Anesthesia progress最新文献

Objective: The purpose of this study was to compare nitrous oxide (N2O) vs virtual reality (VR) as methods for reducing pain and anxiety during a dental injection. The primary objectives were to assess acute changes in stress responses by comparing salivary cortisol levels between the 2 groups and differences in injection pain scores.

Methods: A total of 132 female subjects serving as their own control received maxillary lateral incisor infiltration injections with the use of either N2O or a VR headset during separate appointments spaced at least 2 weeks apart. Salivary cortisol samples were collected at 6 times throughout each appointment. Pain scores for needle insertion and solution deposition were recorded. Data were analyzed statistically using Wald and paired t tests.

Results: N2O significantly lowered salivary cortisol concentrations and subsequent physiologic anxiety as compared with VR (P = .0089). However, no significant differences in needle insertion or solution deposition pain scores were found.

Conclusion: Although VR and N2O may be comparable in terms of perceived pain reduction, N2O was a more effective method than VR for physiologic analgesia and anxiolysis.

Objective: Previous studies of nerve distribution in the orofacial complex have focused primarily on the anatomic courses of nerve fibers and have rarely addressed the density of nerve distribution. The nerve distribution in the mandible was described in only one report which showed an increase in nerve distribution density moving from the alveolar crest toward the inferior alveolar nerve. However, no previous reports have focused on the nerve distribution density in the maxilla.

Methods: In this study involving 6 Wistar rats, tissue samples from the maxillary molar region were obtained and sectioned for staining and analysis. All nerves including nociceptive nerves in 5 regions of the maxilla samples, ranging from the alveolar crest to the superior alveolar nerve, were immunohistochemically stained with antibodies to protein gene product (PGP) and calcitonin gene-related peptide (CGRP) to identify and measure the vertical and horizontal nerve distribution densities in the 5 regions under an optical microscope. We also determined the ratio of nociceptive (CGRP-positive) nerves to all (PGP-positive) nerves.

Results: The densities of both PGP- and CGRP-positive nerves increased vertically from the alveolar crest to the superior alveolar nerve and horizontally from the periosteal side to the periodontal ligament side within the maxilla. The ratio of CGRP- to PGP-positive nerves was on average greater than 80%.

Conclusion: These findings were consistent with those of the previous report on mandibular nerve distribution. However, our results suggest that the overall nerve distribution density in the maxilla is approximately one-third of that in the mandible. The results of this study, which report the nerve distribution density in the posterior maxilla, may support future research on pain and local anesthesia.

Patients with cardiovascular compromise are likely to develop hypotension upon receiving even small doses of sedatives. On the other hand, patients with severe dental phobias or with intellectual disability who have a severe gag reflex often require deeper levels of anesthesia. Thus, achieving an optimal level of anesthesia can be difficult in patients with cardiovascular compromise because of the relatively narrow range of sedative dosing capable of providing sufficient sedation to prevent the gag reflex without compromising hemodynamics. We present a patient with Fontan circulation, severe intellectual disability, and a severe gag reflex who underwent dental treatment using intravenous sedation. Processed electroencephalography (EEG) via a SedLine (Masimo Corporation) monitor was used to identify anesthetic depth, and propofol infusion rates were adjusted based on changes in Patient State Index (PSI) values. However, the PSI values fluctuated greatly in response to stimuli and changes in the depth of anesthesia. In summary, the indications for using feedback control of the sedation level by way of EEG analysis and adjusting propofol infusion rates might be limited in patients with cardiovascular compromise and severe gag reflex because such monitoring may be incapable of keeping pace with rapid changes in the balance between stimulation and the level of anesthesia.

This case series describes the ability of the temporo-masseteric nerve block (TMNB) to expeditiously relieve acute postextraction myogenous pain of masseteric or temporalis origin. In addition, the TMNB injection technique is also briefly reviewed. Briefly, 4 patients with no baseline temporalis or masseter muscle pain developed severe masseteric/temporalis pain during the first postoperative week on the side(s) of their dental extraction(s). The pain was accompanied by trismus. Both the pain and limitation in mouth opening were relieved by the TMNB injection, and symptom alleviation persisted beyond the brief duration of action of the administered local anesthetic. In conclusion, the TMNB injection can potentially serve as a valuable nonopioid adjunct to manage acute postextraction pain of masseteric or temporalis origin. It may be important to delineate acute myogenous postextraction pain from surgical site pain to optimize postoperative pain management and best alleviate trismus. Systematic validation of the TMNB's utility in postextraction pain management is warranted.

Objective: This study revisited data obtained in 2004 regarding whether dentists routinely obtain informed consent (IC) for the administration of local anesthetics and compared those findings with newer data obtained in 2024.

Methods: A previous survey from 2004 which utilized 3 questions including identification of provider type (generalist or specialist) and whether IC is always obtained for local anesthetic administration was replicated in 2024. While the 2004 survey was performed on paper, the 2024 survey was done via a brief oral interview. Both efforts were completed at the annual meetings of The American Dental Society of Anesthesiology (ADSA) in Las Vegas, NV.

Results: A total of 249 respondents opted to participate in the 2024 survey as compared with the 252 respondents from 2004. During the past 20 years, the number of dentists who reported always obtaining IC for the administration of local anesthetics appears to have increased significantly. A total of 196 (79%) of the 2024 participants reported always obtaining IC for local anesthesia compared with 158 (63%) in 2004. Except for dentists limiting their practice to anesthesiology, all other provider categories reported an increase in IC use from 2004 to 2024, and specialists still reported obtaining IC for local anesthesia more frequently than generalists.

Conclusion: The prevalence of including local anesthetic administration with the IC process is increasing in the profession. It is likely that generalists administer many more local anesthetics than specialists overall. The IC subject matter is too nuanced to recommend a single "yes or no" treatment plan as the standard of care for all clinical situations.

Airway management is critical, particularly in patients who undergo oral maxillofacial surgery, and often involves use of nasotracheal intubation which can be difficult. We previously described a technique involving use of a flexible fiberoptic scope to provide continuous indirect vision of the endotracheal tube (ETT) tip and the glottis to assist with successful advancement of the ETT during nasotracheal intubation. Nevertheless, we often have experienced difficulties during intubation using this method as spatial manipulation and direction of the nasal ETT into the trachea may occasionally be difficult. In such cases, combining visualization with the flexible fiberoptic scope along with the cuff inflation technique may be useful to aid manipulation of the ETT, unlike the technique previously combined with a video laryngoscope. We describe this clinical technique which may be used during fiberoptic nasal intubations to help increase success securing the airway.

We present a case in which excessive pressure caused local perfusion failure and a decrease in peripheral oxygen saturation (SpO2) readings in a 10-year-old boy undergoing general anesthesia for a cleft lip and alveolus operation. The pulse oximeter sensor was placed on his left index finger and held in place using adhesive tape before the induction of general anesthesia. Roughly 90 minutes into the operation, his SpO2 became unstable, decreasing rapidly to 85% and returning to 94% repeatedly. As we suspected a problem with the sensor, it was replaced, and his SpO2 readings returned to 100%. However, inspection of his index finger revealed dark purple skin near the sensor, indicating constriction of the underlying vessels attributed to excessive pressure from the adhesive tape. Proper sensor placement is crucial for accurate SpO2 monitoring.

Bronchiectasis is a clinical syndrome characterized by coughing and sputum production in the presence of abnormal thickening and dilatation of the bronchial walls. We report the successful anesthetic management of a 91-year-old patient with severe bronchiectasis undergoing left marginal mandibulectomy for squamous cell carcinoma of the mandibular gingiva. In this case, we utilized respiratory prehabilitation for preoperative optimization of the patient's respiratory function and intravenous moderate sedation with dexmedetomidine and pentazocine plus excellent local anesthesia intraoperatively rather than an intubated general anesthetic. During the procedure, the patient's vital signs were stable, and she did not have any psychological or physical complaints like anxiety or pain and was discharged from the hospital without any complications. Considering the high risk of respiratory complications, intravenous moderate sedation may be a better option than general anesthesia for some surgeries in patients with severe bronchiectasis. These strategies may be useful options for older patients with impaired respiratory function undergoing oral surgery procedures.