SAAD digest最新文献

{"title":"SAAD national course in conscious sedation from the delegate's perspective.","authors":"Seema Yousef","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"27 ","pages":"54-5"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29673857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's new with phentolamine mesylate: a reversal agent for local anaesthesia?","authors":"John A Yagiela","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Phentolamine mesylate (OraVerse), a nonselective a-adrenergic blocking drug, is the first therapeutic agent marketed for the reversal of soft-tissue anaesthesia and the associated functional deficits resulting from an intraoral submucosal injection of a local anaesthetic containing a vasoconstrictor. In clinical trials, phentolamine injected in doses of 0.2 to 0.8 mg (0.5 to 2 cartridges), as determined by patient age and volume of local anaesthetic administered, significantly hastened the return of normal soft-tissue sensation in adults and children 6 years of age and older. Median lip recovery times were reduced by 75 to 85 minutes. Functional deficits, such as drooling and difficulty in drinking, smiling, or talking--and subjects' perception of altered function or appearance--were consistently resolved by the time sensation to touch had returned to normal. Adverse effects of phentolamine injected in approved doses for reversal of local anaesthesia in patients ranging in age from 4 to 92 years were similar in incidence to those of sham injections, and no serious adverse events caused by such use were reported. The clinical use of phentolamine is viewed favorably by dentists who have administered the drug and by patients who have received it. Optimal use may require some modifications of the technique described in the package insert; cost of the agent may be influencing its widespread adoption into clinical practice. Phentolamine mesylate, in the form of OraVerse (Novalar Pharmaceuticals, San Diego, USA) represents a new therapeutic class of drugs in dentistry intended to reverse soft-tissue anaesthesia after nonsurgical dental procedures (e.g., restorative or deep scaling/root planing procedures). As shown in Figure 1, OraVerse is manufactured in 1.7 mL dental cartridges, each of which contains 0.4 mg active drug. This review describes the development of phentolamine as a dental drug, its pharmacologic characteristics, and how it may be used in clinical practice to improve patient care.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"27 ","pages":"3-7"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29673344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A clinician guide to patients afraid of dental injections and numbness.","authors":"Jason M Armfield,&nbsp;Peter Milgrom","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Fears of dental injections remain a clinical problem often requiring cognitive behavioural psychology counselling and sedation in order to carry out needed dental treatment. This study, based on a national survey in Australia, compared patient concerns about numbness caused by local anaesthesia and fears of the injection itself. It also examined associations between dental fearfulness and avoidance associated with patient self-reported negative experiences and treatment need. Clinical advice on how to approach such patients is offered. Relatively high levels of dental anxiety and fear have been reported in several industrialised Western societies (McGrath & Bedi, 2004; Armfield, Spencer & Stewart, 2006; Lahti et al., 2007; Enkling, Marwinski Jöhren, 2006). In the U.K., almost one in three adults consider themselves to always be anxious about going to the dentist (Nuttall et al., 2001). Of concern is that this dental fear may be passed on to the children of anxious adults (Nuttall, Gilbert & Morris, 2008), leading to an inter-generational perpetuation of the problem. There is considerable evidence that dental fear is related to poorer oral health, reduced dental attendance and increased treatment stress for the attending dentist. There are many aspects of going to a dentist that might elicit feelings of apprehension, concern or anxiety in prospective patients (Liddell & Gosse, 1998; Oosterink, de Jongh & Aartman, 2008). One of the most commonly reported concerns relates to receiving injections. Indeed, fear of needles and the treatment of injection fear has been an important focus of a research in the U.K. (Boyle, Newton & Milgrom, 2010). Needle fear, in particular, is a major issue given that the delivery of local anaesthesia via injection is the central plank of pain relief techniques in dentistry (Malamed, 2009) and dentists as well as patients often avoid difficult injections as a consequence, resulting in poor pain control. A less well described anxiety of receiving dental treatment is fear of numbness associated with the dental injection (Morse & Cohen, 1983). Certainly, many dentists believe that their patients avoid local anaesthesia because of a wish to avoid the disturbing effects of numbness (Moore et al., 1998). Milgrom et al. (1997) found that fears about the numbness associated with receiving local anaesthesia significantly differentiated avoiders and non-avoiders of dental treatment. However, these concerns appeared to be much less common than those concerning the perceived pain of injections and fear of bodily injury resulting from the injection (Milgrom et al., 1997; Kaako et al., 1998). Consistent with these findings, whereas 43% of English patients asked to imagine undergoing future third molar surgery expressed concerns primarily about pain, only 6% of patients indicated concern about numbness as their worst fear (Earl, 1994). More recently, a study of Dutch people found that the feeling of numbness from the anaesthesia w","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"27 ","pages":"33-9"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29673856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A visit to Cestradent McKesson; providing inhaled sedation for dentistry since 1938.","authors":"Diana Terry","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"27 ","pages":"58-60"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29673859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The safety and efficacy of using a concentrated intranasal midazolam formulation for paediatric dental sedation.","authors":"Michael Wood","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To add to the evidence base for safe and effective paediatric conscious sedation techniques in primary dental care.</p><p><strong>Objective: </strong>To consider the safety and effectiveness of an alternative sedation technique for facilitating dental treatment in anxious children, thereby avoiding dental general anaesthetic.</p><p><strong>Setting: </strong>Leagrave Dental Sedation Clinic. A primary care-based general and referral clinic for anxious patients, special care dentistry and oral surgery.</p><p><strong>Subjects, materials and methods: </strong>This is a prospective service evaluation of 114 selected anxious children requiring invasive dental treatment. Each child was administered 0.25 mg/kg intranasal midazolam using a concentrated 40 mg/ml midazolam (INM) in 2% lignocaine solution.</p><p><strong>Main outcome measures: </strong>Successful completion of intended dental treatment with a child who is co-operative and who meets the UK accepted definition of conscious sedation.</p><p><strong>Results: </strong>57% of the children found the administration of the new formulation acceptable. Of the 114 patients who received INM, 104 completed the treatment (91%). The 10 children who could not complete the treatment with INM were converted to intravenous sedation and treatment was completed successfully at the same appointment. During treatment there was no desaturation and only one patient desaturated briefly in the recovery area. Parents rated the technique acceptable in 76% of cases and would have the procedure repeated in 83% of cases. Parents rated this technique as having 8.3 out of 10 with only 5 parents awarding a score of less than 7 out of 10. Side effects included blurred vision, sneezing, headaches, restlessness with one patient having post-operative nausea and vomiting.</p><p><strong>Conclusion: </strong>In selected cases intranasal sedation provides a safe and effective alternative for dental GA in short invasive procedures limited to one or two quadrants in children. Other techniques, e.g., oral and intravenous sedation, appear to have a much higher acceptability of administration. This technique may be useful if inhalation sedation, oral sedation or intravenous sedation is considered and the child is still unco-operative, either as a technique on its own or to facilitate cannulation for intravenous sedation. It is recommended that this technique should only be used by dentists skilled in intravenous paediatric sedation with midazolam with the appropriate staff training and equipment at their disposal.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"27 ","pages":"16-23"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29673348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stanley L Drummond-Jackson. Pioneer of intravenous anaesthesia in dentistry.","authors":"Ashish Gopakumar,&nbsp;V Gopakumar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Stanley Lithgow Drummond-Jackson was born in Northumberland and qualified from Edinburgh University Dental School in 1931. Even in the early stages of his practice he devoted his energies to the problem of pain control in dentistry, publishing his first paper in 1935. In the early 20th century most dental anaesthetics were inhalational with nitrous oxide, ether, ethyl chloride and chloroform. The introduction of intravenous hexobarbitone in 1931 led to bold and enthusiastic researchers like Drummond-Jackson to pioneer its use in dental practice. He published his major work on intravenous hexobarbitone in 1952. In 1957, Drummond-Jackson and a group of colleagues formed the now well-known organisation called 'Society for the Advancement of Anaesthesia in Dentistry' or SAAD. SAAD has grown from a group of 40 to over 4000 members worldwide. In 1969, the BMJ published an article condemning Drummond-Jackson's technique of intermittent intravenous methohexitone. At his personal expense, Drummond-Jackson brought a libel action against the BMJ and authors of this paper. There were no winners as the case was settled after 38 days and earned the reputation for being the longest and most expensive libel case in the history of the London Courts. Despite this setback the founder of SAAD devoted the last days of his life in research, teaching and abolishing fear and pain in dentistry. He gained international reputation as a teacher in dental anaesthesia and was honoured with fellowships and awards. He died in 1975 at the age of 66. In the early 1900s dental anaesthesia was only inhalational with mainly nitrous oxide on one hand and ether, ethyl chloride and chloroform on the other. Induction was at times stormy and prolonged and recovery was delayed. The synthesis of barbiturates, especially intravenous hexobarbitone (1931), thiopentone (1932) and methohexitone (1959) opened new avenues for dental anaesthesia. Modern anaesthesia owes a lot to early pioneers, many of them being dentists and Drummond-Jackson was among them.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"27 ","pages":"61-5"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29673860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced paediatric conscious sedation: an alternative to dental general anaesthetic in the U.K.","authors":"Darren Hand,&nbsp;Paul Averley,&nbsp;John Lyne,&nbsp;Nick Girdler","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Child dental anxiety is widespread, and it is not always possible to treat children using traditional methods such as behavioural management, local anaesthesia and even relative analgesia. In such cases a dental general anaesthetic (DGA) is the only option available to facilitate dental treatment in anxious children.</p><p><strong>Aim: </strong>This study describes an advanced conscious sedation protocol which allows invasive treatment to be carried out in anxious children. It incorporates the use of titrated intravenous midazolam and fentanyl and inhalation agents, sevoflurane and nitrous oxide/oxygen, which is administered by a Consultant Anaesthetist. The aim is to produce an evidence- based study which can offer a sedation technique as a safe and effective alternative to a DGA.</p><p><strong>Study design: </strong>Retrospective audit.</p><p><strong>Method: </strong>267 clinical records were audited retrospectively from a specialist sedation-based clinic, for children aged 5-15 years old. The subjects all underwent invasive dental procedures with this technique between August and November 2008 as an alternative to a DGA.</p><p><strong>Results: </strong>262/267 (98%) of the subjects were treated safely and successfully and without the loss of verbal communication using this technique. This included many treatments requiring four quadrant dentistry, with both restorations and extractions as necessary being carried out in one visit. 5 subjects (2%) did not tolerate treatment and had to be referred for a DGA. No medical emergencies occurred.</p><p><strong>Conclusions: </strong>Based on the evidence for this group of patients, this advanced conscious sedation technique, offers a safe and effective alternative to DGA. This technique must be carried out in an appropriate environment by an appropriately trained and experienced team who are able to comply with the recommendations for \"alternative\" sedation techniques.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"27 ","pages":"24-9"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29673854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DSTG annual symposium. 14 and 15 May 2010. Trinity College, Dublin.","authors":"Clare Ola","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"27 ","pages":"68-76"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29673861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secretary's correspondence.","authors":"Derek Debuse","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"27 ","pages":"56"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29673858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between two regional anaesthesia techniques performed by inexperienced operators: the Gow-Gates block versus the Kenneth Reed block.","authors":"G Zanette,&nbsp;G Manani,&nbsp;E Facco,&nbsp;M L Mariuzzi,&nbsp;A Tregnaghi,&nbsp;N D Robb","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>The aim was to compare the efficacy of Kenneth Reed and Gow-Gates inferior alveolar nerve blocks when performed by an inexperienced operator.</p><p><strong>Methods: </strong>A group of 60 patients was randomised into two groups. One group had the Kenneth Reed technique used to administer an inferior alveolar nerve block whilst the other received the Gow-Gates technique. The efficacy of nerve block produced was evaluated both clinically and by electric pulp tester. MRI examination was undertaken to determine the spread of local anaesthetic.</p><p><strong>Results: </strong>There were no significant differences in success rate of anaesthesia between groups. The failure rate for the Gow-Gates technique was 16.6%, whilst the failure rate for the Kenneth Reed technique was 23.3%. Time to onset was less with the Kenneth Reed technique. MRI examination showed the solution was more widely distributed after the Kenneth Reed block had been used.</p><p><strong>Conclusions: </strong>Our research has demonstrated that the Kenneth Reed technique is equally effective at producing anaesthesia of the inferior alveolar nerve. Compared with conventional techniques there is a lower incidence of positive aspiration and potential for lower morbidity as the local anaesthetic is deposited further from the neurovascular bundle than when deposited near the mandibular foramen as in most conventional Inferior Alveolar Nerve Block techniques.</p>","PeriodicalId":21571,"journal":{"name":"SAAD digest","volume":"27 ","pages":"8-15"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29673345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}