Anesthesia Progress Volume 71: Issue 1

Objective

This study aimed to evaluate the incidence of early (up to 2 h) and late (2–24 h) postoperative nausea and vomiting (PONV) and hypotension in patients who underwent general anesthesia for orthognathic surgery using propofol or remimazolam along with remifentanil.

Methods

This retrospective chart review included healthy adult patients under the age of 60 who underwent orthognathic surgery using propofol (P group) or remimazolam (R group) from January 2021 to March 2022. Records were reviewed to gather PONV and intraoperative hypotension data as well as patient characteristics and other variables.

Results

Early PONV was significantly lower in the P group vs the R group (9.5% vs 34.1%, respectively; P = .002), although the difference in late PONV was insignificant (36.9% vs 51.2%, respectively; P = .13). A higher incidence of intraoperative hypotension was noted in the P group (22.6%) vs the R group (2.4%; P = .004); however, there were no differences in average intraoperative systolic blood pressure or vasopressor administration.

Conclusion

These results suggest that propofol is associated with a lower incidence of early PONV as compared to remimazolam; however, antiemetics are still recommended given the frequency of late PONV in both groups. Propofol also caused more episodes of intraoperative hypotension vs remimazolam, but the increase in transient hypotension is likely to be irrelevant during orthognathic surgery in healthy adults under the age of 60.

Objective

Although there are conflicting data, several authors have proposed that articaine’s molecular properties suggest improved perfusion capabilities over other amide anesthetics. The purpose of this prospective, randomized, crossover study was to evaluate the anesthetic efficacy of palatal soft-tissue anesthesia following a buccal infiltration of 1.8 and 3.6 mL of 4% articaine with 1:100,000 epinephrine.

Methods

One hundred eighteen adults received 1.8 or 3.6 mL of 4% articaine with 1:100,000 epinephrine as a buccal infiltration of the maxillary first molar at 2 separate appointments. Palatal soft-tissue anesthesia was evaluated with a dental explorer. Anesthetic success was defined as the absence of pain with an explorer stick. For the subjects who achieved palatal anesthesia, mapping was conducted over 70 minutes, and the overall area of palatal anesthesia was calculated. The data were analyzed using chi-square tests.

Results

The highest percentage of palatal anesthetic success was 20% for the 1.8-mL volume and 32% for the 3.6-mL volume both at 30 minutes. A statistically significant difference between the 1.8- and 3.6-mL volumes was seen at 40 minutes. There was high variability in area measurements for subjects who achieved palatal anesthesia. The highest area measurements were 92 mm² for the 1.8-mL volume at 20 minutes and 113 mm² for the 3.6-mL volume at 10 minutes.

Conclusion

Because of the low success rates (20%–32%) and the high variability of the area anesthetized for the subjects who achieved palatal anesthesia, the clinical efficacy of 1.8 or 3.6 mL of articaine via buccal infiltration for palatal anesthesia is of questionable value.

Objective: The goal of this study was to compare the efficacy of midazolam/meperidine (M/M) vs midazolam/hydromorphone (M/H) for enteral moderate sedation along with inhalational sedation in pediatric dental patients.

Methods: This retrospective chart review analyzed the charts of pediatric patients who received dental treatment under enteral moderate sedation with either M/M or M/H in combination with inhalational sedation (nitrous oxide/oxygen) at El Rio Community Health Centers (affiliated with NYU Langone) in Tucson, Arizona, from July 2014 to December 2020. Included subjects were between 2 and 5 years of age, less than 20 kg, and otherwise healthy. In addition to demographic and drug-dosing data, treatment completion, sedation level, behavioral score, overall effectiveness, and sedation duration data were collected and analyzed from each patient’s chart.

Results: No statistically significant differences were observed when comparing the 2 drug regimens in treatment completion (P = .89), sedation level (P = .74), and overall effectiveness (P = .70). There was a statistically significant difference in behavior scoring, with the M/H group demonstrating higher scores (P = .04) than the M/M group.

Conclusion: The combination of midazolam and hydromorphone may provide an effective alternative to midazolam and meperidine when used with inhalational sedation (nitrous oxide/oxygen) for the moderate sedation of pediatric dental patients.

In Japan and North America, specifically the United States and Canada, dentists are legally permitted to provide sedation and general anesthesia. Although the provision of general anesthesia by dentists was very popular in the United Kingdom, a very small number of poor patient outcomes led it being banned in 1991.¹ This contrast naturally raises concerns and questions of patient safety. Therefore, dentist anesthesiologists in countries where they are currently allowed to provide sedation and general anesthesia should strive to answer the question, “How safe is anesthesia management by dentist anesthesiologists?” with scientific evidence.

Although the Japanese Dental Society

The Necessity of Self-Care

Retrospective Study on the Incidence of Postoperative Nausea and Vomiting and Hypotension During Orthognathic Surgery Using Propofol or Remimazolam

Objective

Methods

Results

Conclusion

Efficacy of Maxillary Buccal Infiltration of Articaine for Palatal Anesthesia: A Prospective, Randomized, Crossover Study

Objective

Methods

Results

Conclusion

Efficacy of Midazolam/Meperidine vs Midazolam/Hydromorphone for Enteral Moderate Sedation in the Pediatric Dental Patient

General Anesthetic Management of a Patient With Spondyloepiphyseal Dysplasia Congenita Undergoing Palatoplasty Revision

Three Cases of Persistent Laryngeal Edema Postradiation Therapy

Perioperative Management of a Patient With Idiopathic Pulmonary Hypertension and a History of Syncope: A Case Report

Use of a Modified Endotracheal Tube for Postoperative Intranasal Hemorrhage

General Anesthesia for a Child With Methylmalonic Acidemia Undergoing Oral Care and Dental Treatment Before Kidney Transplantation

How Safe Is Anesthesia Management by Dentist Anesthesiologists? The Need for an International Collaborative Study on the Safety of Anesthesia Management by Dentist Anesthesiologists

A Review of Muscular Dystrophies

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

Gandhi HA, Olson G, Lee H, et al. Assessing the safety of deep sedation in outpatient pediatric oral health care. J Am Dent Assoc. 2023;154(11):975–983.e1. doi:10.1016/j.adaj.2023.07.019. Epub September 5, 2023. PMID: 37676186.

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

Perioperative Management of a Patient With Idiopathic Pulmonary Hypertension and a History of Syncope: A Case Report

Efficacy of Midazolam/Meperidine vs Midazolam/Hydromorphone for Enteral Moderate Sedation in the Pediatric Dental Patient

How Safe Is Anesthesia Management by Dentist Anesthesiologists? The Need for an International Collaborative Study on the Safety of Anesthesia Management by Dentist Anesthesiologists

General Anesthetic Management of a Patient With Spondyloepiphyseal Dysplasia Congenita Undergoing Palatoplasty Revision