Anesthesia Progress Volume 70: Issue 4

Objective

Remimazolam is a new, ultra-short-acting benzodiazepine that can be used for induction and maintenance of general anesthesia. We compared the hemodynamic stability and depth of anesthesia during general anesthesia using remimazolam or propofol along with remifentanil for oral and maxillofacial surgery.

Methods

A total of 95 patients were divided into remimazolam and propofol groups and then subdivided into bispectral index (BIS) and patient state index (PSI) groups. Blood pressure, heart rate, and BIS/PSI values were compared at fixed time points perioperatively. Time to loss of consciousness and total opioid doses were also compared across groups. Other items that were compared included intraoperative arousal and postoperative nausea and vomiting.

Results

Propofol produced more significant hemodynamic depression than remimazolam, although both groups were stable. BIS/PSI values were similar in both groups. Time to loss of consciousness was significantly shorter in the remimazolam group. Total opioid dosing was higher in the remimazolam group, and there were no differences regarding other postoperative complications.

Conclusion

The perioperative hemodynamics with remimazolam were more stable that with propofol, especially during induction. Therefore, remimazolam may be a safe alternative to propofol for providing TIVA general anesthetics.

Objective

The impact of the COVID-19 pandemic on dental anesthesiologists has not been examined. This study aimed to determine how the COVID-19 pandemic affected Japanese dental anesthesiologists’ professional lives.

Methods

An online questionnaire related to the effects of COVID-19 on dental anesthesiologists’ professional lives was emailed to 351 board-certified dental anesthesiology specialists from the Japanese Dental Society of Anesthesiology. The endpoints of this study were changes in income and job satisfaction as a dental anesthesiologist from 2019 prior to the COVID-19 pandemic.

Results

A total of 141 dental anesthesiologists participated in the survey. Most respondents reported no change in income relative to 2019 for 2020 or 2021. Significantly more dental anesthesiologists reported income decreases relative to 2019 for 2020 (39%) vs 2021 (21.3%; P = .001). Very few dental anesthesiologists reported income increases relative to 2019 for 2020 (2.1%) vs 2021 (15.6%; P < .001). Job satisfaction as a dental anesthesiologist remained unchanged for all 3 years.

Conclusion

Even though many Japanese dental anesthesiologist specialists lost income because of COVID-19, they maintained their job satisfaction.

A tracheal bronchus is a congenital abnormality of the tracheobronchial tree in which a displaced or accessory bronchus arises from the trachea superior to its bifurcation. We herein report a case in which a tracheal bronchus was incidentally found after induction of general anesthesia, and we discuss the potential airway management problems that may have ensued. An 80-year-old man was scheduled for buccal mucosa resection and abdominal skin grafting for treatment of squamous cell carcinoma of the left buccal mucosa. Because of trismus and anticipated airway difficulty, an awake intubation was performed under sedation. A 3-branched structure was incidentally observed at the first branching site that was supposed to be the carina. The tip of the endotracheal tube was repositioned 3 cm above the tracheal trifurcation, and the rest of the procedure proceeded uneventfully. A flexible fiberoptic scope is not used in many anesthesia cases, making the identification of such tracheal or bronchial abnormalities more difficult. Therefore, it is important to carefully check the bronchial morphology on any available chest radiographs before surgery, listen to lung sounds after intubation, and assess thoracic lung compliance without neglecting routine safety checks.

Simpao A, Randazzo I, Chittams J, et al. Anesthesia and sedation exposure and neurodevelopmental outcomes in infants undergoing congenital cardiac surgery: a retrospective cohort study. Anesthesiology. 2023;139(4):393–404. doi: 10.1097/ALN.00000000000 04684

Children undergoing complex cardiac surgery are exposed to substantial cumulative doses of sedative medications and volatile anesthetics and are more frequently anesthetized with ketamine as compared with otherwise healthy children. This study hypothesized that lower neurodevelopmental scores would be associated with this population at 18 months of age due to increased exposure to sedation and anesthesia. Cumulative minimum alveolar concentration hours of exposure to volatile anesthetic agents and

The ASDA-AAOMS-AAP Rules Template

Comparison of Remimazolam and Propofol for Intubated General Anesthesia for Oral and Maxillofacial Surgery

Objective

Methods

Results

Conclusion

The Impact of COVID-19 on Dental Anesthesiologists: An Online Survey of Board-Certified Dental Anesthesiology Specialists of the Japanese Dental Society of Anesthesiology

Objective

Methods

Results

Conclusion

Tracheal Bronchus Detected During General Anesthesia: A Case Report

Management of an Ingested Foreign Body in a COVID-Positive Patient

Ventricular Tachycardia Following Ephedrine During Dexmedetomidine Dental Procedural Sedation

A Case of Anterior Arytenoid Cartilage Dislocation During Nasal Tracheal Intubation Using an Indirect Video Laryngoscope

Anesthetic Management of a Patient With Spinocerebellar Ataxia Type 1

The Use of Pharyngeal Throat Packs in Dental Anesthesia

Respiratory Monitoring for Anesthesia and Sedation

Commentary

Historical Selection: Anderson JA. Respiratory monitoring for anesthesia and sedation. Anesth Prog. 1987;34:228–231.

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

Simpao A, Randazzo I, Chittams J, et al. Anesthesia and sedation exposure and neurodevelopmental outcomes in infants undergoing congenital cardiac surgery: a retrospective cohort study. Anesthesiology. 2023;139(4):393–404. doi: 10.1097/ALN.00000000000 04684

Commentary: Are Anesthesiologists Still “Darting” Their Patients?

Immunohistochemical Analysis of Maxillary Nerve Distribution in Rats

General Anesthesia for a Child With a Living Donor Liver Transplant After Hepatoblastoma and Metastatic Lung Tumor Resection

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

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