Subject(s)
Ambulatory Surgical Procedures/methods , Anesthesia, Dental/methods , Propofol , Affect/drug effects , Anesthesia Recovery Period , Drug Costs , Humans , Methohexital/administration & dosage , Methohexital/adverse effects , Methohexital/economics , Methohexital/pharmacokinetics , Patient Satisfaction , Propofol/administration & dosage , Propofol/economics , Propofol/pharmacokinetics , Propofol/pharmacologyABSTRACT
The physiologic stress of various dental procedures (dental examination, dental prophylaxis, restoration, root canal therapy, and tooth extraction) was measured in 50 nonsmoking healthy men between the ages of 18 and 55 years (mean 34.6 years, range 21 to 53 years) with a salivary cortisol assay. Expectorated saliva was collected at four time points: 10 minutes before the start of the procedure, 15 minutes after the patient was seated, at the end of the procedure, and 1 hour after the completion of the procedure. Of the 196 samples included for analysis, mean cortisol values ranged from 0.1 to 3.8 micrograms/dl with a recovery of 100% +/- 8.4%. The mean cortisol value for the extraction group (1.09 +/- 0.42 microgram/dl) was significantly different (p < 0.05) from the mean values of the examination (0.46 +/- 0.10 microgram/dl), prophylaxis (0.64 +/- 0.64 microgram/dl), root canal (0.49 +/- 0.07 microgram/dl), and restorative (0.60 +/- 0.04 microgram/dl) groups as determined by the Duncan's multiple range test. Cortisol levels decreased from the initial reading to the end of the procedure by about 15% for patients undergoing an examination, root canal, and restorative procedure. Cortisol levels at the end of the procedure were elevated in the prophylaxis (55%) and extraction (148%) groups compared with the baseline cortisol recording. A minority of patients in the prophylaxis group had elevated cortisol levels throughout dental treatment, whereas cortisol levels were elevated during treatment in 80% of patients undergoing extraction. These data suggest that the adrenal stress response associated with tooth extraction(s) is greater than that associated with other routine dental procedures.
Subject(s)
Dental Care/adverse effects , Hydrocortisone/metabolism , Stress, Physiological/etiology , Stress, Physiological/physiopathology , Tooth Extraction/adverse effects , Adolescent , Adrenal Cortex Diseases , Adult , Analysis of Variance , Dental Anxiety/physiopathology , Dental Care for Chronically Ill , Dental Prophylaxis/adverse effects , Dental Restoration, Permanent/adverse effects , Humans , Hydrocortisone/analysis , Male , Middle Aged , Physical Examination/adverse effects , Root Canal Therapy/adverse effects , Saliva/chemistryABSTRACT
In 1943, Olson described a method for administration of thiopental for anesthesia during oral surgical procedures (J Oral Surg 1:197, 1943). Patients were instructed not to eat for 4 hours before the scheduled surgery and to bring an escort. Premedication with atropine or morphine was not routinely used. Following venipuncture, a 2- to 3-mL test dose of thiopental (Pentothal, Abbott Laboratories, North Chicago, IL) was injected. After a pause of 15 to 20 seconds, 6 mL was injected slowly over 40 to 50 seconds. Additional medication was titrated slowly in intermittent doses to maintain an adequate level of anesthesia. The mouth was packed and kept meticulously dry to prevent coughing or laryngospasm. The patient's color and respiration were continually observed and the airway maintained. Initially, a 5% solution was used by Olson; later it was changed to 2%. Use of this concentration made it easier to titrate to "upper levels" of anesthesia because profound depth was not required. Also, adverse effects (eg, coughing, laryngospasm) occurred less frequently, and there was less venous irritation with the 2% solution. Based on his experience of 8,203 cases, Olson claimed that most patients tolerated the anesthetic well, but he recommended avoiding this technique for children younger than 12 years of age.
Subject(s)
Anesthesia, Dental/history , Anesthesia, Intravenous/history , Conscious Sedation/history , Anesthesia, Local/history , Anti-Anxiety Agents/history , Benzodiazepines , History, 20th Century , Lidocaine/history , Oximetry/history , United StatesABSTRACT
Reversal of the sedative and amnesic effects of intravenous diazepam by the benzodiazepine antagonist flumazenil was investigated in 30 patients undergoing conscious sedation for dental surgery. Verbal memory tasks were administered and patients' subjective ratings of mood were obtained before and after diazepam and then periodically after intravenous administration of flumazenil or placebo under double-blind conditions. Immediate and delayed recall and recognition tests showed that diazepam impaired memory and that flumazenil partially reversed this impairment. The subjective ratings showed that diazepam produced physical and mental sedation and that flumazenil reversed this sedation. The reversal produced a return to presurgery scores for mental sedation but not for physical sedation or memory. For physical sedation, the difference between flumazenil and placebo was not demonstrable for more than 15 min after flumazenil administration; for mental sedation, it was demonstrable for as long as 60 min. The reversal by flumazenil of diazepam-induced memory impairment did not change significantly over time.
Subject(s)
Arousal/drug effects , Diazepam/antagonists & inhibitors , Flumazenil/pharmacology , Memory/drug effects , Adult , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Male , Molar, Third/surgery , Random Allocation , Time Factors , Tooth, Impacted/surgeryABSTRACT
An unusual case of several recurrences of multiple and bilateral "idiopathic, traumatic, hemorrhagic" bone cysts in the same patient, with long-term follow-up, is presented. The etiology and pathogenesis of idiopathic bone cysts are discussed. It is recommended that patients be followed for a longer period of time after treatment.
