Anesthesia Progress Volume 70: Issue 3

Objective:

The purpose of this prospective, randomized crossover study was to compare the peak incidence of success, onset, and incidence over time of pulpal anesthesia in maxillary first molars following a buccal infiltration of 1.8 mL or 3.6 mL of 4% articaine with 1:100 000 epinephrine.

Methods:

A total of 118 adults received 1.8 mL or 3.6 mL of 4% articaine with 1:100 000 epinephrine via buccal infiltration of the maxillary first molar at 2 separate appointments. Electric pulp testing (EPT) of the maxillary first molar was performed over 68 minutes.

Results:

There was no significant difference in the peak incidence of anesthetic success (85% and 92%, respectively) in the maxillary first molar between 1.8 mL and 3.6 mL. The difference in onset times (4.5 min for 1.8 mL vs 4.4 min for 3.6 mL) was not statistically significant. However, the 3.6-mL volume did produce a significantly higher incidence of pulpal anesthesia from minutes 48 to 68 compared with the 1.8-mL volume.

Conclusion:

There was no significant difference in peak incidence or onset of pulpal anesthesia in the maxillary first molar between 1.8 mL and 3.6 mL of articaine with epinephrine. The incidence of pulpal anesthesia was significantly higher with 3.6 mL of articaine at 48 minutes and beyond, but neither volume provided complete pulpal anesthesia for all subjects that lasted at least 60 minutes.

There are few reports on rocuronium infiltration under general anesthesia. We report a case of suspected accidental rocuronium infiltration during anesthesia induction. A 25-year-old woman with autism spectrum disorder, intellectual disability, and epilepsy was scheduled for the extraction of 4 impacted third molars under general anesthesia. After induction with sevoflurane, an intravenous (IV) line was established in the left cephalic vein. Rocuronium was administered; however, subcutaneous swelling at the IV site was observed immediately. Spontaneous ventilations were maintained until additional rocuronium was administered via a new IV line. After heat pack application, the swelling disappeared 60 minutes after infiltration, and no tissue damage was observed. A strategy was developed to continue neuromuscular monitoring until recovery occurred. Acceleromyography was used, and the train-of-4 ratios at 99, 130, and 140 minutes after infiltration were 0.79, 0.91, and 1.0, respectively. Sugammadex was administered to prevent neuromuscular blockade recurrence. The patient was extubated once adequate return of muscle function and consciousness were observed. No neuromuscular block prolongation or recurrence were observed postoperatively. When rocuronium infiltration is suspected, it is important to eliminate swelling at the infiltration site and determine a management strategy based on neuromuscular monitoring.

A 54-year-old man with squamous cell carcinoma of the tongue underwent bilateral cervical lymph node dissection, total tongue resection, forearm flap reconstruction, and tracheostomy. The plan was to replace the oral endotracheal tube (ETT) with a cuffed tracheostomy tube at the end of the surgical case while the patient was still under general anesthesia. No major complications were expected as the tracheal foramen was visible once surgical access was obtained. However, removal of the ETT and subsequent placement of the tracheostomy tube failed twice. Successful ventilation was not observed via capnography, and the patient’s peripheral oxygen saturation (SpO₂) dropped to 70%. The anesthesiologist concluded that securing the airway through the tracheostomy would be difficult. The patient was immediately reintubated orally at which time his SpO₂ was 38%, and he was successfully resuscitated and recovered without any sequelae. This rare situation was one we had not encountered previously, so we retrospectively analyzed all tracheostomy cases performed by our department from the past 3 years. Data from 54 patients who underwent tracheostomy tube exchange after tracheostomy were aggregated from their medical records and compared with our patient. Excluding the conditions during surgery, we surmised that tracheal depth, S/H ratio, and body weight were identified as potentially significant risk factors for failed tracheal tube placement or exchange.

Beard J, Methangkool E, Angus S, Urman RD, Cole DJ. Consensus recommendations for the safe conduct of nonoperating room anesthesia: a meeting report from the 2022 Stoelting Conference of the Anesthesia Patient Safety Foundation. Anesth Analg. 2023;137(2):e8–e11. doi:10.1213/ANE.0000000000006539

Summary: This is the report of the 2022 Stoelting Consensus Conference on Crucial Patient Safety Issues in Office-Based Anesthesia. Nonoperating room anesthesia (NORA) is projected to exceed 50% of total anesthesia cases in the near future; however, few published safety recommendations exist. Drawing from a multidisciplinary group of experts, the conference sought to determine best practices for NORA. A

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

Visit Las Vegas for the 2024 ADSA/IFDAS Meeting

Success of Pulpal Anesthesia Following Buccal Infiltration of the Maxillary First Molar With 1.8 mL and 3.6 mL of 4% Articaine With 1:100,000 Epinephrine: A Prospective, Randomized Crossover Study

Objective:

Methods:

Results:

Conclusion:

Suspected Accidental Infiltration of Rocuronium During General Anesthesia Induction: A Case Report

Tracheostomy Tube Exchange Failure Under General Anesthesia: A Case Report and Retrospective Analysis

Positional Change Used to Manage Postextubation Respiratory Failure in a Child With Cerebral Palsy

Perioperative Analgesia Using an Indwelling Catheter to Deliver an Inferior Alveolar Nerve Block: A Case Report

A Case Report of Burning Mouth Syndrome with Dry Mouth Managed by Kampo Medicine

Pronounced QT Prolongation During General Anesthesia in a Child with Left Ventricular Noncompaction Cardiomyopathy: A Case Report

Dental Treatment Under General Anesthesia With Nasal Intubation in a Patient With Selective Immunoglobulin A Deficiency

A Review of Current Oral Sedation Agents for Pediatric Dentistry

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

Beard J, Methangkool E, Angus S, Urman RD, Cole DJ. Consensus recommendations for the safe conduct of nonoperating room anesthesia: a meeting report from the 2022 Stoelting Conference of the Anesthesia Patient Safety Foundation. Anesth Analg. 2023;137(2):e8–e11. doi:10.1213/ANE.0000000000006539

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

Comparison of the Length and Shape of Various Preformed Nasotracheal Tubes

Commentary: Are Anesthesiologists Still “Darting” Their Patients?

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

Immunohistochemical Analysis of Maxillary Nerve Distribution in Rats

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