Journal of dental anesthesia and pain medicine最新文献

Background: Fear of injections and dental anxiety are the major barriers to successful pediatric dental treatment. Visual threats associated with conventional syringes can increase anxiety and pain perception in children, necessitating the use of child-friendly strategies. This study aimed to evaluate and compare the impact of camouflaged and insulin syringes, with and without counter-stimulation, on anxiety levels, pain perception, and behavioral responses during local anesthesia administration in children.

Methods: A clinical trial involving 120 children aged 8-10 years who required bilateral maxillary local anesthesia was performed. Local anesthesia with camouflaged and insulin syringes was administered to each child once with and without thumb pressure counter-stimulation. Anxiety was measured using pulse rates, pain was measured using the Wong-Baker Faces Pain Rating Scale, and behavior was measured using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Statistical analyses were performed using the independent t-test and chi-square test.

Results: Both groups were demographically comparable with no significant differences in age (independent t-test, P = 0.539) or sex distribution (chi-square test, P = 0.854). At first appointment, camouflaged syringes showed significantly lower pain scores (3.58 ± 0.74 vs. 4.17 ± 1.37; P = 0.005), lower pulse rates (89.10 ± 5.84 vs. 99.00 ± 1.80 bpm; P < 0.001), and better behavioral responses (FLACC score: 2.27 ± 0.78 vs. 2.80 ± 0.68; P < 0.001) compared with insulin syringes, as assessed by the independent t-test. These effects were further enhanced by counter-stimulation. At second appointment, although overall scores improved in both groups, post-treatment differences between the syringe types were not statistically significant (P > 0.05).

Conclusion: Camouflaged syringes combined with counter stimulation represent an effective, simple, and non-pharmacological method for reducing anxiety and improving cooperation during local anesthesia administration in pediatric dental patients. However, the findings are limited by the use of a homogenous sample of healthy, cooperative children aged 8-10 years and potential bias due to the inability of blind operators or participants. Future studies should evaluate a broader population and incorporate blind assessment protocols.

Background: The combination of local anesthesia (LA) and distraction techniques effectively reduces procedural pain and anxiety, enhance cooperation, and promote positive dental experiences in children. This study aimed to evaluate the effectiveness of the Hands-Eyes-Mouth Distraction Technique (HEM-DT) and the Covering Patient's Vision Technique (CPV-T) on pain perception and anxiety during local anesthesia administration in children aged 6-12 years.

Methods: Fifty-two healthy children aged 6-12 years requiring LA were randomly allocated into two treatment groups: those receiving the HEM-DT, and those receiving the CPV-T. Anxiety was assessed subjectively using the Animated Emoji Scale before and after the intervention, while pulse rate was recorded using a pulse oximeter before, during, and after LA. Pain perception was measured during LA using the Sounds, Eyes, Motor (SEM) scale and after LA using the colored analog scale. Physiological data were analyzed using independent t-tests for intergroup comparisons, and paired t-tests with repeated-measures ANOVA for intragroup analysis. Wilcoxon signed-rank test was used to evaluate intragroup anxiety scores, and Mann-Whitney U test was used for intergroup comparisons of anxiety and pain scores.

Results: Intragroup comparisons revealed statistically significant differences in pulse rates before, during, and after LA (P < 0.001). Intergroup comparisons also showed statistically significant differences in pulse rates during and after LA. Anxiety scores decreased significantly in the HEM-DT group (P < 0.001), which also had lower mean SEM and colored analogue scale pain scores than the CPV-T group (P < 0.001).

Conclusion: HEM-DT was effective in reducing pain and anxiety during LA administration in children.

Background: Approximately 31% of adults experience dental anxiety, which represents a significant barrier to timely care and ultimately results in poor oral health outcomes. Moderate sedation is an effective method of managing anxiety while preserving patient responsiveness. Total intravenous anesthesia (TIVA) combined with target-controlled infusion (TCI) systems, which utilize pharmacokinetic models, enable precise control of drug delivery by maintaining stable effect-site concentrations. This study evaluated the safety and efficacy of moderate TCI-administered sedation using an Eleveld pharmacodynamic-pharmacokinetic model for propofol and remifentanil in dental practice.

Methods: This prospective study included 114 patients who underwent dental procedures at two clinical sites. Moderate sedation was delivered via a TCI-guided Eleveld model, targeting the effect-site concentrations of propofol and remifentanil. The primary outcome was the incidence of adverse events as defined by the Tracking and Reporting Outcomes of Procedural Sedation criteria. The secondary outcomes included procedural duration, drug dosing, vital sign fluctuations, and patient-reported satisfaction.

Results: After 7725 min of sedation, no adverse events were reported according to the TROOPS criteria. None of the patients experienced hypoxia (SpO₂ <90%), bradycardia (HR < 40 bpm), or clinical over-sedation. Hypotension (MAP < 65 mmHg) occurred in 13 patients who were managed conservatively without intervention. The average recovery time was 10.1 ± 5.2 min. Patient satisfaction was high (99%), with 93.6% of patients reporting little to no recall of the procedure.

Conclusions: TCI-based moderate sedation using the Eleveld model for propofol and remifentanil is safe, effective, and well-tolerated in dental settings. The model offers predictable sedation depth, rapid recovery, and high levels of patient satisfaction, supporting its broader implementation in the management of dental anxiety.

Postoperative sore throat (POST) is a frequent complication of tracheal intubation that compromises patient comfort and satisfaction. This is due to airway irritation and inflammation. Zinc, which is known for its anti-inflammatory and wound-healing effects, has been investigated as a preventive treatment for POST. This protocol was registered in PROSPERO (CRD420250651708).Three databases, PubMed, The Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov were searched using the keywords "Post operative sore throat," and "zinc." A literature search led to the retrieval of six clinical trials, of which three studies were included in the meta-analysis and all six studies were included in the systematic review. The data were synthesized using Cochrane Review Manager v.5.4.1. The Cochrane risk-of-bias 2.0 tool was used to assess the methodological quality of evidence. The pooled analysis included 248 patients (105 males and 143 females). Study findings suggested that zinc reduces the overall incidence of POST in comparison to placebo (P < 0.0001, OR = 0.29 [95% CI 0.16-0.53], I² = 0%). However, the effects of zinc on POST severity varied. The incidence of mild POST was significantly lower in the zinc-administered group at 0 (OR = 0.06 (95% CI 0.01-0.21), I² = 0%, P < 0.0001), 2 (OR = 0.27 (95% CI 0.13-0.57), I² = 0%, P = 0.0006) and 4 h (OR = 0.14 [95% CI 0.04-0.45], I² = 0%, P = 0.0010) post-extubation. There was no significant difference in the severity of moderate and severe POST between the zinc-supplemented group and the placebo group. Pooled analysis of our current evidence demonstrates that zinc significantly reduced the overall incidence of POST, with a maximum effect observed in mild POST.

Background: Postoperative analgesia after oral cancer surgery with free-flap reconstruction is complex because pain arises at both donor and recipient sites and likely varies by flap type. Evidence of flap-specific, time-resolved pain and related patient-controlled analgesia (PCA) behaviors is limited.

Methods: This single-center retrospective cohort included 127 adults who underwent no flap (n = 53), latissimus dorsi(LD; n = 12), fibula (n = 18), forearm (n = 30), or other flaps (n = 14). Visual analog scale (VAS) scores were recorded for overall pain (0-72 h), recipient-site pain (0-72 h), and donor-site pain (12-72 h). Intravenous PCA consisted of fentanyl (700 or 1400 mcg) plus ketorolac (150 mg). PCA logs provided demand counts, effective deliveries, and infused volumes. Group comparisons were performed using repeated-measures analyses with post hoc tests.

Results: Baseline characteristics did not differ between groups. Overall VAS scores differed at most time points from 0 to 72 h (all P ≤ 0.013); the fibula group started higher and declined thereafter. Recipient-site pain showed no between-group difference at 60 h but diverged at 72 h (P = 0.026). Donor site pain showed no overall difference, although the fibula tended to remain higher at 12-24 h. In the LD subgroup, recipient-site VAS scores increased again after 48 h. Total anesthesia time differed markedly and was longest in LD cases (P < 0.001). Among flap patients, fentanyl concentration (700 vs. 1400 mcg) did not differ by flap type. Seventy-two-hour cumulative PCA metrics did not differ between groups; however, effective deliveries were higher during the early 12-24 h window (12 h, P = 0.043; 24 h, P = 0.010). At 12 h, endotracheal tube discomfort exceeded recipient- and donor-site pain (Friedman χ² = 42.71, P < 0.001).

Conclusion: Flap-specific, time-dependent pain trajectories were identified-early higher pain in fibula and later recipient- or donor-persistence in LD flaps. Early differences in PCA deliveries were not reflected in 72-h totals, indicating a partial dissociation between VAS intensity and analgesic-seeking behavior. These findings support flap-tailored multimodal analgesia and time-resolved PCA adjustments, with attention to airway-related discomfort early after surgery.

Traumatic injury involving the temporomandibular joint during early childhood can progress to temporomandibular joint ankylosis. Securing the airway for corrective surgery in pediatric temporomandibular joint ankylosis is a considerable anesthetic challenge. While fiberoptic intubation is the gold standard for anticipated difficult airways, a pediatric fiberoptic bronchoscope may not be readily available. We present the anesthetic management of an 11-year-old girl with bilateral TMJ ankylosis scheduled for corrective surgery, using Glidescope^® assisted nasotracheal intubation as an alternative in the absence of a pediatric fiberoptic bronchoscope. This case demonstrates that innovative airway management strategies, including the use of a feeding tube guide, can be effectively employed in challenging situations.

Background: This study investigated the association among preoperative dental anxiety, intraoperative discomfort, and postoperative pain perception across various types of dental extractions, ranging from simple to complex procedures.

Methods: A prospective observational clinical trial was conducted in 573 patients who underwent dental extractions. Preoperative anxiety was assessed by using a self-reported verbal scale. Intraoperative discomfort was measured using the Self-Perception Questionnaire for Dentoalveolar Oral Surgery. Postoperative pain was assessed on the seventh day using a verbal categorical rating scale.

Results: Preoperative anxiety levels were significantly higher in patients who underwent mandibular third molar extraction. Intraoperative discomfort was significantly influenced by surgical technical complexity, surgical duration, and preoperative anxiety. Mediation analysis revealed that anxiety indirectly influenced postoperative pain through intraoperative discomfort with no direct effect. The analysis confirmed the interplay between anxiety, surgical factors, intraoperative discomfort, and patient demographics in shaping the surgical experience.

Conclusions: The findings indicate that Anxiety did not directly predict postoperative pain in most surgical groups; however, it appeared to contribute to increased intraoperative discomfort, which subsequently elevated postoperative pain levels.

Background: Moderate sedation reliably alleviates procedure-related anxiety in dental patients, enabling the comfortable delivery of surgical periodontal therapy. The principal cause of sedation-related morbidity is hypoxemia, secondary to medication-induced hypoventilation and airway obstruction. The objectives of this investigation were to determine the incidence of hypoxemia during moderate sedation for periodontal or implant surgery and to identify statistically significant predictors of hypoxemia.

Methods: Records of patients who received moderate sedation for periodontal or dental implant surgery were assessed for hypoxemic events, defined as oxygen saturation ≤ 90%. Binomial logistic regression analysis was conducted to evaluate the influence of patient-, sedation-, and procedure-related variables on the occurrence of hypoxemia.

Results: Records from 2,221 sedations were available for analysis. At least one hypoxemic event occurred in 117 (5.3%) sedations. Only 22 (1.0%) sedations involved more than one event. Age (odds ratio [OR]: 1.022; 95% confidence interval [CI]: 1.004 - 1.039; P = 0.02) and total midazolam dose (OR: 1.118; 95% CI: 1.024 - 1.220; P = 0.01) were significant predictors of hypoxemia. The association between body mass index and hypoxemia did not reach statistical significance (OR: 1.042; 95% CI: 0.995 - 1.091; P = 0.08).

Conclusions: The incidence of hypoxemia observed in this study was substantially lower than that reported in patients receiving moderate sedation for minor oral/maxillofacial surgery or gastrointestinal endoscopy. Although further research is warranted, it is possible that patients receiving moderate sedation for periodontal or implant surgery are less likely to experience hypoxemia due to smaller total doses of sedatives, titration of sedatives over longer procedure durations, and the greater need for intraoperative patient cooperation.

This case report presents the hemodynamic management of a 3-year-old patient with Fontan circulation who underwent dental treatment under general anesthesia using minimally invasive cardiac output monitoring devices. To avoid the use of monitoring methods more invasive than the dental procedure itself, cardiac output was continuously assessed using FloTrac™ and BioZ.com™ systems. The bispectral index was maintained between 40 and 67 during anesthesia. Although the patient's body surface area (BSA) was 0.5 m², which is below the validated threshold for both devices, monitoring was cautiously conducted to observe hemodynamic trends. Discrepancies in the cardiac output and index values were observed between the two modalities. Although the absolute values were less reliable owing to the patient's low BSA, hemodynamic stability was maintained by tracking the dynamic changes in cardiac parameters. These observations underscore both the limitations and the potential of noninvasive cardiac monitoring in pediatric patients with Fontan circulation undergoing general anesthesia. Accordingly, future development of monitoring technologies that can accurately measure cardiac output in pediatric patients with BSA < 1 m² is warranted.