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1.
Anesth Prog ; 66(3): 141-150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31545669

RESUMO

Our objective was to estimate the prevalence of mortality and serious morbidity for office-based deep sedation and general anesthesia (DS/GA) for dentistry in Ontario from 1996 to 2015. Data were collected retrospectively in 2 phases. Phase I involved the review of incidents, and phase II involved a survey of DS/GA providers. In phase I, cases involving serious injury or death for dentistry under DS/GA, sourced from the Office of the Chief Coroner of Ontario and from the Royal College of Dental Surgeons of Ontario (RCDSO), were reviewed. Phase II involved a survey of all RCDSO-registered providers of DS/GA in which they were asked to estimate the number of DS/GAs administered in 2015 and the number of years in practice since 1996. Clinician data were pooled to establish an overall number of DS/GAs administered in dental offices in Ontario from 1996 to 2015. Prevalence was calculated using phase I (numerator) and phase II (denominator) findings. The estimated prevalence of mortality in the 20-year period from 1996 to 2015 was 3 deaths in 3,742,068 cases, with an adjusted mortality rate of 0.8 deaths per 1 million cases. The estimated prevalence of serious morbidity was 1 injury in 3,742,068 cases, which adjusts to a serious morbidity rate of 0.25 per 1 million cases. The mortality rate found in this study was slightly lower than those published by earlier studies conducted in Ontario. The risk of serious morbidity was found to be low and similar to other studies investigating morbidity in office-based dental anesthesia.


Assuntos
Anestesia Dentária , Anestesia Geral , Sedação Profunda , Anestesia Dentária/efeitos adversos , Anestesia Dentária/mortalidade , Anestesia Geral/efeitos adversos , Anestesia Geral/mortalidade , Humanos , Ontário/epidemiologia , Estudos Retrospectivos
2.
Anesth Prog ; 66(3): 162-172, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31545675

RESUMO

For decades, the dental profession has provided anesthesia services in office-based, ambulatory settings to alleviate pain and anxiety, ranging from local anesthesia to general anesthesia. However, despite a reported record of safety, complications occasionally occur. Two common contributing factors to general anesthesia and sedation complications are medication errors and adverse drug events. The prevention and early detection of these complications should be of paramount importance to all dental providers who administer or otherwise use anesthesia services. Unfortunately, there is a substantial lack of literature currently available regarding medication errors and adverse drug events involving anesthesia for dentistry. As a result, the profession is forced to look to the medical literature regarding these issues not only to assess the likely severity of the problem but also to develop preventive methods specific for general anesthesia and sedation as practiced within dentistry. Part 1 of this 2-part article will illuminate the problems of medication errors and adverse drug events, primarily as documented within medicine. Part 2 will focus on how these complications affect dentistry, discuss several of the methods that medicine has implemented to manage such problems, and introduce a method for addressing these issues with the dental anesthesia medication safety paradigm.


Assuntos
Anestesia Dentária , Anestesiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Erros de Medicação , Anestesia Dentária/efeitos adversos , Anestesia Geral , Odontologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Erros de Medicação/prevenção & controle
3.
Niger J Clin Pract ; 22(8): 1172-1174, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417065

RESUMO

Dental anesthesia is one of the most frequently performed medical procedures. Although the frequency of ocular complications is extremely low, these reactions can be highly alarming and may bring up medicolegal issues when they do occur. Dentists and oral surgeons should be well-informed of these adverse reactions and should be aware that both ophthalmologists and emergency physicians might be required to care for these patients.


Assuntos
Anestesia Dentária/efeitos adversos , Anestesia Local/efeitos adversos , Anestésicos Locais/efeitos adversos , Carticaína/efeitos adversos , Diplopia/etiologia , Epinefrina/efeitos adversos , Oftalmoplegia/etiologia , Extração Dentária , Adulto , Anestesia Dentária/métodos , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Carticaína/administração & dosagem , Epinefrina/administração & dosagem , Humanos
4.
Drug Des Devel Ther ; 13: 1729-1737, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190751

RESUMO

Background: Sevoflurane is generally the preferred anesthetic agent for general anesthesia in pediatric patients, due to its rapid induction and recovery characteristics. However, it has been recognized that a major complication is emergence agitation when awakening from general anesthesia. The aim of this study was to evaluate the occurrence rate of emergence agitation in the operating room and postoperative recovery area following intraoperative administration of midazolam to pediatric patients under general anesthesia. Patients and methods: One hundred and twenty pediatric patients undergoing dental treatment under sevoflurane anesthesia were enrolled in this study. The patients were divided into three groups (n=40 each in the 0.1 mg/kg midazolam, 0.05 mg/kg midazolam, and control with saline groups). Midazolam or saline was injected intravenously approximately 30 minutes before the end of the dental treatment. We used the Richmond Agitation and Sedation Scale (RASS) to assess the level of sedation and drowsiness at emergence phase in the operating room. We also used the Pediatric Anesthesia Emergence Delirium Scale (PAED) to assess the level of agitation and delirium at the full recovery phase from anesthesia in the recovery area. Results: At the emergence phase, the incidence of emergence agitation in the 0.1 mg/kg midazolam group was significantly lower than in the other groups (p=0.0010). At the recovery phase, there was no significant difference among the three groups. The odds ratio between PAED score and RASS score was 4.0 using logistic regression analysis. The odds ratio between PAED score and Disability was 2.5. Conclusion: Administration of a single dose of 0.1 mg/kg midazolam dose significantly decreases the incidence of severe emergence agitation at the emergence after sevoflurane anesthesia, but not at the recovery phase. Furthermore, the evaluation of sedative and agitation condition using RASS score at emergence from anesthesia is useful to predict occurrence of agitation in the recovery phase.


Assuntos
Anestesia Dentária/efeitos adversos , Anestesia Geral/efeitos adversos , Delírio do Despertar/prevenção & controle , Delírio do Despertar/psicologia , Hipnóticos e Sedativos/farmacologia , Midazolam/farmacologia , Sevoflurano/efeitos adversos , Período de Recuperação da Anestesia , Criança , Relação Dose-Resposta a Droga , Método Duplo-Cego , Delírio do Despertar/tratamento farmacológico , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/uso terapêutico , Injeções Intravenosas , Masculino , Midazolam/administração & dosagem , Midazolam/uso terapêutico , Análise de Regressão
5.
Anesth Prog ; 66(1): 33-36, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30883228

RESUMO

A 26-year-old woman with a history of feeling nauseated during dental local anesthesia presented to our clinic for tooth extraction under intravenous sedation. Although she had experienced episodes of neurally-mediated syncope, her symptoms were controlled well with drug therapy, stopped 3 years earlier. No syncope episodes developed over the previous 2 years. Tooth extraction was performed under intravenous sedation without incident. When she was returned to a sitting position after being roused, convulsion, loss of consciousness, and cardiac arrest developed. One week later, similar symptoms occurred immediately after suture removal. We suspect that the change in body position triggered these episodes. It is important to avoid abrupt changes in body position and any other triggers and to administer preventive drugs in patients at high risk of syncope.


Assuntos
Anestesia Dentária , Parada Cardíaca , Síncope Vasovagal , Adulto , Anestesia Dentária/efeitos adversos , Eletrocardiografia , Feminino , Parada Cardíaca/induzido quimicamente , Humanos , Síncope , Síncope Vasovagal/induzido quimicamente
6.
Pediatr Dent ; 41(1): 52-55, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30803478

RESUMO

Purpose: Use of general anesthesia (GA) for comprehensive dental treatment of children is an essential health benefit. Pediatric dentists utilize dentist anesthesiologists to provide GA for dental rehabilitation of severe early childhood caries. Dentist anesthesiologists deliver GA using intubated or nonintubated GA. The purpose of this study was to compare the incidence of respiratory complications when intubated versus nonintubated general anesthesia was completed by dentist anesthesiologists in a pediatric dentistry setting. Methods: The Society of Ambulatory Anesthesia (SAMBA) Clinical Outcomes Registry (SCOR) database was queried for pediatric dental GA cases completed by dentist anesthesiologists from January 1, 2010 to December 31, 2016. Logistic regression compared intubated GA versus nonintubated GA for differences in the incidence of respiratory complications. Results: Within 9,333 cases, there were 30 incidents of laryngospasm (0.3 percent), 19 incidents of bronchospasm (0.2 percent), two incidents of hypoxia (less than 0.1 percent), and six incidents of difficult airway (0.1 percent). When intubated versus nonintubated GA was compared for respiratory complication incidence, no significant association was found (P=0.81, odds ratio equals 0.93). Conclusion: No significant difference was found between the incidence of respiratory complications with intubated versus nonintubated GA provided by dentist anesthesiologists.


Assuntos
Anestesia Dentária/métodos , Anestesia Geral/métodos , Assistência Odontológica para Crianças/métodos , Intubação Intratraqueal , Anestesia Dentária/efeitos adversos , Anestesia Geral/efeitos adversos , Criança , Pré-Escolar , Assistência Odontológica para Crianças/efeitos adversos , Feminino , Humanos , Incidência , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Masculino , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia
7.
J Appl Oral Sci ; 27: e20180195, 2019 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-30673030

RESUMO

OBJECTIVE: Pain due to administration of local anesthetics is the primary reason for patients' fear and anxiety, and various methods are used to minimize it. This study aimed to measure the degree of pain during administration of anesthesia and determine the latency time and duration of pulpal anesthesia using two anesthetic methods in the maxilla. MATERIALS AND METHODS: A randomized, single-blind, split-mouth clinical trial was conducted with 41 volunteers who required class I restorations in the maxillary first molars. Local anesthesia was administered with a needleless jet injection system (experimental group) or with a carpule syringe (control) using a 30-gauge short needle. The method of anesthesia and laterality of the maxilla were randomized. A pulp electric tester measured the latency time and duration of anesthesia in the second molar. Visual analogue scale (VAS) was used to measure the degree of pain during the anesthetic method. Data were tabulated and then analyzed by a statistician. The t-test was used to analyze the differences between the groups for basal electrical stimulation. Duration of anesthesia and degree of pain were compared using the Mann-Whitney test. A 5% significance level was considered. RESULTS: There was no statistical difference in the basal electrical stimulation threshold (mA) and degree of pain between the two methods of anesthesia (p>0.05). Latency time was 2 minutes for all subjects. The duration of pulpal anesthesia showed no statistical difference (minutes) between the two methods (p<0.001), with a longer duration for the traditional method of anesthesia (median of 40 minutes). CONCLUSIONS: The two anesthetics methods did not differ concerning the pain experienced during anesthesia. Latency lasted 2 minutes for all subjects; the traditional infiltration anesthesia resulted in a longer anesthetic duration compared with the needleless jet injection.


Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Injeções a Jato/métodos , Medição da Dor/métodos , Dor Processual/diagnóstico , Adulto , Anestesia Dentária/efeitos adversos , Polpa Dentária/efeitos dos fármacos , Restauração Dentária Permanente/métodos , Estimulação Elétrica , Feminino , Humanos , Masculino , Agulhas , Limiar da Dor , Reprodutibilidade dos Testes , Método Simples-Cego , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
Orv Hetil ; 159(52): 2212-2216, 2018 12.
Artigo em Húngaro | MEDLINE | ID: mdl-30582357

RESUMO

Dental anaesthesia is one of the most frequently performed medical procedures. Although the frequency of ocular complications is low, these can be alarming and can potentially give rise to medicolegal issues. Dentists and oral surgeons should be well-informed of these adverse reactions. Ophthalmologists and emergency physicians might be required for appropriate care of these patients. Fortunately, most ocular complications related to dental anesthesia are transient. Differential diagnosis includes stroke and intracranial hemorrhage and so vital signs are to be closely monitored. The planned surgical procedure can be carried out once the patient is fully informed and gave consent. The psychological aspect of such unexpected complication must be managed appropriately. We report a case with diplopia and ophthalmoplegia of a reversible and temporary nature. We also include a literature review of ophthalmologic complications after intraoral local anaesthesia in this paper. Orv Hetil. 2018; 159(52): 2212-2216.


Assuntos
Anestesia Dentária/efeitos adversos , Anestesia Local/efeitos adversos , Diplopia/etiologia , Oftalmoplegia/etiologia , Anestesia Dentária/métodos , Anestesia Local/métodos , Humanos , Injeções/efeitos adversos , Extração Dentária
9.
Stomatologiia (Mosk) ; 97(6): 63-66, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30589429

RESUMO

The study comprised 53 patients with side effect history to local anesthetics. The reasons for the occurrence of adverse reactions to local anesthetics was analyzed, and the frequency of their occurrence in dental practice was studied. It was found that in most patients (85%) with 'allergic reactions' to local anesthetics the diagnosis was unreasonable and incompetent. In most cases psychosomatic reactions were mistaken for an immediate allergic reaction. The prevalence of adverse reactions to local anesthetics was 1 case per 448 injections (1:448), true allergic reactions was documented in 0.1% cases.


Assuntos
Anestesia Dentária , Anestésicos Locais , Assistência Odontológica , Hipersensibilidade a Drogas , Anestesia Dentária/efeitos adversos , Anestésicos Locais/efeitos adversos , Humanos , Prevalência
10.
J Anesth Hist ; 4(4): 237-239, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30558769

RESUMO

During the 19th century, patients undergoing anesthesia for surgical and dental procedures were at risk of being given hypoxic or dilute nitrous oxide on four separate occasions. Primary and secondary saturation during surgery could account for two administrations of 100% nitrous-oxide anesthesia, while both diagnostic and therapeutic doses of dilute nitrous oxide were frequently administered in mental asylums.


Assuntos
Anestesia Dentária/história , Anestesia por Inalação/história , Anestésicos Inalatórios/história , Hospitais Psiquiátricos/história , Transtornos Mentais/história , Óxido Nitroso/história , Anestesia Dentária/efeitos adversos , Anestesia Dentária/métodos , Anestesia por Inalação/efeitos adversos , Anestesia por Inalação/métodos , Anestésicos Inalatórios/uso terapêutico , Assistência Odontológica/história , Assistência Odontológica/métodos , História do Século XIX , Humanos , Hipóxia/induzido quimicamente , Hipóxia/história , Transtornos Mentais/induzido quimicamente , Óxido Nitroso/efeitos adversos , Admissão do Paciente/normas
11.
J Dent Educ ; 82(10): 1059-1064, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30275140

RESUMO

The aim of this systematic review was to evaluate the published literature on current educational techniques used to teach local anesthesia administration in U.S. dental schools to determine the methods by which potential complications may be minimized and efficacy maximized. A PubMed search was performed in June 2017 on the following terms: (local anesthesia, education, dental) AND (Humans[Mesh]). Out of 136 articles identified, 13 met the study criteria and were included for review. Of those, the nine with outcome measures were included in the qualitative synthesis. With a quality assessment tool designed for this study, the quality of each included article was assessed independently by three of the authors. Three main pedagogies were identified: didactic instruction based on textbooks and lectures, student-to-student injections, and use of anatomic models. However, the effects of these pedagogies on local anesthesia administration efficacy, patient satisfaction, and student confidence in administering local anesthesia were largely not assessed in these studies. Quality assessment of the reviewed articles yielded a mean score of 62% (range 44-83%) for the observational studies and a mean score of 56% (range 47-63%) for the interventional studies. Due to the heterogeneity of the studies assessed, no meta-analysis could be performed. While the experimental and observational studies reviewed provided some insight into the efficacy of current educational techniques, they had numerous methodological inconsistencies. The inconsistency of the available evidence made it difficult to make fully informed curriculum recommendations based on the existing literature.


Assuntos
Anestesia Dentária , Anestesia Local , Faculdades de Odontologia/estatística & dados numéricos , Anestesia Dentária/efeitos adversos , Anestesia Dentária/métodos , Anestesia Local/efeitos adversos , Anestesia Local/métodos , Humanos , Ensino/estatística & dados numéricos , Estados Unidos
12.
Niger J Clin Pract ; 21(10): 1304-1310, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30297563

RESUMO

Purpose: The study aimed to investigate dental anxiety and oral health-related quality of life among children undergoing dental rehabilitation under general anesthesia (GA) and intravenous sedation (IVS). Materials and Methods: Participants were 99 healthy children aged 3-5 or 6-12 years operated under GA or IVS. Dental anxiety before treatment and 1 month postoperatively were measured using the Frankl behavior scale (FBS), the venham picture test (VPT), the early childhood oral health impact scale (ECOHIS), and the children's fear survey schedule-dental subscale (CFSS-DS). Data were analyzed using Student's t-test and Mann-Whitney U-test. Results: ECOHIS scores decreased in all groups. VPT scores increased in the 3-5-year-olds treated under GA (P = 0.003). Postoperative CFSS-DS anxiety scores were lower in IVS groups. FBS scores were significantly higher for both age groups (P < 0.001). There was no effect of numbers of extracted or treated teeth. Conclusions: Dental rehabilitation under GA and IVS improved the quality of life and dental behavior. In the 6-12-year-olds, there was no statistically significant difference between children undergoing dental operations under GA and those undergoing dental operations under IVS. Dental anxiety decreased in 3-5-year-olds after treatment under GA but not after IVS.


Assuntos
Anestesia Dentária/efeitos adversos , Anestesia Geral/efeitos adversos , Ansiedade ao Tratamento Odontológico/psicologia , Assistência Odontológica/psicologia , Cárie Dentária/psicologia , Saúde Bucal , Qualidade de Vida/psicologia , Anestesia Dentária/psicologia , Anestesia Geral/psicologia , Ansiedade/psicologia , Criança , Comportamento Infantil , Pré-Escolar , Estudos Transversais , Cárie Dentária/terapia , Restauração Dentária Permanente/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos
13.
Pediatr Dent ; 40(5): 346-351, 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-30355430

RESUMO

Purpose: The purpose of this study was to assess the use of a dosing scalar for association with the success of procedural sedation in pediatric dentistry. Methods: This cross-sectional, retrospective study assessed healthy two- to 12-year-olds who received an elixir of midazolam (0.3 mg/kg), meperidine (1.5 mg/kg), and hydroxyzine (1.0 mg/kg). The scaled body weight (SBW) for each patient was determined using the 50th percentile weight-for-age from the 2000 Centers for Disease Control and Prevention (CDC) growth chart. Children under the 50th percentile were dosed at their actual weight. Children weighing over the 50th percentile received a dose that was reduced to the 50th percentile weight-for-age. Statistical analysis evaluated sedation success, measured by the Houpt scale. Lean body weight (LBW) and ideal body weight (IBW) were calculated to compare SBW with other available dosing scalars. Results: The sample consisted of 427 children. The success was 73.8 percent. There was no significant difference in sedation success by dose delivered. The calculated LBW and IBW were significantly greater than the SBW (P<.001, P<.001). Conclusions: Sedation success was not affected by use of a scalar that reduced dosing weight to the 2000 CDC growth chart's 50th percentile weight-for-age.


Assuntos
Anestesia Dentária/métodos , Peso Corporal , Hipnóticos e Sedativos/administração & dosagem , Anestesia Dentária/efeitos adversos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Antagonistas dos Receptores Histamínicos H1/administração & dosagem , Humanos , Hidroxizina/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Masculino , Meperidina/administração & dosagem , Midazolam/administração & dosagem , Obesidade Pediátrica/complicações , Estudos Retrospectivos , Fatores de Risco
14.
Stomatologiia (Mosk) ; 97(4): 77-81, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30199074

RESUMO

Dental health is one of the most important signs of life quality and depends on the level of health care organization. Recently the clinical odontology is intensively developing, including local anesthesia where constant searching of effective remedies and methods of suppression and treatment of pain is carried out. At the same time carrying out adequate local anesthesia has important practical value that is to some extent bound to massive visits of the patients to the clinics. One of the important factors in the solution of problems of effectiveness and safety of local anesthesia is knowledge of anatomy-topographical features of the structure of maxillofacial area as the irregular technique of local anesthesia which is carried out without features of the anatomical structure of jaws is the main reason for ineffective anesthesia. From the practical side, the special attention is paid to the patients having various accompanying diseases with negative treatment emotions that lead to the stress development, disorganization of work of functional systems of the organism, change of the mental state. However the basis of diagnostic process at dentist's consultation depends on the clinical thinking of the doctor which is bound to knowledge of medical psychology and psychoprophylaxis that needs to be applied in the daily practice. In particular clinical situations premedication methods are successfully used for carrying out adequate anesthesia for dental interventions. A wide range of ways and methods of the lower alveolar nerve blockade are used in dentistry, where the composite external and internal anatomy-topographical markers which are difficult to remember for the doctor are applied. It causes the need of carrying out further researches on the maximal simplification of technological and methodological features of mandibular anesthesia and its introduction into dental practice.


Assuntos
Anestesia Dentária , Anestesia Local , Bloqueio Nervoso , Anestesia Dentária/efeitos adversos , Anestesia Dentária/métodos , Anestesia Local/efeitos adversos , Anestesia Local/métodos , Anestésicos Locais/efeitos adversos , Assistência Odontológica , Humanos
16.
Anesth Prog ; 65(3): 156-161, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30235437

RESUMO

To compare the success of perceived pulpal anesthesia between groups using nitrous oxide/oxygen (N2O/O2) and oxygen (O2) in children premedicated with ibuprofen with symptomatic irreversible pulpitis permanent teeth. Thirty-three children (mean age 10.4 ± 1.9 years) with 33 symptomatic irreversible pulpitis permanent teeth were included in this preliminary study. All children were premedicated with ibuprofen and randomly assigned to receive either N2O/O2 (17 participants) or O2 (16 participants). Four percent articaine with epinephrine 1:100,000 was administered, and vital pulp therapy was performed. Children used the Wong-Baker FACES Pain Rating Scale (WBFPS) to report their pain at baseline as well as during carious dentin removal, pulpal exposure, and pulpal tissue removal steps. The success was determined when the reported WBFPS score was ≤4. The chi-square test was used to compare the success between both groups. The success of pulpal anesthesia was 71% (12/17) and 19% (3/16) in the N2O/O2 and O2 groups, respectively. The success in the N2O/O2 group was 52% higher than that in the O2 group (confidence interval = 22.9% to 80.7%; significant difference p = .003). From the result of this preliminary study, N2O/O2 significantly increased the success of perceived pulpal anesthesia in children premedicated with ibuprofen with symptomatic irreversible pulpitis permanent teeth. However, further study with a larger sample is required to confirm this result.


Assuntos
Anestesia Dentária/métodos , Anestésicos Inalatórios/administração & dosagem , Dor Facial/prevenção & controle , Óxido Nitroso/administração & dosagem , Pulpite/terapia , Administração por Inalação , Adolescente , Fatores Etários , Anestesia Dentária/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Carticaína/administração & dosagem , Criança , Dor Facial/diagnóstico , Dor Facial/etiologia , Feminino , Humanos , Ibuprofeno/administração & dosagem , Masculino , Bloqueio Nervoso/métodos , Óxido Nitroso/efeitos adversos , Medição da Dor , Dados Preliminares , Pulpite/complicações , Pulpite/diagnóstico , Método Simples-Cego , Tailândia , Resultado do Tratamento
17.
J Anesth Hist ; 4(3): 196-197, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30217393

RESUMO

As popularized by Elmer McKesson, MD, "secondary saturation" with nitrous oxide could expose patients to a second burst of 100% laughing gas to relax their muscles to assist surgeons. On rare occasions, this technique could provide a second opportunity for hypoxic brain damage and possible admission postoperatively to insane asylums.


Assuntos
Anestesia Dentária/história , Anestesia por Inalação/história , Anestésicos Inalatórios/história , Transtornos Mentais/história , Óxido Nitroso/história , Anestesia Dentária/efeitos adversos , Anestesia Dentária/métodos , Anestesia por Inalação/efeitos adversos , Anestesia por Inalação/métodos , Anestésicos Inalatórios/uso terapêutico , História do Século XX , Hospitais Psiquiátricos/história , Humanos , Transtornos Mentais/induzido quimicamente , Óxido Nitroso/efeitos adversos
18.
J Dent Hyg ; 92(3): 40-46, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29976792

RESUMO

Purpose: The purpose of this study was to examine the differences in educational preparation and practical educational experiences between dental and dental hygiene students in the administration of local anesthesia (LA) and management of LA related complications in the state of California.Methods: Course instructors responsible for teaching LA or the program directors of the 6 dental schools and 29 dental hygiene programs in California (n=35) were invited to participate in this study. A computer-based descriptive survey, a comparative checklist of LA instruction requirements and semi-structured interviews were used for the data collection. Descriptive statistics were used to analyze results.Results: Eighteen LA course instructors or program directors participated in the study for a response rate of 51%. One respondent was from a dental school while 17 were from dental hygiene programs. The majority of the dental hygiene (n=16) respondents reported teaching 12 types of intraoral injections; the dental school respondent reported teaching seven injection types. Fewer student-to-student injection experiences per injection type were required by the dental school (n=7) than the dental hygiene schools (n=12) and the dental school did not indicate a minimum number of student-to-patient injection requirements for graduation. Analysis of a checklist of required elements of LA instruction and individual syllabi revealed common elements of all courses; students are expected to choose the proper local anesthetic, identify the proper injection type, and manage any LA complications. The majority of the interview participants perceived that dental hygiene students had more educational preparation in LA than their dental student cohorts and that dental hygienists were educationally prepared to administer LA safely without direct supervision.Conclusions: Dental hygiene students in California programs appear to be well prepared through their education experiences to administer and manage complications related to local anesthesia. Consideration should be given to supporting changing the supervision requirements for the administration of local anesthesia by dental hygienists licensed in the state of California.


Assuntos
Anestesia Dentária , Anestesia Local , Competência Clínica , Higienistas Dentários/educação , Higienistas Dentários/normas , Anestesia Dentária/efeitos adversos , Anestesia Local/efeitos adversos , California , Lista de Checagem , Currículo , Humanos , Injeções , Entrevistas como Assunto , Licenciamento em Odontologia , Inquéritos e Questionários
19.
J Endod ; 44(9): 1442-1444, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30049470

RESUMO

Ocular complications after an inferior alveolar nerve anesthesia are rare. These complications, although temporary and benign, can be distressing to both the patient and the clinician. A 37-year-old male patient was administered an inferior alveolar nerve block for the root canal treatment of tooth #30. Immediately after the administration of local anesthesia, the patient reported complete loss of vision. The patient recovered completely after 15 minutes. In particular, amaurosis is quite uncommon and usually heralds a more sinister pathology such as stroke. This case report presents an unusual case of ocular complication after an inferior alveolar nerve block. Adequate knowledge of the regional anatomy and physiology of the orbit and its nearby structures, the proposed causes of ocular complications, and prevention and management is necessary to manage such events.


Assuntos
Anestesia Dentária/efeitos adversos , Anestesia Local/efeitos adversos , Anestésicos Locais/efeitos adversos , Cegueira/etiologia , Nervo Mandibular , Bloqueio Nervoso/efeitos adversos , Tratamento do Canal Radicular , Adulto , Humanos , Masculino
20.
Cochrane Database Syst Rev ; 7: CD006487, 2018 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-29990391

RESUMO

BACKGROUND: Pain during dental treatment, which is a common fear of patients, can be controlled successfully by local anaesthetic. Several different local anaesthetic formulations and techniques are available to dentists. OBJECTIVES: Our primary objectives were to compare the success of anaesthesia, the speed of onset and duration of anaesthesia, and systemic and local adverse effects amongst different local anaesthetic formulations for dental anaesthesia. We define success of anaesthesia as absence of pain during a dental procedure, or a negative response to electric pulp testing or other simulated scenario tests. We define dental anaesthesia as anaesthesia given at the time of any dental intervention.Our secondary objective was to report on patients' experience of the procedures carried out. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2018, Issue 1), MEDLINE (OVID SP), Embase, CINAHL PLUS, WEB OF SCIENCE, and other resources up to 31 January 2018. Other resources included trial registries, handsearched journals, conference proceedings, bibliographies/reference lists, and unpublished research. SELECTION CRITERIA: We included randomized controlled trials (RCTs) testing different formulations of local anaesthetic used for clinical procedures or simulated scenarios. Studies could apply a parallel or cross-over design. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological approaches for data collection and analysis. MAIN RESULTS: We included 123 studies (19,223 participants) in the review. We pooled data from 68 studies (6615 participants) for meta-analysis, yielding 23 comparisons of local anaesthetic and 57 outcomes with 14 different formulations. Only 10 outcomes from eight comparisons involved clinical testing.We assessed the included studies as having low risk of bias in most domains. Seventy-three studies had at least one domain with unclear risk of bias. Fifteen studies had at least one domain with high risk of bias due to inadequate sequence generation, allocation concealment, masking of local anaesthetic cartridges for administrators or outcome assessors, or participant dropout or exclusion.We reported results for the eight most important comparisons.Success of anaesthesiaWhen the success of anaesthesia in posterior teeth with irreversible pulpitis requiring root canal treatment is tested, 4% articaine, 1:100,000 epinephrine, may be superior to 2% lidocaine, 1:100,000 epinephrine (31% with 2% lidocaine vs 49% with 4% articaine; risk ratio (RR) 1.60, 95% confidence interval (CI) 1.10 to 2.32; 4 parallel studies; 203 participants; low-quality evidence).When the success of anaesthesia for teeth/dental tissues requiring surgical procedures and surgical procedures/periodontal treatment, respectively, was tested, 3% prilocaine, 0.03 IU felypressin (66% with 3% prilocaine vs 76% with 2% lidocaine; RR 0.86, 95% CI 0.79 to 0.95; 2 parallel studies; 907 participants; moderate-quality evidence), and 4% prilocaine plain (71% with 4% prilocaine vs 83% with 2% lidocaine; RR 0.86, 95% CI 0.75 to 0.99; 2 parallel studies; 228 participants; low-quality evidence) were inferior to 2% lidocaine, 1:100,000 epinephrine.Comparative effects of 4% articaine, 1:100,000 epinephrine and 4% articaine, 1:200,000 epinephrine on success of anaesthesia for teeth/dental tissues requiring surgical procedures are uncertain (RR 0.85, 95% CI 0.71 to 1.02; 3 parallel studies; 930 participants; very low-quality evidence).Comparative effects of 0.5% bupivacaine, 1:200,000 epinephrine and both 4% articaine, 1:200,000 epinephrine (odds ratio (OR) 0.87, 95% CI 0.27 to 2.83; 2 cross-over studies; 37 participants; low-quality evidence) and 2% lidocaine, 1:100,000 epinephrine (OR 0.58, 95% CI 0.07 to 5.12; 2 cross-over studies; 31 participants; low-quality evidence) on success of anaesthesia for teeth requiring extraction are uncertain.Comparative effects of 2% mepivacaine, 1:100,000 epinephrine and both 4% articaine, 1:100,000 epinephrine (OR 3.82, 95% CI 0.61 to 23.82; 1 parallel and 1 cross-over study; 110 participants; low-quality evidence) and 2% lidocaine, 1:100,000 epinephrine (RR 1.16, 95% CI 0.25 to 5.45; 2 parallel studies; 68 participants; low-quality evidence) on success of anaesthesia for teeth requiring extraction and teeth with irreversible pulpitis requiring endodontic access and instrumentation, respectively, are uncertain.For remaining outcomes, assessing success of dental local anaesthesia via meta-analyses was not possible.Onset and duration of anaesthesiaFor comparisons assessing onset and duration, no clinical studies met our outcome definitions.Adverse effects (continuous pain measured on 170-mm Heft-Parker visual analogue scale (VAS))Differences in post-injection pain between 4% articaine, 1:100,000 epinephrine and 2% lidocaine, 1:100,000 epinephrine are small, as measured on a VAS (mean difference (MD) 4.74 mm, 95% CI -1.98 to 11.46 mm; 3 cross-over studies; 314 interventions; moderate-quality evidence). Lidocaine probably resulted in slightly less post-injection pain than articaine (MD 6.41 mm, 95% CI 1.01 to 11.80 mm; 3 cross-over studies; 309 interventions; moderate-quality evidence) on the same VAS.For remaining comparisons assessing local and systemic adverse effects, meta-analyses were not possible. Other adverse effects were rare and minor.Patients' experiencePatients' experience of procedures was not assessed owing to lack of data. AUTHORS' CONCLUSIONS: For success (absence of pain), low-quality evidence suggests that 4% articaine, 1:100,000 epinephrine was superior to 2% lidocaine, 1:100,000 epinephrine for root treating of posterior teeth with irreversible pulpitis, and 2% lidocaine, 1:100,000 epinephrine was superior to 4% prilocaine plain when surgical procedures/periodontal treatment was provided. Moderate-quality evidence shows that 2% lidocaine, 1:100,000 epinephrine was superior to 3% prilocaine, 0.03 IU felypressin when surgical procedures were performed.Adverse events were rare. Moderate-quality evidence shows no difference in pain on injection when 4% articaine, 1:100,000 epinephrine and 2% lidocaine, 1:100,000 epinephrine were compared, although lidocaine resulted in slightly less pain following injection.Many outcomes tested our primary objectives in simulated scenarios, although clinical alternatives may not be possible.Further studies are needed to increase the strength of the evidence. These studies should be clearly reported, have low risk of bias with adequate sample size, and provide data in a format that will allow meta-analysis. Once assessed, results of the 34 'Studies awaiting classification (full text unavailable)' may alter the conclusions of the review.


Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Assistência Odontológica , Anestesia Dentária/efeitos adversos , Anestésicos Locais/efeitos adversos , Humanos , Medição da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
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