Subject(s)
Alveolar Ridge Augmentation , Dental Care for Chronically Ill , Ehlers-Danlos Syndrome , Skin Transplantation , Vestibuloplasty/methods , Adult , Dental Implantation, Endosseous , Ehlers-Danlos Syndrome/classification , Ehlers-Danlos Syndrome/complications , Granuloma, Foreign-Body/etiology , Granuloma, Foreign-Body/surgery , Humans , Male , Polyglactin 910/adverse effects , Sutures/adverse effectsABSTRACT
PURPOSE: The purpose of this study was to evaluate the use of desflurane, a new volatile anesthetic agent, in a standardized endotracheal anesthetic technique for the removal of third molars in ambulatory patients. PATIENTS AND METHODS: Data were kept on 50 American Society of Anesthesiology (ASA) Class I and II patients undergoing oral endotracheal general anesthesia for removal of third molars. A standardized anesthetic technique was used on all patients. Induction was achieved with a bolus of propofol followed by neuromuscular paralysis with succinylcholine and then intubation. A 70% nitrous oxide, 30% oxygen, and desflurane mixture was titrated until there was no movement, and a local anesthetic was administered. The procedure was then completed in a standard fashion. The parameters measured included the length of surgery, the time from gas shutoff to extubation, the time from arrival in the postanesthesia care unit to achieving an Aldrete system score for discharge with an escort, the incidence of nausea and vomiting, and amnesia of the procedure. RESULTS: This study showed that the use of desflurane as the primary anesthetic agent for procedures of less than 1 hour is a useful technique. The agent is expensive, but the decreased recovery time and minimal side effects may offset this expense. CONCLUSION: The desflurane anesthetic technique provides a satisfactory surgical environment in selected patients. It results in rapid postanesthesia recovery and discharge times, thus reducing costs.
Subject(s)
Anesthesia, Dental/methods , Anesthesia, General/methods , Anesthetics, Inhalation , Isoflurane/analogs & derivatives , Molar, Third/surgery , Tooth Extraction , Adult , Ambulatory Surgical Procedures , Anesthesia Recovery Period , Desflurane , Female , Humans , MaleABSTRACT
This report describes a patient who had significant postoperative bleeding 4 days after undergoing surgery while using a tranexamic acid (4.8%) mouth rinse protocol for local control of hemostatis. Patients undergoing dentoalveolar surgery who are receiving chronic oral anticoagulants are treated with a tranexamic acid mouth rinse at our hospital. No systemic modification of their coagulation status is attempted. The postoperative bleeding problem that developed was determined to be caused by an antibiotic-induced vitamin K deficiency rather than a failure of the tranexamic acid protocol.
Subject(s)
Amoxicillin/adverse effects , Anticoagulants/adverse effects , Antifibrinolytic Agents/therapeutic use , Dental Care for Chronically Ill/adverse effects , Penicillins/adverse effects , Postoperative Hemorrhage/etiology , Tranexamic Acid/therapeutic use , Vitamin K Deficiency/complications , Vitamin K Deficiency/etiology , Aged , Drug Interactions , Heart Valve Prosthesis , Humans , Male , Tooth Extraction/adverse effects , Warfarin/adverse effectsABSTRACT
The purpose of this study was to determine the effects of two dosage regimens of dexamethasone on the serum cortisol levels of a group of patients undergoing major maxillofacial surgical procedures. Analysis of the data demonstrated that the use of dexamethasone, 10 to 20 mg intravenously given every 3 hours intraoperatively and every 4 hours postoperatively over 24 hours, followed by a repository dose of 80 mg of intramuscular methylprednisolone, causes short-term serum cortisol suppression. The maximum depression occurred on postoperative day 3; normal levels were restored by postoperative day 7. Therefore, pulsed therapy can be considered relatively safe when known contraindications have been considered.