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A Review of Current Literature of Interest to the Office-Based Anesthesiologist
Mark A. Saxen DDS, PhD and
 Craig P. McKenzie DMD
Article Category: Research Article
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/348194
Page Range: 53 – 55

Gandhi HA, Olson G, Lee H, et al. Assessing the safety of deep sedation in outpatient pediatric oral health care. J Am Dent Assoc. 2023;154(11):975–983.e1. doi:10.1016/j.adaj.2023.07.019. Epub September 5, 2023. PMID: 37676186.

This systematic chart review examined 175 charts of pediatric patients who underwent dental procedures supported by deep sedation (DS) from 2017 through 2019 at a dental clinic. Charts were assessed for the presence of sedation-related adverse events (AEs). A panel of experts performed a second review and confirmed or refuted the designation of AEs (by the first reviewer). AEs were classified with the Tracking

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Perioperative Management of a Patient With Idiopathic Pulmonary Hypertension and a History of Syncope: A Case Report
Aiji Sato (Boku) DDS, PhD;,
 MinHye So MD, PhD;,
 Kazuma Fujikake MD, PhD;,
 Motoshi Tanaka MD;,
 Yuji Kamimura MD, PhD;,
 Haruko Ota MD, PhD;,
 Tomomi Mizutani DDS,
 Kenichiro Ishibashi DDS, PhD;,
 Yasuyuki Shibuya DDS, PhD;, and
 Kazuya Sobue MD, PhD
Article Category: Case Report
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/anpr-70-03-08
Page Range: 29 – 33

Pulmonary hypertension is characterized by higher-than-normal pulmonary arterial pressures. This case report describes the perioperative management of a male patient with idiopathic pulmonary hypertension and a history of vasovagal syncope during previous dental extractions with local anesthesia. He underwent successful extraction of a single tooth with intravenous moderate sedation using dexmedetomidine and midazolam as well as prilocaine with felypressin for local anesthesia. There are many considerations surrounding the anesthetic management of patients with pulmonary hypertension, including the need to maintain systemic blood pressure, avoid hypoxemia and hypercapnia, and ensure adequate analgesia.

Efficacy of Midazolam/Meperidine vs Midazolam/Hydromorphone for Enteral Moderate Sedation in the Pediatric Dental Patient
Bryce W. Kinard DMD,
 Andrew S. Zale DMD, MSD, and
 Kenneth L. Reed DMD
Article Category: Research Article
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/22-00037
Page Range: 15 – 18

Objective: The goal of this study was to compare the efficacy of midazolam/meperidine (M/M) vs midazolam/hydromorphone (M/H) for enteral moderate sedation along with inhalational sedation in pediatric dental patients.

Methods: This retrospective chart review analyzed the charts of pediatric patients who received dental treatment under enteral moderate sedation with either M/M or M/H in combination with inhalational sedation (nitrous oxide/oxygen) at El Rio Community Health Centers (affiliated with NYU Langone) in Tucson, Arizona, from July 2014 to December 2020. Included subjects were between 2 and 5 years of age, less than 20 kg, and otherwise healthy. In addition to demographic and drug-dosing data, treatment completion, sedation level, behavioral score, overall effectiveness, and sedation duration data were collected and analyzed from each patient’s chart.

Results: No statistically significant differences were observed when comparing the 2 drug regimens in treatment completion (P = .89), sedation level (P = .74), and overall effectiveness (P = .70). There was a statistically significant difference in behavior scoring, with the M/H group demonstrating higher scores (P = .04) than the M/M group.

Conclusion: The combination of midazolam and hydromorphone may provide an effective alternative to midazolam and meperidine when used with inhalational sedation (nitrous oxide/oxygen) for the moderate sedation of pediatric dental patients.

How Safe Is Anesthesia Management by Dentist Anesthesiologists? The Need for an International Collaborative Study on the Safety of Anesthesia Management by Dentist Anesthesiologists
Takuro Sanuki DDS, PhD,
 Shota Tsukimoto DDS, PhD,
 Hidetaka Kuroda DDS, PhD,
 Uno Imaizumi DDS, PhD, and
 Naotaka Kishimoto DDS, PhD
Article Category: Commentary
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/23-00043
Page Range: 42 – 43

In Japan and North America, specifically the United States and Canada, dentists are legally permitted to provide sedation and general anesthesia. Although the provision of general anesthesia by dentists was very popular in the United Kingdom, a very small number of poor patient outcomes led it being banned in 1991. 1 This contrast naturally raises concerns and questions of patient safety. Therefore, dentist anesthesiologists in countries where they are currently allowed to provide sedation and general anesthesia should strive to answer the question, “How safe is anesthesia management by dentist anesthesiologists?” with scientific evidence.

Although the Japanese Dental Society

General Anesthetic Management of a Patient With Spondyloepiphyseal Dysplasia Congenita Undergoing Palatoplasty Revision
Hiroka Hattori DDS,
 Aiji Sato (Boku) DDS, PhD,
 Mayuko Kanazawa DDS, PhD,
 Erika Harada DDS,
 Mami Asai DDS,
 Yuko Shikama DDS,
 Hiroko Kobayashi DDS,
 Makoto Hirohata DDS,
 Naoko Tachi DDS, PhD, and
 Masahiro Okuda MD, PhD
Article Category: Case Report
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/23-0005
Page Range: 19 – 23

Spondyloepiphyseal dysplasia congenita (SEDC) is a type of short-limbed dwarfism characterized by platyspondylia, delayed metaphyseal ossification, and irregularly shaped bones. Anesthetic issues in patients with SEDC have reportedly included airway stenosis caused by laryngotracheal hypoplasia, ventilation difficulty due to facial hypoplasia, and intubation difficulty attributed to microgenia. Furthermore, atlantoaxial instability can lead to cervical dislocation due to excessive or violent manipulation of the head and neck. We present the case of a 5-year-old girl with SEDC scheduled for palatoplasty revision. Airway difficulties were anticipated because of microgenia and the cervical collar she wore for atlantoaxial instability. However, mask ventilation and video laryngoscopy proved relatively easy. The patient was placed in Trendelenburg position (approximately 10°) without head tilt for surgical access. A combination of formulas based on the patient’s age and height was used to determine tracheal tube size. However, the 4.5-mm oral Ring, Adair, Elwyn (RAE) tube selected resulted in 1-lung intubation when the tube bend was fixed at the lip, requiring further depth adjustment. Successful anesthetic management of this patient with SEDC incorporated several factors, including an individualized airway management plan, use of a video laryngoscope, careful posturing to avoid excessive cervical strain, and appropriate tube sizing and positioning.

The Necessity of Self-Care
Kyle J. Kramer DDS, MS
Article Category: Editorial
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/586940
Page Range: 1 – 2

What group of people make the worst patients? Some may say it is those who march in with ridiculous demands educated by countless WebMD searches and fueled with guidance from Facebook groups. Others may say it is attorneys or maybe even nurses. The obvious answer in my opinion is that, as a group, doctors far too often make the absolute worst patients. This is not because we are overly noncompliant or argumentative, although that may be true in some cases. No, the primary reason is simply because doctors often avoid being a patient altogether. Far too often we neglect small

Three Cases of Persistent Laryngeal Edema Postradiation Therapy
Takaya Ito DDS, PhD,
 Ryo Wakita DDS, PhD;,
 Yukiko Ichihashi DDS,
 Chihiro Kutsumizu DDS,
 Chihiro Suzuki DDS, PhD; ,
 Naomi Shimada DDS, PhD; , and
 Shigeru Maeda DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/anpr-70-03-06
Page Range: 24 – 28

Radiation therapy (RT) for head and neck cancer, which has made remarkable progress in recent years, is one of the main treatment modalities because it can preserve organ function and morphology after treatment. However, while RT is widely used, complications have been reported, especially laryngeal edema, which can be an airway management problem during general anesthesia. Of the 3 cases of RT-induced laryngeal edema presented here, the first developed 4 days post-RT, the second manifested signs and symptoms associated with laryngeal edema after RT performed 4 years and 4 months previously, and the third exhibited severe laryngeal edema over a decade post-RT despite the absence of clinical signs and symptoms. Patients with a previous history of RT involving the head and neck region may encounter challenges in airway management due to laryngeal edema. Therefore, it is crucial to assess the airway preoperatively and devise a comprehensive airway management plan that encompasses various devices and techniques.

A Review of Muscular Dystrophies
Tiffany Hoang and
 Regina A. E. Dowdy DDS
Article Category: Other
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/673191
Page Range: 44 – 52

Muscular dystrophy encompasses a group of genetic conditions with progressive muscle damage and weakness. Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are X-linked recessive disorders that affect the production of the protein dystrophin. Emery-Dreifuss muscular dystrophy (EDMD) is typically an X-linked-recessive disorder involving the gene that codes for emerin. Facioscapulohumeral muscular dystrophy and oculopharyngeal muscular dystrophy (OPMD) are both autosomal dominant disorders. Although commonly mistaken as a condition in which patients are susceptible to malignant hyperthermia with volatile inhalational anesthetics, muscular dystrophy is more closely associated with rhabdomyolysis. Providers developing an anesthetic plan for dental patients with muscular dystrophy must take into consideration the patient’s baseline cardiac and pulmonary function as well as the potential for abnormalities. Nondepolarizing neuromuscular blocker use is safe but likely to result in prolonged skeletal muscle relaxation. Succinylcholine and volatile anesthetics are generally contraindicated due to the risks of rhabdomyolysis and hyperkalemia with subsequent ventricular fibrillation, cardiac arrest, and death if left untreated. In-depth understanding of the more commonly encountered forms of muscular dystrophy is vital to providing safe and effective ambulatory anesthesia care for patients undergoing dental treatment outside the traditional hospital operating room setting.

Use of a Modified Endotracheal Tube for Postoperative Intranasal Hemorrhage
Yasuhiko Sakata DDS,
 Saori Takagi DDS, PhD,
 Shinnosuke Ando DDS,
 Ryoko Kono DDS,
 Yuki Kiyohara DDS,
 Yuka Oono DDS, PhD, and
 Hikaru Kohase DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/anpr-70-03-09
Page Range: 34 – 38

Orthognathic surgery may induce hemorrhage resulting from nasal mucosal injury or from maxillary osteotomy sites, and if severe, the hemorrhage may cause airway obstruction. The patient in this case report was a 27-year-old woman who underwent Le Fort I and bilateral sagittal split osteotomies under general anesthesia. There were no abnormal intraoperative vital signs. However, immediately after the patient was returned to the ward, significant bleeding that required frequent suctioning was observed in the oral cavity. As the bleeding persisted, the surgeon attempted to insert epinephrine-soaked gauze and polyvinyl acetal sponges into both nasal cavities, but hemostasis was difficult to obtain. To achieve hemostasis by compression/closure at the choana and maintain nasal patency, we inserted a modified cuffed endotracheal tube to serve as a transnasal airway and a choanal hemostatic balloon. This method resulted in hemostasis. The volume of blood loss after returning to the ward was approximately 420 mL. The transnasal airway and choanal balloon was useful for airway management and the prevention of intranasal bleeding into the lower pharyngeal regions. Furthermore, the method was simple and minimally invasive, suggesting its clinical usefulness in similar situations.

Efficacy of Maxillary Buccal Infiltration of Articaine for Palatal Anesthesia: A Prospective, Randomized, Crossover Study
Alexandra Woo DMD, MS,
 John Nusstein DDS, MS,
 Melissa Drum DDS, MS,
 Sara Fowler DMD, MS,
 Al Reader DDS, MS, and
 Ai Ni PhD
Article Category: Research Article
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/23-00023
Page Range: 8 – 14

Objective

Although there are conflicting data, several authors have proposed that articaine’s molecular properties suggest improved perfusion capabilities over other amide anesthetics. The purpose of this prospective, randomized, crossover study was to evaluate the anesthetic efficacy of palatal soft-tissue anesthesia following a buccal infiltration of 1.8 and 3.6 mL of 4% articaine with 1:100,000 epinephrine.

Methods

One hundred eighteen adults received 1.8 or 3.6 mL of 4% articaine with 1:100,000 epinephrine as a buccal infiltration of the maxillary first molar at 2 separate appointments. Palatal soft-tissue anesthesia was evaluated with a dental explorer. Anesthetic success was defined as the absence of pain with an explorer stick. For the subjects who achieved palatal anesthesia, mapping was conducted over 70 minutes, and the overall area of palatal anesthesia was calculated. The data were analyzed using chi-square tests.

Results

The highest percentage of palatal anesthetic success was 20% for the 1.8-mL volume and 32% for the 3.6-mL volume both at 30 minutes. A statistically significant difference between the 1.8- and 3.6-mL volumes was seen at 40 minutes. There was high variability in area measurements for subjects who achieved palatal anesthesia. The highest area measurements were 92 mm2 for the 1.8-mL volume at 20 minutes and 113 mm2 for the 3.6-mL volume at 10 minutes.

Conclusion

Because of the low success rates (20%–32%) and the high variability of the area anesthetized for the subjects who achieved palatal anesthesia, the clinical efficacy of 1.8 or 3.6 mL of articaine via buccal infiltration for palatal anesthesia is of questionable value.

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