Anesthesia Progress Volume 69: Issue 4

Objective:

Pediatric patients who undergo general anesthesia (GA) for dentistry may be treated in different venues. This retrospective study compared patients treated in an ambulatory surgery center (ASC) to those treated in a hospital operating room (H-OR). The 2-venue model was also compared with a historical hospital-only model.

Methods:

Twelve months of data were collected via records review: patient demographics, American Society of Anesthesiology (ASA) classification, and medical comorbidities. Data from patients treated at the H-OR 10 years prior were referenced for comparison.

Results:

Between July 2017 and June 2018, 1148 patients were treated: 635 at the ASC and 513 at the H-OR. The most common age range for both venues was 3 to 8 years. Of all the ASC patients, 78% were ASA I, while 48% of H-OR patients were ASA III (P < .001). The number of patients treated with the 2-venue model represented a 240% annual increase compared with those treated historically using the hospital-only model.

Conclusion:

Because of differences in patient medical comorbidities, both the ASC and H-OR are needed to adequately address the needs of pediatric dental patients who require GA. Treating healthy patients in an ASC also creates increased capacity in the H-OR to better accommodate those with higher medical acuity.

Objective

In recent years, opioid misuse has resulted in much scrutiny on providers' prescribing habits. The purpose of this study was to analyze prescribing habits in the context of third molar extractions as a model for promoting better postsurgical pain management.

Methods

This was a cross-sectional survey of oral maxillofacial surgeons in Connecticut and New Jersey. A total of 291 practitioners were contacted to complete an online survey using Qualtrics Research Services to determine prescribing habits following third molar extractions.

Results

The most common approach for postoperative analgesia was nonsteroidal anti-inflammatory drugs (NSAIDs) and an opioid/acetaminophen (APAP) combination as 2 separate prescriptions, reported by 36% of participants. The combination of hydrocodone/APAP was the most common opioid formulation, and an average of 10.93 ± 4.51 opioid pills were prescribed with a maximum of 20 pills reported. Most providers (79%) consistently provided patients with opioid information. Only 22% reported always checking opioid-monitoring programs; however, providers were more likely to check if prescribing more than ∼11 opioid pills (P = .0228). Most reported using dexamethasone (82%) and bupivacaine (56%) intraoperatively, while ketorolac was less common (15%). No association was found between the quantity of opioids prescribed and the use of intraoperative ketorolac, steroids, or bupivacaine (P > .05).

Conclusion

There remains to be a universal standard for using opioids for postoperative pain management in dentistry. Providers should be mindful when prescribing opioids and consider using NSAIDs and APAP for baseline pain plus a separate opioid prescription for breakthrough pain. Additional focus on minimizing the quantity of opioids prescribed and self-reflecting on prescribing and practice habits to further reduce opioid-related complications is warranted.

Objective:

Despite the common clinical impression that patients with a history of drug use are challenging to anesthetize with local anesthesia, literature on this clinical phenomenon is sparse. The objective of this pilot study was to assess if differences in local anesthetic efficacy for dental treatment exist between marijuana users and nonusers.

Methods:

Subjects were healthy adult males and females who qualified as either chronic marijuana users or nonusers. All subjects had an asymptomatic, vital maxillary lateral incisor that responded to an electric pulp test (EPT). A standard maxillary infiltration injection technique was employed using 1.7 mL 2% lidocaine with 1:100,000 epinephrine over the test tooth, and the tooth was tested with an EPT at 3-minute intervals.

Results:

A total of 88% of nonusers (15/17) and 61% of users (11/18) were successfully anesthetized, defined as anesthesia onset within 10 minutes and lasting at least 15 minutes. The difference in the proportion of anesthetized subjects was not statistically significant (P = .073). For subjects with successful anesthesia, there was no significant difference between nonusers and users in the onset or duration of anesthesia.

Conclusion:

No significant differences in local anesthetic efficacy with respect to local anesthetic success, onset, or duration of action were found between chronic marijuana users and nonusers. However, larger studies are likely needed to provide more definitive evidence.

The Japanese Dental Society of Anesthesiology (JDSA), with ∼2600 members, celebrated its 50^th anniversary with a special banquet after its annual scientific session at the Imperial Hotel Tokyo on Sunday, October 30^th, hosted by JDSA President, Professor Takehiko Iijima. Professor Emeritus Yuzuro Kaneko gave the celebration address titled “The History of Japanese Dental Anesthesiology.”

Dental anesthesiology in Japan began with physician anesthesiologists who saw the need to train dentists to provide anesthesia for dental and oral & maxillofacial surgery. Professor Yasuya Kubota, a physician who later trained as a dentist, opened the first dental anesthesiology department

Difficulty Controlling Sedation Level Using Processed Electroencephalography Monitoring in a Patient With Intellectual Disability, Fontan Circulation, and a Severe Gag Reflex

Riko UmemotoDDS,

Satoshi TachikawaDDS, PhD,

Daisuke KikuchiDDS,

Aoi OoshioDDS,

Risa KajiwaraDDS, PhD,

Rie NishidaDDS, PhD,

Asuka TaguchiDDS, PhD,

Takehiko IijimaDDS, DMSc, and

Rikuo MasudaDDS, PhD

No Shortage of Stress

Comparison of Pediatric Dentistry Under General Anesthesia in a Surgery Center vs a Hospital

Objective:

Methods:

Results:

Conclusion:

Opioid-Prescribing Patterns in Connecticut and New Jersey Following Third Molar Extractions

Objective

Methods

Results

Conclusion

Local Anesthetic Efficacy in Marijuana Users and Nonusers: A Pilot Study

Objective:

Methods:

Results:

Conclusion:

Severe Bleeding During Orthognathic Surgery for a Noonan Syndrome Patient

Complications After Dental Sedation: A Myotonic Mystery Case Report

New-Onset Accelerated Idioventricular Rhythm During Dental Rehabilitation

Perioperative Management of a Patient With Tongue Cancer Who Developed Pneumomediastinum Following Tracheostomy Performed to Secure the Airway

Japanese Dental Society of Anesthesiology Celebrates 50 Years

An Objective Measure of Recovery ^*

Commentary

Literature Review for Office-Based Anesthesia

Lei D, Wu C, Wu Z, Wang L, Zhao Q, She Y. Efficacy of different doses of intranasal dexmedetomidine in preventing emergence agitation in children with inhalational anesthesia. Eur J Anaesthesiol. 2022;39(11):858–867.

Erratum

Difficulty Controlling Sedation Level Using Processed Electroencephalography Monitoring in a Patient With Intellectual Disability, Fontan Circulation, and a Severe Gag Reflex

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

Effect of Thermomechanical Stimulation on Pain During IANB Injections

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

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

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