Anesthesia Progress Volume 71: Issue 3

Objective

Dilution of concentrated epinephrine prior to intravenous use during clinical emergencies can delay urgent interventions. The objective of this study was to determine whether diluted epinephrine remains stable and sterile over time in common hospital settings.

Methods

Epinephrine samples were prepared by clinically relevant double dilution techniques. Samples were stored in 10-mL syringes and incubated under 1 of 4 simulated hospital environments with a mixture of lighting and temperature settings: 4°C/20°C, with or without fluorescent lighting. Samples were incubated for 0, 15, 30, 60, or 90 days. Capillary zonal electrophoresis was used to quantify the concentration of epinephrine and/or presence of any degradation products. All samples were tested for the presence of bacterial growth using blood agar cultures.

Results

Diluted epinephrine samples remained stable for up to 90 days in all 4 simulated clinical storage conditions. No bacterial colony-forming units were detected in any of the environmental samples regardless of incubation duration, light, or temperature conditions.

Conclusion

Diluted epinephrine for anticipated clinical emergencies may remain clinically useful for up to 90 days, thus improving patient safety, access to medications, and overhead costs by reducing waste.

Objective

More than 1 in 8 New Zealand (NZ) adults are dentally anxious, which can lead to avoiding dental care and a higher risk of poor oral health. However, little is known about how dentally anxious patients are identified and managed by NZ general dentists. This survey aimed to investigate how NZ dentists identify and manage dentally anxious patients.

Methods

We conducted an email survey of NZ dentists in 2022, obtaining 212 responses. Along with demographic information, respondents were queried about whether they ask patients about past/current dental fears and their likely origin, how they assessed those fears, their usual management of dentally anxious patients, and how the management of dentally anxious patients could be improved.

Results

Almost three-quarters reported personally asking patients about past and/or current dental fears, and half enquired about bad life experiences that had led to those fears. Only 6 respondents (2.8%) reported using a formal dental anxiety/phobia assessment tool prior to treatment. For managing severely anxious adult dental patients, all dentists used at least 1 pharmacologic or psychological technique or referral to a colleague.

Conclusion

The study identified several weaknesses among NZ dentists in identifying and managing dental anxiety patients. The use of formal dental anxiety/phobia assessment tools prior to treatment needs improvement. Addressing dental anxiety is a complex issue that requires a multipronged approach involving improved education, the development and implementation of better assessment tools, and a greater understanding of how dentists’ current assessment and management of dental anxiety can be improved.

Objective

To evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine via primary intraosseous (IO) injection with the QuickSleeper device vs inferior alveolar nerve block (IANB) for mandibular first molars diagnosed with symptomatic irreversible pulpitis (SIP).

Methods

Sixty-four patients with a first mandibular molar with SIP were randomly divided into 2 groups: IO (n = 32) and IANB (n = 32). Each received either an IO injection with the 5th generation QuickSleeper device or a conventional IANB with 1.7 mL 4% articaine with 1:100,000 epinephrine. Success was defined as no/mild pain upon the access cavity preparation and initial filing. Injection pain, anesthetic onset, heart rate (HR) change, HR recovery time, and duration of anesthesia were also recorded and analyzed.

Results

The success rates were 40.6% for IANB and 81.2% for IO (P < .001). IO exhibited a significantly lower injection pain (P = .027), a shorter onset of action (P < .001), a greater heart rate increase (P < .001), a faster heart rate recovery time (P < .001), and a shorter duration of action (P < .001) vs IANB.

Conclusion

Primary IO anesthesia using the fifth generation of the QuickSleeper device was more successful than IANB when using 4% articaine with 1:100,000 epinephrine to anesthetize mandibular first molars with SIP. The QuickSleeper device appeared to be a viable alternative to IANB for mandibular anesthesia.

Sprung J, Deljou A, Schroeder D, Warner D, Weingarten T. Effect of propofol infusion on need for rescue antiemetics in postanesthesia care unit after volatile anesthesia: a retrospective cohort study. Anesth Analg. 2024;139(1):26–34. doi:10.1213/ANE.0000000000006906

This retrospective analysis examined the anesthetic records of 47,847 patients undergoing procedures with volatile agents, with or without propofol infusion, at a single institution from May 2018 through December 2020. The study tested the hypothesis that adding a propofol infusion to a volatile-based anesthetic would be associated with a dose-dependent decrease in the use of rescue antiemetic drugs in the postanesthesia care unit (PACU).

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

Do You Have a Backup Plan or Exit Strategy?

Stability of Epinephrine in a Normal Saline Solution

Objective

Methods

Results

Conclusion

Identification and Management of Dental Anxiety by New Zealand Dentists

Objective

Methods

Results

Conclusion

Efficacy of QuickSleeper Intraosseous Injection of 4% Articaine in Mandibular First Molars With Symptomatic Irreversible Pulpitis: A Randomized Controlled Trial

Objective

Methods

Results

Conclusion

Petroleum Jelly–Based Foreign Body in the Nasopharynx: A Case Report

Intraoperative Endobronchial Intubation After Successful Submental Intubation

Anesthetic Management of a Pediatric Patient With Pfeiffer Syndrome

An Automatic Cuff Pressure Controller (SmartCuff) Detected Cuff Damage in a Tracheal Tube: A Case Report

Intranasal Premedication With Dexmedetomidine in an Adult Patient With Intellectual Disabilities: A Case Report

Dental Sedation and General Anesthesia Considerations for Patients Posthepatic Transplantation

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

Sprung J, Deljou A, Schroeder D, Warner D, Weingarten T. Effect of propofol infusion on need for rescue antiemetics in postanesthesia care unit after volatile anesthesia: a retrospective cohort study. Anesth Analg. 2024;139(1):26–34. doi:10.1213/ANE.0000000000006906

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