in Intubated Versus Laryngeal Mask Airway–Managed Dentistry: A Meta-Analysis

Objective:

Methods:

Results:

Conclusion:

Effect of Intrapapillary Local Anesthetic on Postoperative Pain Following Dental Treatment Under General Anesthesia in Pediatric Patients

Objective:

Methods:

Results:

Conclusion:

Effects of Local Anesthetics With Vasoconstrictors on Dental Pulp Blood Flow and Oxygen Tension

Objective:

Methods:

Results:

Conclusion:

Prolonged Washout Period for Avoiding Azilsartan-Induced Refractory Hypotension During General Anesthesia for a Patient With Renal Impairment

Management of a Patient With Tracheal Stenosis After Previous Tracheotomy

Accelerated Idioventricular Rhythm Following Intraoral Local Anesthetic Injection During General Anesthesia

A Case of Nasal Mucosa Cautery With Reintubation Under Pharyngeal Suction for Massive Epistaxis After Extubation

Simulation Technology in Anesthesiology

HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8–11.

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

**Meethil AP, Saraswat S, Chaudhary PP, Dabdoub SM, Kumar PS. Sources of SARS-CoV-2 and other microorganisms in dental aerosols. J Dent Res. 2021;100(8):817–823.**

Curious Case of the Pretracheal Stethoscope

Airway Complications in Intubated Versus Laryngeal Mask Airway–Managed Dentistry: A Meta-Analysis

Effect of Intrapapillary Local Anesthetic on Postoperative Pain Following Dental Treatment Under General Anesthesia in Pediatric Patients

Effects of Local Anesthetics With Vasoconstrictors on Dental Pulp Blood Flow and Oxygen Tension

Prolonged Washout Period for Avoiding Azilsartan-Induced Refractory Hypotension During General Anesthesia for a Patient With Renal Impairment