Anesthesia progress最新文献

Objective: Angiogenesis is associated with angiogenic therapy and wound healing processes. It is important for anesthesiologists to understand the effects of perioperative and long-term use of anesthetics on angiogenesis. This study aimed to determine the effects of ketamine on in vitro angiogenesis: the proliferation of human umbilical vein endothelial cells (HUVEC) and normal human diploid fibroblasts (NHDF), HUVEC migration, and in vitro capillary tube formation in cocultured HUVEC and NHDF.

Methods: The effects of ketamine at concentrations of 1, 10, and 50 µM on the proliferation of HUVEC and NHDF for 48 hours were determined by using a water-soluble tetrazolium salt reagent. Quantitation of migration for 22 hours was achieved by measuring the fluorescence of migrating HUVEC exposed to ketamine using an angiogenesis system. The effects of ketamine on capillary tube formation with or without vascular endothelial growth factor (VEGF) were investigated in cocultured HUVEC and NHDF incubated for 3 and 10 days.

Results: Ketamine did not show any enhancing or suppressive effects on the in vitro proliferation of HUVEC and NHDF, HUVEC migration, or capillary tube formation in cocultured HUVEC and NHDF for either 3 or 10 days in the presence or absence of VEGF.

Conclusion: Ketamine had no effects on in vitro angiogenesis using cultured HUVEC and NHDF. Ketamine can potentially be used as an anesthetic agent with no influence on angiogenesis.

We describe a case of profound bradyarrhythmia after sugammadex administration during ambulatory anesthesia. The patient was a 21-year-old man with autism spectrum disorder undergoing planned general anesthesia for dental treatment. After treatment completion, sugammadex was administered upon awakening, and sudden bradyarrhythmia appeared immediately. The patient's heart rate decreased to approximately 30 beats/min but quickly recovered to roughly 80 beats/min after the administration of intravenous atropine. Electrocardiography suggested sinoatrial block or sinus arrest. Although the exact mechanism is unknown, severe electrocardiographic changes can occur within a few minutes of sugammadex administration.

Hypomelanosis of Ito (HI), a neurocutaneous syndrome, is characterized by skin depigmentation and skeletal, muscular, central nervous system, cardiac, and renal manifestations. A wide variety of cutaneous manifestations besides depigmentation have been reported. Herein we describe a 23-year-old woman with HI whose extracutaneous symptoms included severe mental and motor impairment, convulsions, and deformity of the orofacial region. She also had severe obesity, asthma, multiple allergies, and skin hypersensitivity. Although no extracutaneous manifestations were problematic during perioperative management of dental procedures under general anesthesia, erythema developed at 3 time points: during induction, during emergence, and in recovery. We speculated that mechanical stimuli to the skin and administration of multiple drugs likely caused histamine release, leading to the 3 episodes of erythema. Because patients with HI often have hypersensitivity reactions in the skin, both cutaneous and extracutaneous manifestations should be considered in the anesthetic management of patients with HI.

Hemangiomas in the head and neck region, especially those that may impact the airway, require special attention perioperatively because of the potential for difficulties with airway management and bleeding control. This case report describes the management of a 31-year-old male with a large hemangioma of the tongue and pharynx undergoing surgical extraction of mandibular third molars under intubated general anesthesia. Despite taking precautions and avoiding traumatizing the hemangioma while securing the airway, massive bleeding occurred during the surgical extractions, which prompted emergent transfer for angiographic embolization and a stay in the intensive care unit until extubation. This case report highlights the additional attention needed for patients with hemangiomas within the oral cavity and upper airway because of the potential for unexpected massive bleeding that can affect airway management and cardiovascular stability.

Objective: Previous studies have reported that the noise generated by dental equipment can interfere with the auscultation of respiratory sounds during sedation. Therefore, this study aimed to identify whether positing the acoustic sensor on the chest or cervical position would be least susceptible to interference from dental suction device noise, a prominent noise noted during respiratory sound monitoring during dental sedation.

Methods: This prospective cohort study was conducted with 30 students. Sound intensity (dB) and frequency (kHz) levels from the dental suction were recorded from the cervical and chest regions under both oral and nasal breathing conditions and analyzed.

Results: The mean intensity of dental suction sounds was significantly lower in the chest region compared with the cervical region, regardless of the breathing condition (P < .001). Furthermore, in the chest region, the mean sound frequency during oral breathing was significantly lower than that during nasal breathing (P < .01).

Conclusions: Our study suggests that monitoring respiratory sounds in the chest region can significantly reduce interference from noise generated by dental suction devices compared with monitoring at the cervical region.

We present a case of an infant patient with Robin sequence (Pierre Robin sequence; PRS) who underwent general anesthesia for a glossopexy procedure. Pediatric patients with PRS are prone to upper airway obstruction during general anesthesia induction and intubation difficulties due to micrognathia and glossoptosis. In this case, we facilitated mask ventilation by inserting a nasopharyngeal airway before induction and successfully intubated the patient using a 2-person technique that combined the use of a video laryngoscope and a flexible fiber-optic scope. This experience suggests that the use of appropriate devices can help ensure airway patency and enhance visualization and maneuverability during intubation.

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.

Recently, intranasal dexmedetomidine (DEX) has been reported to be effective as a preanesthetic medication, mostly in healthy pediatric patients. We attempted to administer intranasal DEX premedication in this case to an adult patient with intellectual disability who previously had difficulty tolerating premedication with oral midazolam. Using an intranasal atomization delivery device (MAD Nasal, Teleflex), we administered 1.5 µg/kg of DEX intranasally and were able to achieve adequate sedation, which facilitated a smooth mask induction of general anesthesia with sevoflurane. Premedication with intranasal DEX may be a useful method for enabling induction of general anesthesia in adult patients with intellectual disabilities.

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.