Effect of Intraosseous Anesthesia on Control of Hemostasis in Pigs

IntroductionIntraosseous anesthesia is used to deliver anesthetic into cancellous bone adjacent to the root apices. No study has assessed the effect of this anesthetic technique on hemostasis. The purpose of this study was to compare the amount of bleeding from soft tissue and bone in pig jaws after preoperative intraosseous or infiltration anesthesia with 2% lidocaine containing 1:50,000 epinephrine.MethodsTwelve pigs were divided into 3 groups. The first group received infiltration anesthesia on one half of the jaw and no anesthesia on the other half. The second group received intraosseous anesthesia on one half of the jaw and no anesthesia on the other half. The third group received infiltration anesthesia on one half of the jaw and intraosseous anesthesia on the second half. Blood was collected during flap reflection to measure the volume of soft tissue bleeding. Osteotomies were then prepared with blood collected from the surgical site to measure the volume of osseous bleeding.ResultsThe median soft tissue blood loss observed in animals receiving infiltration anesthesia (1.14 mL) was significantly less as compared with animals that received no anesthesia (4.49 mL) or intraosseous anesthesia (2.45 mL). Compared with median hard tissue blood loss observed in animals without anesthesia (1.51 mL), significantly less blood loss was observed in animals receiving either infiltration anesthesia (0.67 mL) or intraosseous anesthesia (0.76 mL).ConclusionsInfiltration anesthesia resulted in significantly less soft tissue bleeding (p = .004) as compared with no anesthesia. Infiltration and intraosseous anesthesia resulted in significantly less osseous bleeding than the use of no anesthetic (p < .001). The volume of blood loss for each animal was shown to be below the maximum safe volume of blood loss for a single procedure.     

表面麻醉联合STA在儿童多生牙拔除术的应用

目的:比较表面麻醉联合STA无痛麻醉与STA无痛麻醉、传统压力注射器局部麻醉在儿童多生牙拔除术中的应用效果.方法:选择5～14岁上颌前牙区多生牙患儿90例为研究对象,分为A、B、C三组,每组30例.A组为表面麻醉联合STA无痛麻醉;B组为STA无痛麻醉;C组为传统压力注射器局部麻醉,3组均采用唇腭侧局部浸润麻醉.记录3...     

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局部麻醉(简称"局麻")是无痛治疗的基本手段,有效的局麻是许多牙科门诊工作顺利、安全进行的重要保证,但局麻针刺操作和注射药物可能对患者精神和肌体产生不良作用。局麻前进行个体化评估是保证麻醉有效性和避免局麻意外的必要措施,局麻前评估内容一般包括患者年龄、体重、健康状况、精神心理状况、麻醉史、麻醉方法和药物选择、局麻意外应急预备等。全面准确的评估及相应准备可确保局麻效果、避免或减少麻醉风险,是每个牙科医生都应具备的理念和能力。     

口腔无痛麻醉在儿童乳磨牙牙髓切断术中的应用

目的比较牙周膜无痛麻醉注射和传统手推骨膜上浸润麻醉方法在儿童乳磨牙牙髓切断术中的应用价值。 方法选择2018年1月至2019年7月于青岛市口腔医院儿童口腔科就诊,年龄为5~ 7岁,下颌双侧第二乳磨牙深龋坏,需进行牙髓切断术治疗的儿童50例,共100颗牙齿。全部患儿一侧下颌第二乳磨牙采用计算机控制口腔局部麻醉系统（STA）牙周膜注射麻醉,对侧下颌第二乳磨牙采用传统手推骨膜上浸润麻醉,以此分为无痛麻醉组和传统麻醉组,各50颗牙齿。采用Wong-Baker面部表情疼痛量表（Wong-Baker量表）评价两组注射时疼痛程度及牙髓切断术中麻醉效果,治疗结束后24 h电话随访评价软组织不适情况。采用χ²检验分别比较注射时、牙髓切断过程中无痛麻醉组和传统麻醉组Wong-Baker量表得分。 结果注射时,无痛麻醉组无痛或微痛率为88%,较痛或很痛率为12%,传统麻醉组无痛或微痛率为42%,较痛或很痛率为54%,无痛麻醉组要显著低于传统麻醉组,差异有统计学意义（χ²= 23.502,P<0.001）;牙髓切断过程中,无痛麻醉组无痛或微痛率为98%,较痛或很痛率为2%,传统麻醉组无痛或微痛率为96%,较痛或很痛率为4%,经χ²检验,术中无痛麻醉组和传统麻醉组麻醉两者麻醉效果相当,差异无统计学意义（χ²= 0.344,P= 0.57）;术后无痛麻醉组软组织麻木不适的发生率（2%）显著低于传统麻醉组（100%）,其中传统麻醉组5例儿童出现自伤性溃疡。 结论儿童乳磨牙牙髓切断术中,STA系统牙周膜注射麻醉和传统手推骨膜上浸润麻醉两种方法麻醉效果相当,但是STA系统牙周膜注射麻醉较传统手推骨膜上浸润麻醉注射时疼痛程度更轻,术后不适反应更小。     

Evaluation of electronic dental anesthesia in children.

OBJECTIVE: The purpose of this study was to determine the effectiveness and acceptance of electronic dental anesthesia in comparison with local anesthesia in restorative procedures in children. STUDY DESIGN: Twenty-eight children, aged 6 to 12 years, participated in the study. Each patient had symmetric teeth requiring class I cavity preparations. One tooth was treated with electronic dental anesthesia; the antimere tooth was treated with local anesthesia. The tooth and the method were selected at random, and the two restorations were performed at the same appointment. Pain was assessed by means of two pain scales, the color scale and the sound, eye, and motor scale. Behavior was assessed through use of the North Carolina Behavior Rating Scale. The ratings of pain and behavior were made at 4 separate intervals (after rubber dam clamp placement, with the handpiece operating adjacent to the tooth, during penetration of the dentin-enamel junction of the tooth, and 5 minutes postoperatively). The recorded values for the steps of the restorations completed with electronic dental anesthesia and local anesthesia were analyzed by means of chi(2) analysis to determine any statistically significant difference between the techniques at a level of P <.05. RESULTS: Although the success rate of electronic dental anesthesia was less than that of local anesthesia, there was no significant difference between the two methods. On the other hand, 53.6% of the patients preferred electronic dental anesthesia, whereas 35.7% preferred local anesthesia. CONCLUSIONS: In restorative dental care in children, electronic dental anesthesia appears to be beneficial in reducing discomfort, as judged from behavioral observations and self-reports.     

日间门诊全麻下拔牙的临床应用及评价

目的:回顾性分析日间门诊全麻下拔牙的病例资料,总结日间门诊全麻下拔牙的麻醉特点、诊疗规范、手术特点和安全性。方法:收集日间门诊全麻下拔牙病例,总结选择全麻的原因、拔除牙位、离院评价得分,分析日间门诊全麻下拔牙的麻醉特点、手术特点。根据术中情况和术后复查分析该方法的安全性。结果:共收集18个病例,男11例,女7例,年龄7～50岁。选择全麻的原因包括:无法配合手术的儿童、智障、癫痫、咽部敏感、局麻药物过敏和有紧张晕厥病史。拔除牙位主要是阻生智齿和埋伏多生牙,均采用气管内插管静吸复合麻醉。所有病例手术顺利并安全离院,离院标准评分均在13分以上。结论:严格遵从诊疗规范的情况下,日间门诊全麻下拔牙对因各种原因无法配合局麻下手术的患者是一种安全有效的治疗方法。     

Local anesthesia failure problems in conservative dental therapy clinic

There were evaluated the prevalence of local anesthetic injection failure in therapeutic dentistry. 121 practitioners were interrogated using a special questionnaire. In the second stage of our study 447 teeth in caries and pulpitis patients were treated using articaine based local anesthesia. Results showed that anesthesia failure problem is still important. Prevalence of anesthesia failure differs depending on dental diagnosis and number of tooth. It is more for pulpitis in comparison with caries. The most difficult for achieving adequate anesthesia teeth are lower molars.     

New horizons in local anesthesia

The computer-controlled local anesthesia system and the TEA system present 21st-century alternatives to the traditional syringe. The TEA system is a non-invasive form of anesthesia that blocks pain electronically, using the same cellular mechanism as local chemical anesthesia. Targeted electronic anesthesia provides pain control for restorative dental procedures without the use of needles or postoperative discomfort, numbness, and swelling. The computer-assisted system outperforms syringes for traditional injections. This new system generates a precisely controlled anesthetic flow rate that eliminates the need for the operator to use thumb pressure to administer the injection. The lightweight pen-grasp handle results in greater tactile feedback, precision, operator ease, and patient comfort. The greatest advantage may be in the new techniques that it makes available. With these techniques, a dentist can target the teeth to achieve profound pulpal anesthesia, often without the annoying side effects of facial numbness. With this new advanced system in the maxillary arch, the AMSA injection offers clinical advantages over traditional anesthesia techniques, according to Dr. Mark Friedman, whom I consulted with earlier this year. In the mandibular arch, a safe and predictable PDL injection technique may replace the need for an inferior alveolar block in numerous clinical situations. The use of these modified injection techniques can have a positive influence on patient safety, patient comfort, and office productivity. Both of these systems take the fear and anxiety out of dental injections. They offer exciting advanced technology for local pain control. Significantly, if patient stress and anxiety are reduced, the operator immediately benefits. New horizons in local anesthesia offer improved opportunities for patient comfort using computer-controlled local anesthetic systems and TEA.     

Computerized anesthesia delivery system vs. traditional syringe: comparing pain and pain-related behavior in children

The aim of this study was to compare the behavioral reaction of children who receive local anesthesia with a traditional syringe with the behavioral reaction of children who receive local anesthesia with a computerized device (Wand) and to differentiate between the reactions of highly anxious children with those displaying low anxiety. One hundred and twenty-five children aged 4-11 yr were randomly allocated to receive local anesthesia with the Wand or a traditional injection. Parents completed the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Two independent observers scored videotapes of the anesthesia in 15-s intervals. The occurrence of muscle tension, crying, verbal protest, movement, and resistance was registered and a score was given on the Venham distress scale. The mean injection time with the Wand was four times as long as with the traditional syringe. During the first 15 s of the injection, low-anxious children receiving local anesthesia with the Wand displayed less muscle tension, less verbal protest and less movement than children receiving local anesthesia with the traditional syringe. Within the high-anxious group no differences were found. It was concluded that low-anxious children seem to benefit from the use of the Wand instead of the traditional syringe in receiving local anesthesia.     

Use of transcutaneous electroneurostimulation for enhancing the effectiveness of conduction anesthesia in dental polyclinic practice

The efficiency of mandibular conduction anesthesia was assessed in patients with inflammatory disorders in the area innervated by the mandibular nerve. In patients with conduction anesthesia induced after an electroneurostimulation session, the efficiency of anesthesia was considerably higher than in those operated on under mandibular anesthesia only.     

Evaluation of the Akinosi mandibular block technique in oral surgery

The Akinosi mandibular block technique for administration of local anesthesia was compared with conventional nerve block techniques in patients undergoing the removal of impacted third molars using a within-subject experimental design. Success rates were equivalent, and both techniques resulted in acceptable quality of anesthesia. Buccal nerve anesthesia was achieved with the Akinosi technique in 80% of cases. The Akinosi technique appears to be a successful alternative to traditional mandibular block techniques for oral surgery.     

家长陪伴的麻醉诱导在儿童口腔颌面手术中应用效果评价

目的:探讨家长陪伴能否提高口腔颌面外科手术患儿麻醉诱导期的安全性。方法:采用随机对照研究,入选120例2~6岁口腔颌面外科手术患儿,随机分为2组,每组各60例。2组家长均进行术前宣教,试验组（P组）患儿家长在麻醉诱导期陪伴患儿,对照组（N组）患儿则无家长陪伴。在麻醉诱导时记录并比较2组患儿的血压、心率、氧饱和度,以及诱导时的配合度。采用SPSS 17.0软件包进行数据分析。结果:有家长陪伴的患儿与无家长陪伴的患儿相比,在麻醉诱导期心率及氧饱和度明显平稳,配合度也较好。结论:麻醉诱导期家长陪伴能有效提高口腔颌面外科手术患儿围术期麻醉安全性,是一项值得开展及推广的医患合作新途径。     

New advances in local anesthesia

In dentistry, local pain management is a critical component of patient care. When efforts to achieve local anesthesia are unsuccessful, the resulting stress for both the patient and practitioner can be significant. This Forum has reviewed new technologies that are reported to increase the probability of a favorable outcome with local anesthesia. Like all new techniques, devices, and drugs, there is a learning curve that must be mastered. However, the potential benefits of the new devices and techniques available in local anesthesia broaden the practitioners' choices. There may not yet be a "magic bullet" in local anesthesia, but the advances reviewed here hold great promise. Our participants seem to agree that predictable local anesthesia will always require a thorough understanding of the broad range of devices, techniques, and drugs available and a commitment by the dentists to use them wisely.     

Changes in autonomic homeostasis during anesthesia induction in patients operated on for congenital cleft palate

Variation pulsometry was used to study vegetative homeostasis changes over the course of induction anesthesia and tracheal intubation in children operated on for palatal clefts. The same premedication scheme was employed in all the patients. The same neuroleptic doses were administered in induction anesthesia. Induction anesthesia parallel with electroanalgesia with an Electronarcol-1 apparatus helped reduce the promedol dose necessary for adequate anesthesiologic protection from 1.2-1.4. to 0.2-0.4 mg/kg. This was associated with the minimal changes in autonomic nervous system functioning, evidencing the efficacy of electroanalgesia in induction anesthesia for this patient population.     

心血管病患者拔牙阿替卡因肾上腺素局麻临床效果观察

目的 比较局部麻醉剂阿替卡因肾上腺素和利多卡因用于老年心血管疾病患者拔牙时,对患者血压和心率等变化的影响,探寻阿替卡因肾上腺素用于老年心血管疾病患者拔牙的安全性.方法 本研究包括 228 例老年心血管疾病患者的 239 颗牙齿,随机分组为阿替卡因肾上腺素组(实验组)和利多卡因组(对照组),分别记录麻醉注射前3min,麻醉注射即刻,麻醉注射后3min、拔牙手术中、拔牙手术后3min患者的血压、心率.对数据进行统计分析.结果 与利多卡因相比,阿替卡因肾上腺素在麻醉注射即刻、拔牙手术中心率明显加快,差异具有统计学意义(P<0.05).在麻醉注射后3min收缩压升高,差异具有统计学意义(P<0.05).在任何时点舒张压均无明显升高.两组在麻醉注射后、拔牙手术后血压、心率均回复到麻醉注射前水平.结论 局部麻醉剂阿替卡因肾上腺素对无心动过速、经过全身系统治疗的、病情稳定的心血管疾病患者拔牙是安全可行的.     

STA牙周膜注射在下颌埋伏阻生智齿拔除中的应用评价

目的比较传统下齿槽神经阻滞麻醉和计算机控制给药下牙周膜注射麻醉在注射及给药过程中的疼痛情况和麻醉效果。方法 120例下颌埋伏阻生智齿随机分成实验组和对照组,每组60例。实验组采用牙周膜注射单颗牙麻醉,对照组采用下齿槽神经阻滞麻醉。分别在不同4个时间点测量患者血压和心率;应用疼痛视觉模拟量表测定患者对两种麻醉注射方法的疼痛值。结果对照组在麻醉剂注射中和注射后2分钟血压明显升高;实验组在整个麻醉和手术过程中血压无明显变化。实验组的疼痛均值明显低于对照组。结论在下颌埋伏阻生智齿拔除术中,单颗牙牙周膜注射麻药时的疼痛明显低于传统的下齿槽神经阻滞麻醉,而二者麻醉效果相当。     

Nasal cannula technique for ventilating during the administration of general anesthesia in neonates and pediatric patients

ABSTRACT

Objective: Minor surgeries on the oral cavity, e.g., frenulectomies, are often performed under general mask anesthesia. The objective is to present the nasal cannula technique for ventilating step-by-step method for ventilating during general anesthesia for minor surgeries in neonates and pediatric patients.

Technique: The nasal cannula technique for ventilating has been used in over 20 pediatric cases (neonates and toddlers), without the need to re-mask during the procedure and without complications or oxygen desaturations. After induction of general mask anesthesia, propofol with or without adjunctive ketamine is administered. The anesthesia mask is exchanged with a nasal cannula, using the largest sized prongs that accommodate the nares, and the nasal cannula is connected to the anesthesia circuit. This permits administration of inspired fractions of oxygen.

Conclusion: The nasal cannula technique for ventilating provides a safe method for delivering general anesthesia and ventilating during minor surgeries for neonates and pediatric patients.     

INTRAFLOWTM麻醉释放系统的临床应用评价

目的　分析评价INTRAFLOWTM麻醉释放系统的临床效果及安全性。方法　 12 0例患者随机分成 2组 ,实验组 6 0例应用INTRAFLOWTM麻醉释放系统注射麻醉 ,对照组 6 0例采用局部浸润麻醉 ;注射后记录麻醉起效时间、患者血压、心率变化 ;麻醉效果采用患者自评 (视觉模拟标尺表法 ,即VAS法 )及医生评定相结合。结果　 2组的麻醉效果差异无显著性 (P >0 .0 5 ) ,麻醉后的血压、心率记录差异亦无显著性 (P >0 .0 5 ) ,但实验组麻醉起效较对照组快 (P <0 .0 1) ;实验组麻醉 1颗或相邻的 2颗牙齿只需要注射 1个部位 ,对照组视牙位及治疗目的的不同需要注射 1～ 3个部位。结论　INTRAFLOWTM麻醉释放系统具有良好的麻醉效果和安全性 ,麻醉起效快、操作方便     

The use of conscious sedation versus general anesthesia in modern dentistry: rising ethical dilemmas

Conscious sedation and general anesthesia have been in the use of the dental profession since the first half of the 19th century. Although seemingly appealing to use due to alleviation of pain and anxiety induced by the dental treatment, the alteration of consciousness level of dental patients is not without risk. Morbidity and mortality due to dental treatment performed under general anesthesia were investigated at the last decades of the 20th century. The mortality rates found in these investigations were surprisingly high comparing to researches of morbidity and mortality due to other medical procedures, performed under general anesthesia. Therefore, although general anesthesia is sometimes the only way to treat certain patients, maintaining strict indications for dental treatment under general anesthesia is necessary. Conscious sedation was found as a safer alternative for achieving a level of consciousness enabling dental treatment in those patients who are unable to receive treatment in normal dental clinic settings. We therefore believe that conscious sedation should be the golden standard for the treatment of those patients. The practicing of dentistry in patients who have need of dental treatment under special settings such as general anesthesia and sedation raises ethical dilemmas to the caregiver. The following review will summarize the available data on morbidity and mortality due to dental treatment given under general anesthesia and conscious sedation. The ethical questions arising from their practicing will be discussed and some answers shall be proposed.     

采用不同麻醉方法拔除上前磨牙的临床对比

目的 比较拔除上前磨牙时采用单牙无痛局部麻醉系统(STA)行牙周韧带(PDL)内注射麻醉和常规金属注射器颊腭双侧局部浸润麻醉在注射及拔牙过程中疼痛情况和麻醉效果.方法 选择100例因为正畸需要拔除双侧上前tEi磨牙的患者为研究对象,随机选择其中一侧作为试验牙,另一侧作为对照牙:实验组应用计算机控制STA进行盐酸阿替卡因PDL内注射麻醉,对照组采用常规金属注射器进行盐酸阿替卡因颊腭双侧局部浸润麻醉.麻醉5 min后进行拔牙手术.利用直观模拟标度尺(VAS)及问卷获得患者麻醉注射及拔牙时的痛觉数据和颊部软组织是否麻木不适数据.结果 实验组和对照组麻醉注射疼痛感觉VAS值分别是(0.4011±0.556)、(4.1038 4±1.512),两组注射疼痛感觉比较差异有统计学意义(P<0.01);而实验组与对照组在麻醉镇痛成功率方面比较差异无统计学意义(P>0.05);实验组只有2%患者有颊侧软组织麻木不适感,而对照组100%患者有颊侧软组织麻木不适感,两者差异有统计学意义(P<0.01).结论 在上前磨牙拔除中.应用STA-PDL注射麻醉可以达到良好的麻醉效果,同时麻醉注射时疼痛轻微,对邻近颊部软组织功能影响小,麻醉药物用量较少.