Cardiorespiratory effects of outpatient anesthesia for oral surgery: trichloroethylene-halothane.

The cardiorespiratory effects of trichloroethylene supplementation of nitrous oxide-oxygen anesthesia, with simultaneous use of halothane at induction as needed, were studied in outpatient oral surgery patients undergoing dental extractions under general anesthesia. The technique produced no deleterious cardiovascular effects that could be attributed to the combined use of these agents. Elevations of blood pressure, stroke volume, and peripheral resistance indicated light anesthesia. The versatility of halothane combined with the absence of nephrotoxic and hepatotoxic breakdown products of trichloroethylene provides a satisfactory technique for outpatient oral surgery. The agents appear pharmacologically complimentary in that halothane lacks analgesic properties and postoperative shivering occurs, while induction with trichloroethylene is slow and tachypnea is a problem.     

Hypoxemia during outpatient general anesthesia

A high incidence of arterial oxygen desaturation during outpatient general anesthesia was found when patients were continuously monitored with the ear oximeter. The incidence of hypoxemia is minimized by the use of supplemental oxygen.     

Kalipsol-based balanced intravenous anesthesia in pediatric outpatient dental practice]

Basing on clinical studies of anesthesia in 568 children, central hemodynamic studies, analysis of the blood acid-base balance and gases, glycemia level, and assessment of the psychoneurologic status, the authors validate the usefulness of calypsol-based anesthesia in practical outpatient pedodontics. Such anesthesia did not influence the stability of central hemodynamics parameters, nor did it change the acid-base balance and blood sugar level; it provided an adequate protection of the patient from surgical stress with the adaptation mechanisms remaining intact. The child may leave the clinic 2.5-3 h after the intervention and a test for adequate adaptation to the environment. Calypsol-based balanced anesthesia improves outpatient care of the children, introduction of this method into practice will bring about a good economic effect.     

Spontaneous tension pneumothorax following outpatient general anesthesia

A case is reported in which a spontaneous tension pneumothorax developed after outpatient general anesthesia with a nitrous oxide oxygen mixture. The patient was not intubated or ventilated with positive pressure on the airway. The pneumothorax could be attributed to either a postanesthetic coughing episode, the administration of nitrous oxide, which may have caused already present apical blebs to increase in size to the point of rupture, or both.     

Clinical assessment of etomidate for outpatient general anesthesia: a preliminary evaluation

Etomidate, a nonnarcotic, nonbarbiturate hypnotic agent, was assessed in a group of 20 patients requiring general anesthesia for outpatient oral surgical procedures. Changes in mean blood pressure, heart rate, and transcutaneous oxygen tension (PtcO2) were examined following the intravenous administration of etomidate for the induction and maintenance of general anesthesia. Clinical evidence of pain on injection, myoclonic muscle activity, apnea, nausea, and emesis were documented. A postoperative questionnaire evaluated levels of amnesia and acceptance of the drug by the patient and surgeon. No significant (P less than 0.05) change in PtcO2 occurred during etomidate infusion; however, a statistically significant but clinically insignificant change did occur in mean blood pressure and heart rate. Although myoclonic muscle activity, pain on injection, and nausea and vomiting were documented, the subjective evaluation of this agent by patient and surgeon was favorable.     

A technique for making a facial moulage under general anesthesia

A technique for making a facial moulage under general anesthesia has been described. Where there is a need to form an impression of the face, especially in handicapped and young patients, the procedure is simple and timesaving.     

Cost of a genioplasty under deep intravenous sedation in a private office versus general anesthesia in an outpatient surgical center.

The cases of twenty-four patients who underwent genioplasties either under deep intravenous (IV) sedation in a dental office or under general anesthesia in a surgical center were reviewed. A cost comparison of this operation in these two environments showed that it was twice as expensive to have the same procedure done in an outpatient surgical suite under general anesthesia as it was in a private office under IV sedation.     

A composite general anesthesia technique using ketamine for pediatric outpatients.

A study of 43 pediatric oral surgery patients was conducted in a clinical environment. The anesthetic regimen of a minimum dose of ketamine hydrochloride, nitrous oxide-oxygen, and a local anesthetic was tested for recovery time and degree of acceptance by parents and patients. With this regimen, the average recovery time from completion of the procedure was 30 minutes. The combination of these drugs provided a rapid, smooth induction, additional time while the ketamine-induced anesthesia was dissipating, no major complications, and good acceptance by parents and patients.     

An overview of outpatient sedation and general anesthesia for dental care in California

This paper reviews the principal pharmacologic interventions for the management of pain and anxiety in the apprehensive dental patient, including oral sedation, intravenous sedation, and general anesthesia.     

Hemodynamic effects of locally applied epinephrine used with various general anesthetic techniques.

Halothane-nitrous oxide-oxygen (GOF), nitrous oxide-oxygen with diallyl-nor-toxiferine (Jackson-Rees method), or nitrous oxide-oxygen with droperidol-pentazocine (modified NLA) were administered in 190 instances of repair of cleft lips and cleft palates. Epinephrine, 1:30,000, 1:100,000, or 1:300,000, was injected as the vasoconstrictor around the operative field. Epinephrine concentration of 1:100,000 provided sufficient hemostasis, whereas 1:300,000 was insufficient. With the same concentration of epinephrine, GOF and modified NLA seemed to be better than the Jackson-Rees method, since the GOF and modified NLA groups showed less increase of pulse rate, blood pressure, and plethysmographic changes. A 1:30,000 concentration of epinephrine could be used safely with the Jackson-Rees method and the hemostasis with this concentration was superior to 1:100,000. However, it is recommended only for the cleft lip operation, since these patients are younger and need better hemostasis, and hypersalivation after reversal does not disturb the postoperative course. So-called epinephrine-induced arrhythmia with halothane anesthesia occurred in 1 of 34 instances with 1:300,000 solution and in 5 of 48 instances with 1:100,000 solution. Propranolol was given in only one instance. All others returned to normal rhythm with hyperventilation with pure oxygen. The use of 1:100,000 solution of epinephrine as an adjunct with modified NLA is the most satisfactory and safe method for cleft palate operations, and 1:30,000 with the Jackson-Rees is the better method for cleft lip repairs.     

Adverse events with outpatient anesthesia in Massachusetts.

PURPOSE: This retrospective study documented the frequency of various complications associated with outpatient anesthesia. PATIENTS AND METHODS: A questionnaire was mailed to the 157 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons (MSOMS) and all members responded. Morbidity data were obtained for the calendar year 1999. Mortality data included 1999 and the preceding 4 years. This continues our long-term survey of ambulatory oral surgical office deaths in Massachusetts since 1984. The data include anesthesia-related complications and all office deaths for the patients treated by these oral and maxillofacial surgeons. RESULTS: The most common complication in our survey continues to be syncope, which occurred in 1 in 160 patients receiving local anesthesia. The incidences of other specific anesthetic problems are given. Two treatment-related deaths occurred among approximately 1,706,100 patients treated during the 5-year period of 1995 through 1999, for a mortality rate of 1/853,050. CONCLUSIONS: The results of this retrospective practitioner survey documented the specific incidence of untoward anesthetic events with outpatient anesthesia and found a mortality rate consistent with the 6 similar mortality studies since 1980. These 7 retrospective reviews found 34/28,399,193 outpatient deaths for an overall dental anesthesia mortality rate of 1/835,000.