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Usefulness of Tulip Airway in Edentulous Elderly Patients. 郁金香气道在老年无牙患者中的应用。
Q3 Medicine Pub Date : 2022-09-01 DOI: 10.2344/anpr-69-01-01
Yasuhiko Imashuku, Hirotoshi Kitagawa, Takayoshi Mizuno

Objective: Mask ventilation can be difficult in elderly edentulous patients. Various solutions have been proposed to address this challenge. This study assessed the use of a new airway-securing device called the Tulip Airway and investigated its application in simulated edentulous patients.

Methods: This pilot study utilized a modified edentulous airway training mannequin and a high-performance simulator. Participants attempted to ventilate the edentulous mannequin using a Guedel oropharyngeal airway and face mask (M method) or the Tulip Airway (T method). Successful inflation of the mannequin model lung was confirmed visually. The time required for the insertion of the Tulip Airway was also assessed. A high-performance simulator was then used to compare ventilation volumes achieved using the M and T methods, and data subsequently analyzed.

Results: In the edentulous mannequin, lung inflation was not achieved by any participants using the M method, but all were successful using the T method. Insertion time for the Tulip Airway was ∼8 seconds. Median ventilation volumes achieved using the high-performance simulator were higher for the T method (308 mL) compared with the M method (192 mL; P < .05).

Conclusion: The results of this pilot study indicate that the Tulip Airway is an effective airway device for use in edentulous patients with difficult mask ventilation.

目的:老年无牙患者面罩通气困难。已经提出了各种解决方案来应对这一挑战。本研究评估了一种称为郁金香气道的新型气道固定装置的使用,并调查了其在模拟无牙患者中的应用。方法:本研究采用改良无牙气道训练模型和高性能模拟器。参与者尝试使用Guedel口咽气道和面罩(M法)或Tulip气道(T法)为无牙假人模型通气。视觉上证实了人体模型肺的成功充气。还评估了插入郁金香气道所需的时间。然后使用高性能模拟器比较使用M和T方法获得的通风量,并随后分析数据。结果:在无牙假人模型中,所有参与者使用M法均未实现肺膨胀,但使用T法均成功。Tulip气道的插入时间为~ 8秒。使用高性能模拟器获得的中位通风量,T法(308 mL)高于M法(192 mL);P & lt;. 05)。结论:本初步研究结果表明,郁金香气道是一种有效的气道装置,适用于无牙患者面罩通气困难。
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引用次数: 0
Perioperative Management of Oral Antithrombotics in Dentistry and Oral Surgery: Part 1 牙科和口腔外科口腔抗血栓药物的围手术期管理:第1部分
Q3 Medicine Pub Date : 2022-09-01 DOI: 10.2344/anpr-69-03-05
B. J. Statman
Increasing numbers of patients seeking dental care are at heightened thrombotic or thromboembolic risk and are therefore taking either oral antiplatelet (OAP) or oral anticoagulant (OAC) agents that disrupt the coagulation process. In addition, the arsenal of OAP and OAC agents in use has continued to expand as new drug development persists. The impairment of functional coagulation by these agents can lead to prolonged and/or major blood loss from surgical sites during invasive dental procedures. To properly manage these patients perioperatively, sedation and anesthesia providers for dentistry and oral surgery must understand the pharmacokinetics and pharmacodynamics of these agents as well as the factors that influence and augment bleeding and thrombotic risk. Part 1 of this review will present a summary of the coagulation processes and discuss the pharmacokinetic and pharmacodynamic properties of oral antithrombotics currently approved for use in the United States. Part 2 will focus on factors that affect perioperative management of antithrombotic agents with special consideration given to procedures typically encountered when providing sedation and anesthesia in the dental setting.
越来越多的寻求牙科保健的患者有血栓或血栓栓塞的高风险,因此服用口服抗血小板(OAP)或口服抗凝剂(OAC),这些药物会破坏凝血过程。此外,随着新药开发的持续进行,正在使用的OAP和OAC制剂的武器库也在继续扩大。在侵入性牙科手术中,这些药物对凝血功能的损害可导致手术部位长时间和/或大量失血。为了在围手术期正确管理这些患者,牙科和口腔外科的镇静和麻醉提供者必须了解这些药物的药代动力学和药效学,以及影响和增加出血和血栓形成风险的因素。本综述的第一部分将概述凝血过程,并讨论目前在美国批准使用的口服抗血栓药物的药代动力学和药效学特性。第2部分将重点关注影响抗血栓药物围手术期管理的因素,特别考虑到在牙科环境中提供镇静和麻醉时通常遇到的程序。
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引用次数: 0
A Review of Current Literature of Interest to the Office-Based Anesthesiologist. 对办公室麻醉师感兴趣的当前文献综述。
Q3 Medicine Pub Date : 2022-09-01 DOI: 10.2344/1878-7177-69.3.48
Mark A Saxen
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引用次数: 0
Risk Factors for Postoperative Sore Throat After Nasotracheal Intubation. 鼻气管插管术后咽喉痛的危险因素分析。
Q3 Medicine Pub Date : 2022-09-01 DOI: 10.2344/anpr-69-01-05
Masanori Tsukamoto, Shiori Taura, Sayuri Kadowaki, Takashi Hitosugi, Yoichiro Miki, Takeshi Yokoyama

Objective: Postoperative sore throat is relatively frequent complication after orotracheal intubation. However, there are few reports about postoperative sore throat in nasotracheal intubation. In this retrospective study, we investigated the risk factors of postoperative sore throat in nasotracheal intubation.

Methods: Anesthesia records of patients 16 to 80 years of age who underwent nasotracheal intubation were included. Patients underwent oral and maxillofacial surgery from February 2015 until September 2018. Airway device (Macintosh laryngoscope, Pentax-AWS, or McGRATH video laryngoscope, or fiberoptic scope), sex, age, height, weight, American Society of Anesthesiologists classification, intubation attempts, duration of intubation, intubation time, tube size, and fentanyl and remifentanil dose were investigated. Fisher exact test, Wilcoxon rank sum test, Welch t test, and Steel-Dwass multiple test were used, and a multivariable analysis was performed using stepwise logistic regression to determine the risk factors of postoperative sore throat.

Results: A total of 169 cases were analyzed, and 126 patients (74.6%) had a postoperative sore throat. Based on the univariate analysis of the data, 12 factors were determined to be potentially related to the occurrence of a postoperative sore throat. However, after evaluation using stepwise logistic regression analysis, the 2 remaining variables that correlated with postoperative sore throat were airway device (P < .05) and intubation attempts (P = .04). In the model using logistic regression analysis, the fiberoptic scope had the strongest influence on the incidence of sore throat with reference to Pentax-AWS (odds ratio = 5.25; 95% CI = 1.54-17.92; P < .05).

Conclusion: Use of a fiberoptic scope was identified as an independent risk factor for postoperative throat discomfort. Compared with direct laryngoscopy and other video laryngoscopes, the use of a fiberoptic scope had a significantly higher incidence of sore throat.

目的:术后咽痛是气管插管术后较为常见的并发症。然而,关于鼻气管插管术后喉咙痛的报道很少。在这项回顾性研究中,我们探讨了鼻气管插管术后喉咙痛的危险因素。方法:收集16 ~ 80岁鼻气管插管患者的麻醉记录。患者从2015年2月至2018年9月接受了口腔颌面手术。调查气道设备(Macintosh喉镜、Pentax-AWS或McGRATH视频喉镜或光纤镜)、性别、年龄、身高、体重、美国麻醉师学会分类、插管次数、插管时间、插管时间、管径、芬太尼和瑞芬太尼剂量。采用Fisher精确检验、Wilcoxon秩和检验、Welch t检验和Steel-Dwass多重检验,采用逐步logistic回归进行多变量分析,确定术后咽喉痛的危险因素。结果:共分析169例患者,术后出现咽痛126例(74.6%)。根据数据的单因素分析,确定了12个因素与术后喉咙痛的发生有潜在的关系。然而,经逐步logistic回归分析评估后,与术后喉咙痛相关的剩余2个变量为气道装置(P <.05)和插管次数(P = .04)。在logistic回归分析模型中,与Pentax-AWS相比,光纤镜对喉咙痛的发生率影响最大(优势比= 5.25;95% ci = 1.54-17.92;P & lt;. 05)。结论:纤维镜的使用是术后咽喉不适的独立危险因素。与直接喉镜和其他视频喉镜相比,使用纤维喉镜的咽喉痛发生率明显更高。
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引用次数: 1
ACE-Inhibitor or ARB-Induced Refractory Hypotension Treated With Vasopressin in Patients Undergoing General Anesthesia for Dentistry: Two Case Reports. 加压素治疗牙科全麻患者ace抑制剂或arb诱导的难治性低血压:两例报告
Q3 Medicine Pub Date : 2022-09-01 DOI: 10.2344/anpr-69-02-06
Caitlin M Waters, Kristen Pelczar, Edward C Adlesic, Paul J Schwartz, Joseph A Giovannitti
Two case reports present the use of vasopressin for treating refractory hypotension associated with continued angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy prior to general anesthesia for oral surgery. Both patients were treated in an ambulatory dental surgery clinic and took either their ACEI or ARB medication for hypertension within 24 hours prior to undergoing an intubated general anesthetic. Persistent profound hypotension was encountered intraoperatively that was refractory to treatment with traditional methods. However, the ACEI- or ARB-induced refractory hypotension was successfully managed with the administration of vasopressin.
两例报告显示,在口腔手术全身麻醉前,血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体阻滞剂(ARB)治疗难治性低血压的使用加压素。两名患者均在门诊牙科诊所接受治疗,并在接受插管全身麻醉前24小时内服用高血压ACEI或ARB药物。术中出现传统方法难以治疗的持续性深度低血压。然而,ACEI或arb诱导的难治性低血压在给予加压素的情况下得到了成功的治疗。
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引用次数: 1
Anesthesia Management of a Patient With Familial Cold Autoinflammatory Syndrome: A Case Report. 家族性感冒自体炎症综合征患者的麻醉处理:1例报告。
Q3 Medicine Pub Date : 2022-09-01 DOI: 10.2344/anpr-69-02-04
Ruri Teshima, Akiko Nishimura, Akira Hara, Yuhei Ubukata, Sayaka Chizuwa, Mone Wakatsuki, Takehiko Iijima

Familial cold autoinflammatory syndrome (FCAS) is a rare phenotype of cryopyrin-associated periodic syndrome (CAPS) and is characterized by repetitive systemic inflammation triggered by cold stimulation. Recently, we treated a 13-year-old female with FCAS/CAPS scheduled to undergo removal of an impacted tooth. To minimize perioperative heat loss, a forced-air warming system was utilized to prewarm the patient for 10 minutes before induction of general anesthesia. The patient's core and peripheral temperatures were monitored with axillary, superficial temporal artery, and rectal thermometers. The difference in temperatures at these 3 locations decreased to 0.4° C within 60 minutes as a result of the forced-air warming system before induction. Perioperative use of the warming system successfully prevented the occurrence any significant redistribution hypothermia and any symptoms of FCAS/CAPS.

家族性寒冷自体炎症综合征(FCAS)是一种罕见的低温素相关周期性综合征(CAPS),其特征是由寒冷刺激引发的重复性全身炎症。最近,我们治疗了一名患有FCAS/CAPS的13岁女性,计划进行阻生牙的移除。为了尽量减少围手术期的热损失,在全麻诱导前使用强制空气加热系统对患者进行预热10分钟。用腋窝体温计、颞浅动脉体温计和直肠体温计监测患者核心和外周温度。由于感应前的强制空气加热系统,这三个位置的温差在60分钟内降至0.4°C。围手术期使用升温系统成功地防止了任何显著的再分布性低体温和FCAS/CAPS的任何症状的发生。
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引用次数: 0
Reliability and Validity of the Dental Anxiety Question Used With Children. 儿童牙科焦虑问题的信度和效度。
Q3 Medicine Pub Date : 2022-09-01 DOI: 10.2344/anpr-69-01-04
Masahiro Heima, Kelsey Stehli

Objective: Dental fear screening is an important part of providing a positive pediatric dental experience. To improve efficiency, the development of a single-item dental fear assessment tool for children has been desired. In this psychometric analysis, the reliability and validity of the Dental Anxiety Question (DAQ) is studied when used in children aged 7 to 18 years.

Methods: Participants completed the DAQ (pre-tx-DAQ), the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and a demographic information questionnaire before treatment. Participants repeated the DAQ after treatment (post-tx-DAQ) and once more at least 2 weeks later (follow-up-DAQ). Stability reliability within the DAQ scores and criterion validity with the CFSS-DS were evaluated.

Results: Stability reliability analyses between pre-tx-DAQ/post-tx-DAQ and post-tx-DAQ/follow-up-DAQ demonstrated significant positive correlations: Spearman rank correlation coefficient (rs) = 0.420, rs2 = 0.18, P < .001, and rs = 0.563, rs2 = 0.32, P < .001, respectively. Criterion validity analysis between the pre-tx-DAQ and CFSS-DS also demonstrated a significant correlation: Pearson correlation coefficient (r) = 0.584, r2 = 0.34, P < .001.

Conclusion: The stability reliability and criterion validity of the DAQ was proved among children.

目的:牙科恐惧筛查是提供积极的儿童牙科体验的重要组成部分。为了提高效率,人们一直希望开发一种针对儿童的单项目牙科恐惧评估工具。在这个心理测量分析中,研究了牙科焦虑问题(DAQ)在7至18岁儿童中使用的信度和效度。方法:受试者在治疗前完成DAQ (pre-tx-DAQ)、儿童恐惧量表-牙科量表(CFSS-DS)和人口统计信息问卷。参与者在治疗后重复DAQ(后-DAQ),至少2周后再重复一次(随访-DAQ)。评估了DAQ评分的稳定性、可靠性和CFSS-DS的效度。结果:前daq /后daq与后daq /随访- daq之间存在显著正相关,Spearman秩相关系数(rs) = 0.420, rs2 = 0.18, P <.001, rs = 0.563, rs2 = 0.32, P <分别措施。pre- daq与CFSS-DS的效度分析也显示出显著的相关性:Pearson相关系数(r) = 0.584, r2 = 0.34, P <措施。结论:该量表在儿童中具有良好的稳定性、信度和效度。
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引用次数: 0
A Case of Wide QRS Tachycardia After the Local Administration of Epinephrine to Reduce Bleeding During General Anesthesia. 全麻局部肾上腺素减少出血后宽QRS心动过速1例。
Q3 Medicine Pub Date : 2022-06-01 DOI: 10.2344/anpr-68-03-05
Nayuka Usami, Midori Tooyama, Wakana Oda, Yuu Kawamoto, Saki Kishimoto, Ayano Minamide, Hitoshi Niwa

We report a case of wide QRS tachycardia or ventricular tachycardia with a pulse after the administration of epinephrine under general anesthesia. After induction and achieving a sufficiently deep plane of general anesthesia, gauze soaked in a 1:100,000 epinephrine solution was applied to the patient's nasal mucosa and 1% lidocaine with 1:100,000 epinephrine was administered via intraoral infiltration. Several minutes after the start of surgery, the patient's blood pressure and heart rate suddenly increased and a wide QRS tachycardia was observed on the electrocardiogram, which then reverted to a normal sinus rhythm. According to the past reports, similar arrhythmias have occurred after administration of epinephrine in the head and neck. These findings suggest that anesthesia providers must be aware of the risks associated with epinephrine and local anesthetic use, particularly in the head and neck region.

我们报告一个病例宽QRS心动过速或室性心动过速与脉搏后给予肾上腺素全麻。诱导并达到足够深度的全麻平面后,将1:10万肾上腺素溶液浸泡的纱布敷于患者鼻黏膜,1%利多卡因加1:10万肾上腺素经口内浸润。手术开始几分钟后,患者血压和心率突然升高,心电图显示宽QRS心动过速,随后恢复正常窦性心律。根据过去的报道,类似的心律失常发生在头颈部使用肾上腺素后。这些发现表明,麻醉提供者必须意识到肾上腺素和局部麻醉使用的相关风险,特别是在头颈部区域。
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引用次数: 3
Tooth Technician or Oral Health Doctor? 牙齿技师还是口腔健康医生?
Q3 Medicine Pub Date : 2022-06-01 DOI: 10.2344/anpr-69-02-15
Kyle J Kramer
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引用次数: 0
General Anesthesia for a Dissociative Identity Disorder Patient With 20 Personalities: A Case Report. 全身麻醉治疗分离性身份障碍患者1例。
Q3 Medicine Pub Date : 2022-06-01 DOI: 10.2344/anpr-68-04-04
Izumi Kuroda, Mayumi Hashimoto, Aiji Sato, Naoko Tachi, Nozomi Okuni, Hikari Tashiro, Hiroka Hattori, Hidemitsu Hasegawa, Masahiro Yamada, Masahiro Okuda
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引用次数: 2
期刊
Anesthesia progress
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