• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.4
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• pp.271-280
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• 2017

Background: The number of patients with Alzheimer's disease is growing worldwide, and the proportion of patients requiring dental treatment under general anesthesia increases with increasing severity of the disease. However, outpatient anesthesia management for these patients involves great risks, as most patients with Alzheimer's disease are old and may show reduced cardiopulmonary functions and have cognitive disorders. Methods: This study retrospectively investigated 43 patients with Alzheimer's disease who received outpatient anesthesia for dental treatment between 2012-2017. Pre-anesthesia patient evaluation, dental treatment details, anesthetics dose, blood pressure, duration and procedure of anesthesia, and post-recovery management were analyzed and compared between patients who underwent general anesthesia or intravenous sedation. Results: Mean age of patients was about 70 years; mean duration of Alzheimer's disease since diagnosis was 6.3 years. Severity was assessed using the global deterioration scale; 62.8% of patients were in level ${\geq}6$. Mean duration of anesthesia was 178 minutes for general anesthesia and 85 minutes for intravenous sedation. Mean recovery time was 65 minutes. Eleven patients underwent intravenous sedation using propofol, and 22/32 cases involved total intravenous anesthesia using propofol and remifentanil. Anesthesia was maintained with desflurane for other patients. While maintaining anesthesia, inotropic and atropine were used for eight and four patients, respectively. No patient developed postoperative delirium. All patients were discharged without complications. Conclusion: With appropriate anesthetic management, outpatient anesthesia was successfully performed without complications for dental treatment for patients with severe Alzheimer's disease.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.1
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• pp.49-59
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• 2021

Background: To evaluate changes in the effectiveness of phentolamine mesylate in combination with different local anesthetics (LAs) and vasoconstrictors. A prospective randomized double-blind study was conducted with 90 patients divided into three groups, with each group being administered one of three different LAs: lidocaine 2% 1/80,000, articaine 4% 1/200,000, and bupivacaine 0.5% 1/200,000. Methods: We compared treatments administered to the mandible involving a LA blockade of the inferior alveolar nerve. Results were assessed by evaluating reduction in total duration of anesthesia, self-reported patient comfort using the visual analog pain scale, incidence rates of the most common adverse effects, overall patient satisfaction, and patient feedback. Results: The differences among the three groups were highly significant (P < 0.001); time under anesthesia was especially reduced for both the lip and tongue with bupivacaine. The following adverse effects were reported: pain at the site of the anesthetic injection (11.1%), headaches (6.7%), tachycardia (1.1%), and heavy bleeding after treatment (3.3%). The patients' feedback and satisfaction ratings were 100% and 98.9%, respectively. Conclusions: Efficient reversal of LAs is useful in dentistry as it allows patients to return to normal life more readily and avoid common self-injuries sometimes caused by anesthesia. Phentolamine mesylate reduced the duration of anesthesia in the three studied groups, with the highest reduction reported in the bupivacaine group (from 460 min to 230 min for the lip and 270 min for the tongue [P < 0.001]).

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.2
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• pp.113-118
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• 2021

Background: Consumers and patients in the last two decades have increasingly turned to various internet search engines including Google for information. Google Trends records searches done using the Google search engine. Google Trends is free and provides data on search terms and related queries. One recent study found a large public interest in "dental anesthesia". In this paper, we further explore this interest in "dental anesthesia" and assess if any patterns emerge. Methods: In this study, Google Trends and the search term "dental pain" was used to record the consumer's interest over a five-year period. Additionally, using the search term "Dental anesthesia," a top ten related query list was generated. Queries are grouped into two sections, a "top" category and a "rising" category. We then added additional search term such as: wisdom tooth anesthesia, wisdom tooth general anesthesia, dental anesthetics, local anesthetic, dental numbing, anesthesia dentist, and dental pain. From the related queries generated from each search term, repeated themes were grouped together and ranked according to the total sum of their relative search frequency (RSF) values. Results: Over the five-year time period, Google Trends data show that there was a 1.5% increase in the search term "dental pain". Results of the related queries for dental anesthesia show that there seems to be a large public interest in how long local anesthetics last (Total RSF = 231) - even more so than potential side effects or toxicities (Total RSF = 83). Conclusion: Based on these results it is recommended that clinicians clearly advice their patients on how long local anesthetics last to better manage patient expectations.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.531-537
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• 2022

Wide-awake, local anesthesia, no tourniquet (WALANT) is a technique that removes the requirement for operations to be performed with a tourniquet, general/regional anesthesia, sedation or an anesthetist. We reviewed the WALANT literature with respect to the diverse indications and impact of WALANT to discuss the importance of future surgical curriculum integration. With appropriate patient selection, WALANT may be used effectively in upper and lower limb surgery; it is also a useful option for patients who are unsuitable for general/regional anesthesia. There is a growing body of evidence supporting the use of WALANT in more complex operations in both upper and lower limb surgery. WALANT is a safe, effective, and simple technique associated with equivalent or superior patient pain scores among other numerous clinical and cost benefits. Cost benefits derive from reduced requirements for theater/anesthetic personnel, space, equipment, time, and inpatient stay. The lack of a requirement for general anesthesia reduces aerosol generating procedures, for example, intubation/high-flow oxygen, hence patients and staff also benefit from the reduced potential for infection transmission. WALANT provides a relatively, but not entirely, bloodless surgical field. Training requirements include the surgical indications, volume calculations, infiltration technique, appropriate perioperative patient/team member communication, and specifics of each operation that need to be considered, for example, checking of active tendon glide versus venting of flexor tendon pulleys. WALANT offers significant clinical, economic, and operative safety advantages when compared with general/regional anesthesia. Key challenges include careful patient selection and the comprehensive training of future surgeons to perform the technique safely.

• Journal of Veterinary Science
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• v.21 no.6
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• pp.84.1-84.11
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• 2020

Background: Gastroesophageal reflux (GER) has been reported to be a common finding in dogs under general anesthesia. Objectives: The aim of this retrospective study was to assess the esophageal and gastric contents in a population of dogs undergoing computed tomographic myelography (myeloCT) examination and to evaluate the factors influencing the presence of esophageal fluid (gastric content, duration of anesthesia, body position, and intrinsic factors). Methods: Esophageal and gastric contents of 83 non-brachycephalic dogs were retrospectively assessed based on plain and myelo-CT scans. Age, weight, breed, sex, and the time between the 2 computed tomography [CT] scans were included. Results: Esophageal fluid was present in 19% (16/83) of the animals, and 14% (12/83) and 46% (37/83), respectively, had fluid or food material in their stomachs. The frequency of observing esophageal fluid on myelo-CT scans was significantly increased compared with plain CT scans (p = 0.006). The presence of gastric fluid was significantly associated with an increased frequency of observing esophageal fluid compared to other gastric contents (p = 0.049; odds ratio, 3.1). The presence of esophageal fluid was not correlated with alimentary gastric contents (p = 0.17). Increased body weight and duration of anesthesia were significantly associated with an increased frequency of observing esophageal fluid (p = 0.022, p = 0.021). Conclusions: Unlike alimentary gastric contents, fluid gastric contents were correlated with the presence of esophageal fluid upon myelo-CT. The observation of fluid in the esophagus may be consistent with GER. This study provides data additional to pH monitoring studies of GER and may support previous studies recommending shorter pre-anesthetic fasting periods in dogs.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.3
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• pp.173-185
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• 2024

Background: Excessive fear of dental procedures leads to disruptive behavior during dental examinations and treatments. Dental examinations and treatments of these patients usually require additional techniques, such as sedation. The most commonly used techniques are inhalation of nitrous oxide, infusion of propofol with fentanyl, and premedication and infusion of midazolam. Methods: A prospective observational epidemiological study was conducted on patients who required sedoanalgesia techniques for dental exploration and procedures. The reasons for the inability of patients to cooperate (excessive fear or intellectual disability), age, sex, weight, systemic pathology, oral pathology, treatment performed, time of intervention, anesthetic technique performed, and occurrence of complications were recorded. Results: In total, 218 patients were studied. Sixty-five patients came for fear of dental treatment and 153 for presenting with a diagnosis of intellectual disability and not collaborating in the treatment with local anesthesia. The average age of all patients was 30.54±17.30 years. The most frequent oral pathologies found in patients with excessive fear were tartar (6.8%) and wisdom teeth (6.4%), followed by missing teeth (5%). In patients with disabilities, a combination of tartar and cavities appeared most frequently (41.3%), followed by cavities (15.6%). The most frequently used sedoanalgesia technique was the infusion of propofol with fentanyl in both groups of patients, followed by nitrous oxide. Conclusion: The combination of propofol and fentanyl was the most frequently used alternative in patients who were unable to collaborate because of intellectual disability or carry out longer or more complex treatments. Inhaled nitrous oxide and midazolam were the sedative techniques of choice for simpler oral treatments, such as tartrectomies, shallow obturations, and shorter interventions, or in younger patients.

• Hip & pelvis
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• v.35 no.1
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• pp.24-31
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• 2023

Purpose: A response to conservative treatment is usually obtained in cases of ischiogluteal bursitis. However, the time required to achieve relief of symptoms can vary from days to weeks, and there is a high recurrence rate, thus invasive treatment in addition to conservative treatment can occasionally be effective. Therefore, the aim of this study was to examine surgical excision in cases of refractory ischiogluteal bursitis and to evaluate patients' progression and outcome. Materials and Methods: A review of 21 patients who underwent surgical excision for treatment of ischiogluteal bursitis between February 2009 and July 2020 was conducted. Of these patients, seven patients were male, and 14 patients were female. Injection of steroid and local anesthetic into the ischial bursa was administered at outpatient clinics in all patients, who and they were refractory to conservative treatment, including aspiration and prescription drugs. Therefore, surgery was considered necessary. Excisions were performed by two orthopedic specialists using a direct vertical incision on the ischial area. A review of each patient was performed after excision, and quantification of the outcomes recorded using clinical scoring systems was performed. Results: The results of radiologic evaluation showed that the mean lesion size was 6.2 cm×4.5 cm×3.6 cm. The average disease course after excision was 21.6 days (range, 15-48 days). Measurement of clinical scores, including the visual analog scale and Harris hip scores, was performed during periodic visits, with scores of 0.7 (range, 0-2) and 98.1 (range, 96-100) at one postoperative month, respectively. Conclusion: Surgical excision, with an expectation of favorable results, could be considered for treatment of ischiogluteal bursitis that is refractory to therapeutic injections, aspirations, and medical prescriptions, particularly in moderate-to-severe cases.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.2
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• pp.130-140
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• 2024

Objective: To assess whether local anesthetic infiltration could minimize the carotid baroreceptor reflex (CBR) which has an incidence after carotid artery stenting (CAS) that varies from 29% to 51%. Methods: This retrospective single-center study included 51 patients (mean age, 70.47 years) who underwent CAS for carotid stenosis. The groups included patients who underwent CAS for asymptomatic ischemic stroke (n=41) or symptomatic disease (n=10). Preprocedural percutaneous lidocaine injections (PPLIs) were administered to 70.6% and 5.9% of patients who underwent elective CAS and emergency CAS, respectively. Results: Among patients who received PPLIs, the mean degree of stenosis was 80.5% (95% confidence interval [CI]: ±10.74, 51-98%). The mean distance from the common carotid artery bifurcation to the most stenotic lesion (CSD) was 8.3 mm (95% CI: ±0.97, 6.3-10.2 mm); the mean angle between the internal carotid artery and common carotid artery (CCA) trunk (IAG) was 65.6° (95% CI: ±2.39, 61-70°). Among patients who did not receive PPLIs, the mean degree of stenosis was 84.0% (95% CI: ±8.96, 70-99%). The mean CSD was 5.9 mm (95% CI: ±1.83, 1.9-9.9 mm); the mean IAG was 60.4° (95% CI: ±4.41, 51-70°). The procedure time was longer in the PPLI group than in the no PPLI group (28.19 [n=39] vs. 18.88 [n=12] days) (P=0.057); the length of intensive care unit stay was shorter in the PPLI group (20.01 [n=36] vs. 28.10 [n=5] days) (P=0.132). Conclusions: Targeted PPLI administration to the carotid bulb decreased aberrant heart rates and blood pressure changes induced by carotid stent deployment and balloon inflation. As CBR sensitivity increases with decreasing distance to the stenotic lesion from the CCA bifurcation, PPLIs may help stabilize patients during procedures for stenotic lesions closer to the CCA.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.36-42
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• 1999

Background: The current maximal recommended doses of lidocaine are 7 mg/kg with $5\;{\mu}g/ml$ of epinephrine. But in clinical practice, sometimes more doses of lidocaine are required to produce adequate regional anesthesia. Method: Twenty-two healthy women patients were divided into two groups and pretreated with valium 5 mg p.o., morphine 5 mg i.m., and midazolam 2 mg i.v. before operation. Of these, 7 mg/kg of 2% lidocaine with $5\;{\mu}g/ml$ of epinephrine were given to 11 patients epidurally. Initial 3 ml of epinephrine mixed lidocaine was given as a test dose and remaining doses were given 5 ml/30 sec with 3 min intervals. Radial arterial blood were drawn at 5, 10, 15, 20, 30, 45, 60, 90, 120 min to measure plasma lidocaine concentrations. After confirming all of the peak plasma concentrations of 7 mg/kg lidocaine were absolutely under $5\;{\mu}g/ml$, the other 11 patients were given 10 mg/kg of 2% lidocaine with $5\;{\mu}g/ml$ of epinephrine epidurally and blood samplings were taken according to the same method of 7 mg/kg group. The peak plasma concentration ($C_{max}$), time to reach to $C_{max}$ ($T_{max}$), time to reach to $T_4$, maximal sensory block level, systemic toxicity, and vital sign changes were investigated. Result: $C_{max}$ was significantly higher in 10 mg/kg group ($5.1{\pm}1.3\;{\mu}g/ml$) than 7 mg/kg group($3.3{\pm}0.5\;{\mu}g/ml$), but $T_{max}$ ($10.5{\pm}2.7$ min vs $10.9{\pm}3.1$ min) was not different. Time to reach $T_4$ was significantly shorter in 10 mg/kg group ($9.5{\pm}2.7$ min) than 7 mg/kg group ($12.7{\pm}3.2$ min) but maximal sensory block level ($T_{3.7{\pm}0.7}$ vs $T_{2.7{\pm}1.0}$) was not different. In four patients of 10 mg/kg group, peak plasma concentrations exceeded $5\;{\mu}g/ml$, but no systemic toxicities appeared. No significant vital sign changes were observed. Conclusion: The current maximal recommended doses of lidocaine, merely based on body weight are not always appropriate. Further studies are needed to determine more precise guideline of maximal doses that include various pharmacokinetic components.

• Journal of Veterinary Clinics
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• v.25 no.6
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• pp.488-493
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• 2008

This study compared the effect of injectable combinations of anesthetics on each of the fluorescein angiographic phases in order to determine the most useful anesthetic combination for the procedure. Acepromazineketamine (AK), xylazine-ketamine (XK), diazepam-ketamine (DK) and zolazepam-tiletamine (ZT) group were administered randomly to 8 dogs with a two-week interval between different combination doses. The vital signs including the heart rate and arterial pressure were measured before anesthesia and every five minutes during anesthesia. Serial angiographic images were obtained after injecting a sodium fluorescein dye (25 mg/kg) and the onset time of arterial phase (AP), arteriovenous phase (AVP), early venous phase (EVP) and late venous phases (LVP) were recorded. The onset time of the AP, AVP and EVP were significantly slower in the AK and XK groups than in the DK and ZT groups. The total duration of the AP and AVP in the AK group was significantly longer than those in the ZT group. The heart rates were significantly higher in the DK and ZT groups. The arterial pressure was significantly higher in the AK and XK groups (p<0.05). There were significant differences in each angiographic onset time and duration depending on the changes in the heart rates and arterial pressure. The AK and XK groups showed a long angiographic duration allowing an accurate evaluation. Overall, it is believed that AK and XK are more useful for performing fluorescein retinal angiography than DK and ZT.