The Perfect and Famous Anesthetic Known as Methyl in Boston in 1895.

Extravagant claims were made for proprietary dental anesthetics in Boston, MA, in the late 1800s. For instance, in 1883, Urial K. Mayo introduced an inhaled Vegetable Anaesthetic comprised of nitrous oxide that had been uselessly pretreated with botanical material. This misguided concept may have been inspired by homeopathy, but it was also in line with the earlier false belief of Elton R. Smilie, Charles T. Jackson, and William T.G. Morton that sulfuric ether could volatilize opium at room temperature. In 1895, the Dental Methyl Company advertised an agent they called Methyl, a supposedly perfect topical anesthetic for painless dental extraction. The active ingredient was probably chloroform. Anesthetic humbug did not cease in Boston on Ether Day of October 16, 1846.

Inhalation Conscious Sedation with Nitrous Oxide and Oxygen as Alternative to General Anesthesia in Precooperative, Fearful, and Disabled Pediatric Dental Patients: A Large Survey on 688 Working Sessions.

Aim. To evaluate the effectiveness and the tolerability of the nitrous oxide sedation for dental treatment on a large pediatric sample constituting precooperative, fearful, and disabled patients. Methods. 472 noncooperating patients (aged 4 to 17) were treated under conscious sedation. The following data were calculated: average age; gender distribution; success/failure; adverse effects; number of treatments; kind of dental procedure undertaken; number of dental procedures for each working session; number of working sessions for each patient; differences between males and females and between healthy and disabled patients in relation to success; success in relation to age; and level of cooperation using Venham score. Results. 688 conscious sedations were carried out. The success was 86.3%. Adverse effects occurred in 2.5%. 1317 dental procedures were performed. In relation to the success, there was a statistically significant difference between healthy and disabled patients. Sex and age were not significant factors for the success. Venham score was higher at the first contact with the dentist than during the treatment. Conclusions. Inhalation conscious sedation represented an effective and safe method to obtain cooperation, even in very young patients, and it could reduce the number of pediatric patients referred to hospitals for general anesthesia.

Performance of a new carbon dioxide absorbent, Yabashi lime® as compared to conventional carbon dioxide absorbent during sevoflurane anesthesia in dogs.

In the present study, we compare a new carbon dioxide (CO2) absorbent, Yabashi lime(®) with a conventional CO2 absorbent, Sodasorb(®) as a control CO2 absorbent for Compound A (CA) and Carbon monoxide (CO) productions. Four dogs were anesthetized with sevoflurane. Each dog was anesthetized with four preparations, Yabashi lime(®) with high or low-flow rate of oxygen and control CO2 absorbent with high or low-flow rate. CA and CO concentrations in the anesthetic circuit, canister temperature and carbooxyhemoglobin (COHb) concentration in the blood were measured. Yabashi lime(®) did not produce CA. Control CO2 absorbent generated CA, and its concentration was significantly higher in low-flow rate than a high-flow rate. CO was generated only in low-flow rate groups, but there was no significance between Yabashi lime(®) groups and control CO2 absorbent groups. However, the CO concentration in the circuit could not be detected (≤5ppm), and no change was found in COHb level. Canister temperature was significantly higher in low-flow rate groups than high-flow rate groups. Furthermore, in low-flow rate groups, the lower layer of canister temperature in control CO2 absorbent group was significantly higher than Yabashi lime(®) group. CA and CO productions are thought to be related to the composition of CO2 absorbent, flow rate and canister temperature. Though CO concentration is equal, it might be safer to use Yabashi lime(®) with sevoflurane anesthesia in dogs than conventional CO2 absorbent at the point of CA production.

Fall in inspired oxygen and anaesthetic agent concentrations during change of soda lime absorber.

Following an episode of reduction in inspired oxygen concentration (FiO(2)) and inhalational agent concentration (Fi agent) during the changing of a soda lime absorber, We conducted an in vitro experiment to understand the impact of disconnection of the absorber on inspired gas dilution at different fresh gas flows. We found that both in Dräger Fabius GS and Primus anaesthesia work stations, disconnection of the absorber caused progressive reduction in FiO(2) and Fi agent as the FGF was decreased. The operating principle of fresh gas decoupling (FGD) valve is a potential source of this complication, which must be kept in mind while changing the soda lime during the course of surgery where an anaesthetic work stations utilizing FGD valves are used.

Combining interscalene brachial plexus block with intravenous-inhalation combined anesthesia for upper extremity fractures surgery: a randomized controlled trial.

BACKGROUND: A parallel-group randomized controlled trial (RCT) was conducted to evaluate the effect of combining the interscalene brachial plexus block (IBPB) with Intravenous-inhalation combined anesthesia to isolated Intravenous-inhalation anesthesia in the upper extremity fractures surgery of elderly patients. METHODS: One hundred elderly patients who underwent upper extremity surgery were randomly assigned to received isolated Intravenous-inhalation combined anesthesia (group CI, n = 50) and IBPB associated with Intravenous-inhalation combined anesthesia (group NB, n = 50). Associated side effects, recovery time after operation, as well as the dose of intraoperative vasoactive agents and auxiliary drugs were noted. RESULTS: The two groups were not significantly different in gender (P = 0.539), ages (P = 0.683) and weight (P = 0.212). Five patients (10%) in the group NB and 17 patients (34%) in the group CI suffered from preoperative hypotension (P = 0.004). Besides, lower incidence of other adverse effects such as mental stress, incision pain and hypertension were also found in the group NB; however, the differences were not statistically significant (P > 0.05). The consumption of general anesthetics in the group NB was significantly less than that of the group CI (propofol, P = 0.004; lsoflurane, P < 0.001), and the recovery time of the group NB was significantly shorter than that of the group CI (P = 0.020). CONCLUSION: Combining IBPB with Intravenous-inhalation combined anesthesia in elderly patients hold a greater potential for upper extremity fractures surgery due to its improved clinical effectiveness and fewer side effects.

[Awake fiberoptic intubation - gold standard for the anticipated difficult airway]. / Fiberoptische Wachintubation - Goldstandard für den erwartet schwierigen Atemweg.

Awake fiberoptic intubation seems to continually lose importance in recent years. Alternative options of airway management are coming more and more into the focus of clinical anaesthesia and are moreover advertised specifically for the difficult airway. The concern seems justified that this intubation technique - once the indisputed standard in the management of the anticipated difficult airway - is practised less and less so that especially younger colleagues can hardly gain routine practice. This article aims at counteracting this trend and particularly demonstrates a practical approach. Against this background the equipment is described and tips and tricks are given for execution. The main focus are safety aspects and the success factor of a good topical mucosal anaesthesia, which is of greater importance than a concomitant sedation.

Induction of murine TNBS colitis is strictly controlled by a modified method using continuous inhalation anesthesia with sevoflurane.

BACKGROUND: Trinitrobenzenesulfonic acid (TNBS)-induced colitis is one of the most widely used experimental colitis models. However, there is no standard procedure for inducing colitis by TNBS because it is difficult to achieve a uniform distribution of colitis. We have developed a modified method of murine TNBS-induced colitis that involves inhalation anesthesia with sevoflurane combined with both single and repeated TNBS administrations. AIMS: To compare the usefulness of our newly developed method for inducing murine TNBS-induced colitis with that of conventional intraperitoneal anesthesia. METHODS: TNBS in ethanol was administered to C57BL/6J mice held in an inverted vertical position either under continuous inhalation anesthesia with sevoflurane, in accordance with our newly developed method, or by intraperitoneal injection with 2.5 % avertin, in accordance with the conventional procedure. Body weight change, cytokine profile, and histological findings were examined during the course of colitis. RESULTS: The dispersion of anesthesia time, TNBS retention time, and nadir weight during the course of colitis was decreased using the newly developed method compared with the conventional procedure. Optimization of the modified TNBS-induced colitis, as evidenced by the predominant expression of Th1 and Th17 cytokines on day 7, was attained by the injection of 2.25 mg TNBS in 55 % ethanol. Regulation of the TNBS retention time using inhalation anesthesia with sevoflurane allowed strict control of the disease severity of TNBS-induced colitis. Using the modified method we were also able to develop a chronic TNBS-induced colitis model by repeated TNBS administration without excessive mortality of the mice. CONCLUSIONS: Our modified method for murine TNBS-induced colitis using continuous inhalation anesthesia with sevoflurane provides a better experimental colitis model following both single and repeated TNBS administrations.

Determining the appropriate oral surgery anesthesia modality, setting, and team.

This article reviews the anesthesia modalities available to the practicing oral and maxillofacial surgeon, including the anesthesia TEAM makeup. If office-based anesthesia is not the best option for the patient, alternative locations are discussed including out-patient surgery centers and hospitals. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has fought long and hard to establish and maintain our ability to provide office-based anesthesia. This is our Standard of Care!

Anesthetic management for implantation of a treatment device: the Rheos Baroreflex Hypertensive Therapy System.

Resistant hypertension is a prevalent dilemma. Despite all available antihypertensive medications and multiple strategies such as healthier diets and exercise programs, many patients are still unable to maintain or reach a therapeutic goal for systolic blood pressure. Because of this major health concern, CVRx, Inc has developed a treatment involving baroreflex activation therapy (Rheos Baroreflex Hypertension Therapy System) to treat patients with uncontrolled high blood pressure. The surgical implantation of this system is similar to a carotid endarterectomy procedure; however, the anesthetic management for this procedure is unique and challenging. This case report describes a 45-year-old African American woman with a history of hypertension who was receiving multiple antihypertensive medications and, thus, was a qualified candidate for implantation of this device. The goal of anesthetic management during implantation of this hypertension therapy system is to preserve the carotid sinus baroreceptor sensitivity by avoiding administering anesthetic agents that inhibit the baroreceptor reflex during electrode placement and the testing period. Because of the restriction of some of the anesthetic agents that an anesthesia provider can use, this procedure poses major challenges to the anesthesia provider in planning for anesthesia care and managing risks to the patient.

[Concept of mechanisms of anesthetic and therapeutic properties of xenon].

The molecular theory of L. Poling is a genius example of scientific prediction, made in the middle of 20th century, when the studies about clathrates and methods of roentgen structured analysis were doing their first steps. The views expressed in this message are some additions on the structure of xenon clathrates, function-free xenon water associates and the use of cameras in the liberated associates of the water molecules, for the process of supramolecular detoxification and attempts to develop this theory more widely, to better understand the mechanisms of xenon anesthesia and treatment for further justification of its therapeutic features as well as for the use of other inert gases (Ar, Kr) in modern medicine.

Anestesia en odontopediatría fuera de quirófano / Anesthesia in pediatric dentistry outside the operating room

Introducción: La anestesia fuera del quirófano crece constantemente, sobre todo en odontopediatria. Objetivo: Lograr una técnica anestésica segura en el consultorio del odontólogo, con participación activa de los padres y en forma ambulatoria. Material y método: Trabajo descriptivo sobre 50 pacientes ASA I y II de ambos sexos, con edades entre los 4 y los 15 años. Se realizó inducción inhalatoria con sevofluorano combinado con midazolam más fentanilo. Se mantuvo la ventilación espontánea con bigotera o máscara nasal. Resultados: Se lograron cortos tiempos de inducción y despertar, y estabilidad hemodinámica y respiratoria; los criterios de alta fueron adecuados y no se presentaron complicaciones de importancia. Discusión: Son requisitos indispensables el cuidado estricto de la vía aérea, las indicaciones precisas, el manejo interdisciplinario y los equipos y medicamentos de reanimación cardiopulmonar. Conclusión: La técnica anestésica utilizada fue segura y sin complicaciones; permitió realizar el 100 por ciento de los procedimientos, demostrando ser una alternativa válida y viable.

Introduction: Anesthesia outside the operating room is constantly becoming more frequent, particularly in pediatric dentistry. Objective: To achieve a safe anesthesia technique in the dentist’s office in ambulatory form with the active participation of the parents. Material and method: Descriptive paper regarding 50 ASA I y II patients of both sexes, aged between 4 and 15 years. Induction by inhalation was carried out with sevofluorane combined with midazolam plus fentanyl. Spontaneous ventilation with nasal cannula or mask. Results: Short induction and awakening times were achieved, as well as hemodynamic and respiratory stability; release criteria were adequate and no important complications appeared. Discussion: Indispensable requisites are: strict care of the airway, precise indications, interdisciplinary management and CPR teams and drugs. Conclusion: The anesthesia technique used was safe and without complications; it allowed carrying out 100 percent of the procedures and proved to be a valid and viable option.

Introdução: A anestesia fora da sala de cirurgia cresce de forma constante, principalmente em odontopediatria. Objetivo: Desenvolver uma técnica anestésica segura no consultório do odontologista, com a participação ativa dos pais da criança e de forma ambulatorial. Material e método: Trabalho descritivo sobre 50 pacientes ASA I e II de ambos os sexos, com idades entre 4 e 15 anos. Foi realizada indução inalatória com sevofluorano combinado com midazolam mais fentanilo. Manteve-se a ventilação espontânea utilizando bigodeira ou máscara nasal. Resultados: Foram conseguidos tempos curtos de indução e de acordar, e estabilidade hemodinâmica e respiratória; os critérios de alta foram adequados e não se apresentaram complicações importantes. Discussão: São requisitos essenciais o cuidado rigoroso da via aérea, as indicações precisas, o manejo interdisciplinar e o equipamento e os medicamentos de reanimação cardiopulmonar. Conclusão: A técnica anestésica utilizada é segura e livre de complicações; possibilitou realizar todos os procedimentos, provando ser uma alternativa válida e viável.

[Delayed diagnosis of a postanaesthesia temporomandibular joint dislocation]. / Luxation de l'articulation temporomandibulaire diagnostiquée au décours d'une anesthésie générale.

Temporomandibular joint (TMJ) dislocation during anaesthesia is a rare occurrence. Patients with a history of prior dislocations or TMJ dysfunction, and patients with mandibular retrognathism are at risk of this complication. This is a case report of delayed diagnosis of TMJ dislocation after a general anaesthesia for aortic valvular replacement surgery in a predisposed patient. Considering this unusual presentation, TMJ evaluation should be performed during preoperative anaesthetic assessment. In at-risk patients, one should not worry about TMJ dislocation during intubation but concentrate on glottic exposure. However, afterwards, one should be highly aware of this possible complication in order to detect it early, allowing an immediate simple manual reduction. This manoeuver may be performed with or without sedation by a practitioner, familiar with this way of resetting a dislocated jaw.

Acupuncture of LI-4 in anesthetized healthy humans decreases cerebral blood flow in the putamen measured with positron emission tomography.

To minimize the influence of exogenous factors, 13 volunteers were anesthetized with sevoflurane 1 MAC while exposed to manual acupuncture stimulation of LI-4 (Group 1, n = 7) or a placebo point in the space between the third and fourth metacarpals (Group II, n = 6). During anesthesia (baseline) and anesthesia + acupuncture, one H2(15)O scan was performed, respectively. Group I demonstrated a significant decrease in regional cerebral blood flow in the right medial frontal gyrus (20%) and in the left putamen (17%). In Group II regional cerebral blood flow was decreased in the right medial frontal gyrus (22%); in the putamen no significant changes were observed. These data suggest that needle penetration of the skin affects the medial frontal gyrus, whereas acupuncture of LI-4 influences the putamen.