• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.2
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• pp.137-140
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• 2016

Spinal muscular atrophy (SMA) is an autosomal recessive, severe neuromuscular disorder in which degeneration of alpha motor neurons in the spine progressively weakens and ultimately paralyzes the proximal muscles. It occurs in one per 6,000-10,000 infants, and is a genetic disorder with the second-highest mortality rate worldwide. An 18-year-old male patient with SMA was referred for general anesthesia for difficulty in performing dental treatment due to limited mouth opening caused by temporomandibular joint (TMJ) pain. However, the patient had a high risk of general anesthesia complications, so TMJ pain during mouth opening was reduced through local anesthesia of the TMJ. Fortunately, the anesthesia was successful in reducing pain during mouth opening, enabling the patient to receive dental treatment with an adequate mouth opening.

• Journal of Yeungnam Medical Science
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• v.34 no.2
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• pp.161-168
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• 2017

Peripheral nerve blocks are commonly used for surgical anesthesia, postoperative analgesia, and to reduce opioid requirements. Although these blocks have traditionally been carried out using local anesthetics, single-injection techniques can be short-lived and limited by the relatively brief duration of action of currently available local anesthetics. Increasing the dose or concentration of local anesthetics may prolong the duration of analgesia, but may also increase the risk such as unwanted motor weakness or systemic toxicity of local anesthetics. Numerous adjuvant medications have been added to local anesthetics to prolong the durations of anesthesia and analgesia achieved by peripheral nerve blocks, and currently, a number of different adjuvants are used to improve quality of the block. This article will review the several nerve block adjuvants used in combination with local anesthetics to provide blockade of peripheral nerves in clinical practice, describing the rationale for their use in peripheral nerve blocks, and the evidence for their effectiveness.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.4
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• pp.315-321
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• 2022

Although rare, hypodermic needle fractures can occur in the maxillofacial region. In cases of fracture, urgent intervention is required to prevent further complications. We present the case of a 37-year-old female patient with a fractured needle in the left sublingual fossa during a lingual nerve block 6 months before referral. The fragment of a 30-gauge needle was located using cone-beam computed tomography and retrieved under local anesthesia with blunt dissection. The patient recovered uneventfully, except for predictable postoperative inflammatory complications, which resolved within 2 weeks. Precautions should be implemented to prevent needle fractures, which are usually preventable. However, if the retrieval is unsuccessful, the patient should be referred to a well-equipped surgical unit without delay.

• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.4
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• pp.179-188
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• 2013

Background: Today, there are computer controlled local anesthesia devices used clinically. The main principle is to control injection speed by computer aided system, and it relieves pain. However, there are few objective data considering this subject. In this literature review, we researched studies about computer controlled anesthetic delivery. We compared pain control effect of computer controlled to conventional local anesthetic syringe system. Methods: A bibliographic search in PubMed was performed and we reviewed original articles. Results: There were 18 publications that compared pain control effect of computer controlled to conventional system. There were 8 articles reported of children, similar pain control effect was found in 7 of them. One study showed superior pain control effect of computer controlled anesthetic delivery. For adults, 10 studies showed superior pain control effect in computer aided system. Conclusions: Computer controlled anesthetic delivery has similar or superior pain control effect compared to conventional local anesthetic syringe system. For both children and adults, computer controlled anesthetic delivery could be clinically useful, still it may be more effective for adults.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.3
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• pp.159-165
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• 2019

Background: Dental procedures commonly involve the injection of local anesthetic agents, which causes apprehension in patients. The objective of dental practice is to provide painless treatment to the patient. The purpose of this study was to evaluate the effect of Low Level Laser Therapy (LLLT) in reducing the pain due to local anesthetic injection. Materials and Methods: A prospective, split-mouth study was conducted on 25 patients. In Condition A, LLLT was administered followed by the administration of a standard local anesthetic agent. Patients' perception of pain with use of LLLT was assessed based on a Visual Analogue Scale (VAS). In Condition B, LLLT was directed to the mucosa but not activated, followed by the administration of local anesthesia. VAS was used to assess the pain level without the use of LLLT. Results: Comparison between Condition A and Condition B was done. A P value < 0.001 was considered significant, indicating a definite statistical difference between the two conditions. Conclusion: In our study, we observed that LLLT reduced pain during injection of local anesthesia. Further multi-centric studies with a larger sample size and various modifications in the study design are required.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.1
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• pp.29-35
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• 2017

Background: No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior alveolar nerve block for surgery on impacted lower third molars. Method: This study was conducted at the Faculty of Dentistry, Mahidol University in Bangkok, Thailand. The randomized, single-blind, comparative split-mouth study was carried out in patients with symmetrically impacted lower third molars, as identified on panoramic radiographs. Each patient underwent surgery for the removal of the lower third molars by the same surgeon under local anesthesia at two separate visits, 3 weeks apart. The onset and duration of local anesthesia, intra-operative pain, surgical duration, and number of additional anesthetics administered were recorded. Results: The subjective and objective onset of action for the local anesthetics showed statistically significant differences (P < 0.05). However, the intra-operative pain, surgical duration, duration of local anesthesia, and number of additional anesthetics administered did not show statistically significant differences. Conclusion: The use of 4% articaine for the inferior alveolar nerve block was clinically more effective in the onset of subjective and objective anesthesia as compared with the use of 4% lidocaine. Based on the pain scores from the visual analogue scale, 4% lidocaine provided more analgesia during the procedure, and patients noted less intra-operative pain than with 4% articaine; however, the difference was not clinically significant.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.5
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• pp.277-285
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• 2018

Chemo-mechanical caries removal methods are known to be more effective compared with conventional methods in pain reduction. $Carie-care^{TM}$, a chemo-mechanical caries removal agent, was introduced in 2010 but a systematic review of its efficacy has not yet been performed. The purpose of this study was to investigate the effectiveness of $Carie-care^{TM}$ on the outcomes of treatment of caries in children and adolescents. The primary outcome was pain while the secondary outcomes included complete caries removal (CCR), time, need for local anesthesia and behavioral response changes. A Comprehensive literature search was performed in PubMed, EMBASE, and the Cochrane Library up to 30 September 2018. The following keywords were used in the search: 'chemo-mechanical caries removal agent', 'dental caries', 'Carie-care', 'chemo-mechanical caries removal', 'chemo-mechanical caries excavation', other related keywords, and their combinations. From 942 studies identified, 16 were analyzed. Finally, 4 studies met the eligibility criteria and 260 teeth in 120 children and adolescents were included in this review. This review showed that $Carie-care^{TM}$ reduces pain during caries treatment but requires a longer time for effective treatment than conventional methods. Local anesthesia was not required in the Chemo-mechanical caries removal (CMCR) group. In addition, dental anxiety decreased compared to the control group, and co-operation was more positive. Therefore, it may be a useful alternative to conventional methods in children and adolescents, but further verification through additional studies is needed.

• Archives of Craniofacial Surgery
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• v.16 no.2
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• pp.88-91
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• 2015

In adult congenital muscular torticollis (CMT) patients, physical therapy is not as effective because the development of sternocleidomastoid muscle (SCM) muscle is complete. While surgical release can address CMT in adult patients, the risk of general anesthesia and visible postoperative scar is a concern, expecially in patients with mild symptoms. In this paper, we report our experience in treating such patients with minimal-incision myotomy under local anesthesia. A review was performed for all adult patients who had undergone the simple myotomy procedure. Surgical indication was reserved for patients with mild fibrotic band in the SCM muscle with minimal lengthdiscrepancybetween the muscles. All patients had recognizable head tiltand palpation of fibrotic band on affected side of the neck. Surgical details are described in the main body of text. Three female patients had undergone the procedure. Torticollis was resolve in all patients with complete restoration of ranage of motion. There were no postoperative complications, and patient satisfaction was high. We have reported three cases of mild CMT in adult female patients, who had undergone minimal-incision myotomy under local anesthesia. Outcomes were satisafactory with no morbidity to report. With careful patient selection, this method offers an alternate treatment option for adult CMT patients with mild symptoms.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.32 no.3
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• pp.153-156
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• 2021

Indications of fiberoptic laryngeal laser surgery (FLS) procedure have broadened by the development of flexible fiberoptic endoscopes and flexible laser systems. FLS procedure performed under local anesthesia and it is the unique value of FLS. The surgery can be performed on patients who are impossible to undergo general anesthesia and difficult to be exposed by laryngeal microsurgery. Main indication of FLS procedure was small to moderate sized hemorrhagic vocal polyp, but we experienced a case of huge vocal polyp with difficult laryngeal exposure treated by FLS procedure under local anesthesia. The vocal polyp was removed successfully without vocal fold scar through fiberoptic laryngeal laser surgery under local anesthesia.

• Kosin Medical Journal
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• v.33 no.3
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• pp.468-476
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• 2018

Perioperative anaphylaxis, although rare, is a severe, life-threatening unexpected systemic hypersensitivity reaction. Simultaneous administration of various drugs during anesthesia, the difficulty of communicate with patients in sedation and anesthesia, and coverage of the patient with surgical drapes are considered to be factors that impede early recognition of anaphylactic reactions. It is very important to perform an intradermal skin test because antibiotics are the most common cause of perioperative anaphylaxis. We report a case of negative-intradermal skin test antibiotic anaphylaxis mistaken for local aesthetic systemic toxicity without increase of serum tryptase for confirmative diagnostic biomaker during surgery under brachial plexus block. It is not possible to exclude the danger of anaphylaxis completely, even if it is negative-intradermal skin test and normal tryptase level. Therefore, anesthesiologists should be closely monitored and treated early for antibiotics related hypersensitive reaction, like other medicines during anesthesia.