Anesthesia progress
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Anesthesia progress · Jan 2000
Inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen: radiographic study of local anesthetic spread in the pterygomandibular space.
We studied the spread of local anesthetic solution in the inferior alveolar nerve block by the injection of local anesthetic solution into the pterygomandibular space anterior to the mandibular foramen (anterior technique). Seventeen volunteers were injected with 1.8 mL of a mixture containing lidocaine and contrast medium utilizing the anterior technique. ⋯ The results indicate that the contrast medium mixture spreads rapidly in the pterygomandibular space to the inferior alveolar nerve in the subjects who exhibited inferior alveolar nerve block effect. We concluded that the anesthetic effect due to the anterior technique was produced by the rapid distribution of anesthetic solution in the pterygomandibular space toward the mandibular foramen, and individual differences in the time of onset of analgesia may be due to differences in the histologic perineural tissues.
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Anesthesia progress · Jan 1999
ReviewKetamine: review of its pharmacology and its use in pediatric anesthesia.
The management of the uncooperative pediatric patient undergoing minor surgical procedures has always been a great challenge. Several sedative techniques are available that will effectively alleviate anxiety, but short of general anesthesia, no sedative regimen is available that will enable treatment of the uncooperative child. Ketamine produces a unique anesthetic state, dissociative anesthesia, which safely and effectively enables treatment of these children. The pharmacology, proposed mechanisms of action, and clinical use of ketamine (alone and in combination with other agents) are reviewed and evaluated.
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Anesthesia progress · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialUse of sevoflurane inhalation sedation for outpatient third molar surgery.
This study attempted to determine if sevoflurane in oxygen inhaled via a nasal hood as a sole sedative agent would provide an appropriate level of deep sedation for outpatient third molar surgery. Twenty-four patients scheduled for third molar removal were randomly assigned to receive either nasal hood inhalation sevoflurane or an intravenous deep sedation using midazolam and fentanyl followed by a propofol infusion. ⋯ A trend toward earlier recovery in the sevoflurane group was identified. Sevoflurane can be successfully employed as a deep sedative rather than a general anesthetic for extraction of third molars in healthy subjects.
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Anesthesia progress · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of a new type of video glasses on the perceived intensity of pain and unpleasantness evoked by a cold pressor test.
The aim of the study was to evaluate whether distraction induced by a new generation of video glasses (I-Glasses, Virtual i-O, Seattle, WA) has an effect on the perceived intensity of pain and unpleasantness. The effects of three-dimensional video, two-dimensional video, and no video glasses (control) were compared in two groups of healthy volunteers (13 males and 11 females) in a randomized, controlled trial. A cold pressor stimulus (1-2 degrees C chilled water) was used to induce experimental pain, and the volunteers rated the intensity of pain and unpleasantness on 100-mm visual analogue scales. ⋯ Three-dimensional video provided a significant reduction in both pain and unpleasantness (P < .01) compared with the control condition in the male group. However, in the female group, there was a significant reduction in unpleasantness with two-dimensional video compared with the control (P < .05). This suggests that the use of distraction by means of video glasses is able to reduce the perceived intensity of pain and unpleasantness.
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Anesthesia progress · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialEvaluation of prilocaine for the reduction of pain associated with transmucosal anesthetic administration.
This investigation evaluated the use and efficacy of prilocaine HCl (4% plain Citanest) for minimizing pain associated with the intraoral administration of local anesthesia. Clinical anecdotes support the hypothesis that prilocaine without a vasoconstrictor reduces pain during injection. To determine relative injection discomfort, use of 4% plain prilocaine was compared with use of 2% lidocaine with 1:100,000 epinephrine and 2% mepivacaine with 1:20,000 levonordefrin. ⋯ However, there were statistically significant differences among the injection sites. Post hoc analysis revealed that prilocaine was associated with significantly less pain perception when compared to mepivacaine and lidocaine. These results suggest that differences in initial pain perception during transmucosal injection may be a function of the local anesthetic use, and prilocaine can produce less discomfort than the others tested.