Journal of Dental Anesthesia and Pain Medicine最新文献

Background: In order to assess the effectiveness of various analgesio-sedative combinations for pain relief and sedation in pediatric dental patients, a thorough evaluation of clinical studies and patient outcomes is necessary.

Methods: A total of 128 healthy, uncooperative pediatric dental patients were randomly allocated to receive one of the four combinations of drugs via the intranasal (IN) route: Group I received midazolam-ketamine (MK), Group II received dexmedetomidine-ketamine (DK), Group III received midazolam-fentanyl (MF), and Group IV received dexmedetomidine-fentanyl (DF) in a parallel-arm study design. The efficacy and safety of the combinations were evaluated using different parameters.

Results: The onset of sedation was significantly faster in the DF group than in the DK, MF, and MK groups (P < 0.001). The depth of sedation was significantly higher in the DK and DF groups than in the MK and MF groups (P < 0.01). DK and DF produced significant intra- and postoperative analgesia when compared with combinations of MK and MF. No significant adverse events were observed for any of the combinations.

Conclusions: The DK and DF groups showed potential as analgesio-sedatives in view of their anxiolytic and analgesic effects.

[This corrects the article on p. 345 in vol. 21, PMID: 34395902.].

Damage to the endotracheal tube (ETT) during oral and maxillofacial surgeries is a rare but serious intraoperative complication. Herein, we present a case of a partially damaged ETT that was repaired using Dermabond surgical adhesive (Ethicon, Sommerville, NJ, USA) during a Lefort osteotomy. Dermabond surgical adhesive can be a simple and viable tool to repair partially transected ETTs where ETT exchange carries a high risk of airway loss. Our case adds to one of the several techniques for managing damaged ETT in an intraoperative setting.

Background: Dentists make various efforts to reduce patients' anxiety and fear associated with dental treatment. Dental sedation is an advanced method that dentists can perform to reduce patients' anxiety and fear and provide effective dental treatment. However, dental sedation is different from general dental treatment and requires separate learning, and if done incorrectly, can lead to serious complications. Therefore, sedation is performed by a limited number of dentists who have received specific training. This study aimed to investigate the proportion of dentists who practice sedation and the main sedatives they use in the context of the Republic of Korea.

Methods: We used the customized health information data provided by the Korean National Health Insurance. We investigated the number of dental hospitals or clinics that claimed insurance for eight main sedatives commonly used in dental sedation from January, 2007 to September, 2019 at the Health Insurance Review and Assessment Service. We also identified the changes in the number of dental medical institutions by region and year and analyzed the number and proportion of dental medical institutions prescribing each sedative.

Results: In 2007, 302 dental hospitals prescribed sedatives, and the number increased to 613 in 2019. In 2007, approximately 2.18% of the total 13,796 dental institutions prescribed sedatives, increasing to 3.31% in 2019. In 2007, 168 institutions (55.6%) prescribed N₂O alone, and in 2019, 510 institutions (83.1%) made claims for it. In 2007, 76 (25.1%) hospitals made claims for chloral hydrate, but the number gradually decreased, with only 29 hospitals (4.7%) prescribing it in 2019. Hospitals that prescribed a combination of N₂O, chloral hydrate, and hydroxyzine increased from 27 (8.9%) in 2007 to 51 (9%) in 2017 but decreased to 38 (6.1%) in 2019. The use of a combination of N₂O and midazolam increased from 20 hospitals (6.6%) in 2007 to 51 hospitals (8.3%) in 2019.

Conclusion: While there is a critical limitation to the investigation of dental hospitals performing sedation using insurance claims data, namely exclusion of dental clinics providing non-insured treatments, we found that in 2019, approximately 3.31% of the dental clinics were practicing sedation and that N₂O was the most commonly prescribed sedative.

Background: Extrusion of debris is a major factor that results in postoperative pain during root canal treatment with various instruments and instrumentation techniques. Therefore, instrumentation techniques that extrude minimal debris into the periapical area while reducing pain are desirable. This study aimed to compare the incidence of postoperative pain and intake of analgesic medication (frequency and quantity) after endodontic treatment of mandibular posterior teeth using two single files and full-sequence continuous rotary systems with different kinematic motions.

Methods: Thirty-five of 105 patients were assigned equally to three groups according to the instrumentation system used: ProTaper Next (PN) X2, 25/06 (Dentsply, Maillefer, Ballaigues, Switzerland), One Shape (OS), #0.25/06 (Micro Mega, Besancon, France), and Wave One Gold (WG), Red - #0.25, 0.07 (Dentsply, Maillefer, Ballaigues, Switzerland). Five specialists were included in this study design; each professional prepared 21 teeth, and randomly selected 7 per instrument system. The VAS sheet ranging from 0 to 10 was used to record the initial and postoperative pains at 24, 48, and 72 h, and 7^th day after single visit endodontic treatment in mandibular premolars and molars with a diagnosis of asymptomatic irreversible pulpitis with or without apical periodontitis. Postoperatively, an analgesic, ibuprofen 400 mg was administered for intolerable pain at a dose of 1 tablet for 6 h. The patients were asked over the telephone regarding postoperative pain at intervals of 24, 48, and 72 h, and 7^th day using a visual analogue scale.

Result: There were no statistically significant differences among the PN, OS, and WG systems (P > 0.05) with regard to the incidence of postoperative pain at any of the four time points assessed.

Conclusion: The intensity of postoperative pain, frequency, and analgesic intake were similar across all three types of instrument systems; however, the reciprocating single file (WG) was associated with less postoperative pain than the full sequence continuous rotary file.

General anesthesia may influence the postoperative sleep cycle; however, no clinical studies have fully evaluated whether anesthesia causes sleep disturbances during the postoperative period. In this scoping review, we explored the changes in postoperative sleep cycles during surgical procedures or dental treatment under general anesthesia. We compared and evaluated the influence of general anesthesia on sleep cycles and sleep disturbances during the postoperative period in adult and pediatric patients undergoing surgery and/or dental treatment. Literature was retrieved by searching eight public databases. Randomized clinical trials, observational studies, observational case-control studies, and cohort studies were included. Primary outcomes included the incidence of sleep, circadian cycle alterations, and/or sleep disturbances. The search strategy yielded six studies after duplicates were removed. Finally, six clinical trials with 1,044 patients were included. In conclusion, general anesthesia may cause sleep disturbances based on alterations in sleep or the circadian cycle in the postoperative period in patients scheduled for elective surgery.

Background: With advances in safety measures for anesthesia, conscious sedation has gained popularity in the field of dentistry and has become essential in dental practice worldwide. However, in Tanzania, intravenous (IV) sedation is rarely practiced in the dental field. Therefore, we report the establishment of sustainable IV conscious sedation in dental practices and subsequently train local OMS residents in Tanzania.

Methods: In 2019, intravenous conscious sedation was initiated at the University Dental Clinic of the Muhimbili University of Health and Allied Science (MUHAS), Tanzania. During the preparatory phase of the program, local oral and maxillofacial surgeons (OMSs) were given a series of lecture notes that concentrated on different aspects of IV conscious sedation in dentistry. During the on-site training phase, an oral surgeon from the United States joined the OMSs for case selection, IV-conscious sedation procedures, and patient follow-up. Patients were recruited from existing patient records at the MUHAS Dental Clinic.

Results: The first conscious IV sedation program in dentistry was successfully launched at the University Dental Clinic in Tanzania. The local team of OMSs was trained on the safe administration of sedative agents (midazolam or ketamine) to perform various minor surgical procedures in a dental office. Nine patients with different ages, body masses, and medical conditions benefited from the training. No complications were associated with IV conscious sedation in the dental office.

Conclusion: This was the first successful "hands-on" training on IV conscious sedation provided to OMSs in Tanzania. It laid the foundation for the sustainable care of patients with special needs requiring oral health-related care in the country.