Anesthesia & pain control in dentistry
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Anesth Pain Control Dent · Jan 1993
Case ReportsAn anaphylactoid reaction following local anesthesia: a case report.
A case report of an adverse reaction to a preparation of an amide local anesthetic, prilocaine with epinephrine, is presented. Signs and symptoms were consistent with an anaphylactic reaction and the patient responded positively to treatment based on this assumption. Treatment included administration of epinephrine injected sublingually and oxygen by inhalation. ⋯ A number of explanations are possible and a final diagnosis of an anaphylactoid reaction was made. Local anesthetic allergies and their management are reviewed. The literature demonstrates that an allergic reaction to amide local anesthetics can occur and a thorough history, intradermal testing, and subcutaneous challenge are reasonable approaches to determine a safe agent for subsequent use.
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Anesth Pain Control Dent · Jan 1992
Comparative StudyIntraoral conduction anesthesia with epinephrine-containing local anesthetics and arterial epinephrine plasma concentration.
Following conduction anesthesia using either lidocaine 2% with epinephrine 1:80,000, articaine 4% with epinephrine 1:100,000, or articaine 4% with epinephrine 1:200,000, the arterial plasma epinephrine concentration was measured. Eighteen healthy young patients scheduled for osteotomy of a mandibular third molar were studied. Each local anesthetic-epinephrine combination was tested in six patients. ⋯ The result was explained by the concentration difference in the local anesthetics. Although the vasodilating action of lidocaine and articaine is almost identical, there will be enhanced vasodilation by the doubled concentration in the case of articaine (4%) and the local resorption of epinephrine may be facilitated. There were no significant changes in the measured cardiovascular parameters.
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Anesth Pain Control Dent · Jan 1992
Multicenter StudyProtocol for studying depth of anesthesia using the spectral edge frequency.
The preliminary results of a multicenter study designed to determine the utility of the processed EEG in combination with heart rate and blood pressure for estimating anesthetic depth are reported. The study is planned to include 1,000 ASA I, II, and III patients undergoing surgery with at least a 60-minute duration of anesthesia. The preliminary results indicate that the use of EEG and clinical signs may provide better control of anesthetic depth. The study design provides ideal conditions for determining whether spectral edge frequency is a useful criterion for management of routine general anesthesia in a typical clinical environment.
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Anesth Pain Control Dent · Jan 1992
Randomized Controlled Trial Clinical TrialClinical investigation of potency and onset of different lidocaine sprays for topical anesthesia in dentistry.
The clinical effects of three lidocaine-containing solutions with and without frigen (freon-113) as a propellant, after different waiting periods, and with different dosages applied were investigated in 130 outpatients who were undergoing dental treatment in the maxilla under local anesthesia. They were divided randomly into five groups (A through E): (A) Xylocaine spray with frigen, two applications (20 mg lidocaine); (B) Xylestesin spray with frigen, two applications (14 mg lidocaine); (C) Xylestesin spray with frigen, three applications (21 mg lidocaine); (D) Xylestesin pump spray without frigen, two applications (14 mg lidocaine); and (E) no topical anesthesia. They were further divided into 12 subgroups to evaluate waiting periods between the application of the topical anesthesia and the injection (1, 2, or 3 minutes). ⋯ However, a 3-minute waiting period may be appropriate for sensitive patients. An increase in the dosage failed to show better analgesia. The pump spray without frigen proved to be effective.