Anesthesia progress最新文献

{"title":"Kawasaki Disease and General Anesthesia for Dental Treatment: A Case Report.","authors":"Sarah Lee,&nbsp;David B Guthrie,&nbsp;Ralph H Epstein","doi":"10.2344/anpr-68-01-06","DOIUrl":"https://doi.org/10.2344/anpr-68-01-06","url":null,"abstract":"<p><p>Kawasaki disease (KD) is an acute vasculitis of childhood and is the leading cause of acquired heart disease in children in developed countries. Failure to quickly diagnose and treat patients with KD can result in severe cardiac sequelae, especially coronary artery aneurysms (CAAs). Patients with a prior diagnosis of KD who require general anesthesia (GA) may present unique challenges depending on the severity of any cardiovascular sequelae. This case report describes the perioperative management of a 5-year-old male patient previously diagnosed with incomplete KD approximately 1 year before presenting to Stony Brook University Hospital for full mouth dental rehabilitation under GA. Most uniquely, the patient was at high risk for coronary artery thrombosis due to a giant CAA of his right coronary artery and a small CAA of his left anterior descending artery. The discussion also includes the implications of dental treatment under GA for patients with a history of KD.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 3","pages":"146-153"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500318/pdf/i0003-3006-68-3-146.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of Current Literature of Interest to the Office-Based Anesthesiologist.","authors":"Mark A Saxen","doi":"10.2344/0003-3006-68.3.188","DOIUrl":"https://doi.org/10.2344/0003-3006-68.3.188","url":null,"abstract":"In response to the COVID-19 pandemic, guidance issued from the World Health Organization and the Centers for Disease Control and Prevention recommend minimizing aerosol generating procedures (AGPs) and adopting personal protective equipment and engineering practices when AGPs must be performed. Tracheal intubation and extubation have been classified as AGPs; however, the underlying evidence for this classification is weak and based upon data from studies of other viral respiratory infections. Using mean airborne particles as a surrogate for infection risk, this study quantified the number of aerosolized particles generated in the intubation field using high resolution, real-time monitoring. Tracheal intubation, including face mask ventilation, produced very low quantities of aerosolized particles compared with a volitional cough. Tracheal extubation, particularly when associated with coughing, produced particle levels 15-fold greater than intubation but 35-fold less than volitional coughing. Thus, the study does not support the designation of tracheal intubation as an AGP. Extubation without coughing was found to be quantitatively different than extubation with coughing. Acknowledging that coughing is sometimes interpreted as an indicator of the return of protective reflexes after extubation, practices to reduce aerosolization and coughing following extubation are warranted. The authors caution that no broad conclusions about the risk of actual SARS-CoV-2 infection can be drawn from this study due to several limitations, including the relatively small number of observations, the limited spatial area of aerosolization studied, and the absence of known COVID-19 patients in the study. Comment: This study raises several considerations for the dental anesthesia provider. Intubation appears to have several advantages for limiting and controlling exposure to potentially infectious aerosol in the intraoperative period. Extubation and recovery appear to carry the highest risk of infection particularly when associated with coughing. Patients with a reactive airway and other conditions are known to be more prone to experience coughing, laryngospasm, and other complications associated with extubation. Nonintubated airway management techniques are often viewed as providing less mechanical irritation to the trachea than endotracheal intubation; however, coughing and other respiratory complications are more likely to occur in the minimally protected, nonintubated airway during the perioperative period. This is especially true during lighter levels of sedation or following stimulation from oral secretions, bleeding, and manipulation of the head. Deeper levels of sedation and anesthesia, such as those achieved during anesthesia induction, as well as the use of opioids help to control coughing. A recent review of the risks of extubation and coughing in the COVID-19 era by Sibert et al may be of interest to many dental anesthesia providers. (Saxen MA)","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 3","pages":"188-190"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500313/pdf/i0003-3006-68-3-188.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Management of a Patient With Ring 18 Syndrome.","authors":"Midori Maekawa,&nbsp;Makoto Yasuda,&nbsp;Haruka Sasaki,&nbsp;Yasuharu Tachinami,&nbsp;Kentaro Mizuta","doi":"10.2344/anpr-68-03-01","DOIUrl":"https://doi.org/10.2344/anpr-68-03-01","url":null,"abstract":"<p><p>Ring 18 syndrome or ring chromosome 18 is an extremely rare genetic disorder involving the fusion of the 18th chromosomal ends to form a ring, often with genetic material loss of varying degrees. Although clinical presentation can be extremely variable, characteristic features usually include craniofacial malformations, delayed development, hypotonia, and other skeletal and congenital heart defects. We report the management of a 20-year-old male with ring chromosome 18 who underwent general anesthesia for dental treatment. Clinical manifestations for this patient included intellectual disability, short stature, hypertelorism, flat nasal bridge, micrognathia, a \"carp-shaped\" mouth, and aortic and pulmonary valve regurgitation. Although mask ventilation and oral intubation were easily performed, nasal intubation was difficult because of rhinostenosis. When providing general anesthesia for a patient with ring chromosome 18, anesthesiologists should evaluate the patient preoperatively for congenital heart defects and prepare for a potential difficult airway.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 3","pages":"178-179"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500322/pdf/i0003-3006-68-3-178.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Management of a Rett Syndrome Patient at High Risk for Respiratory Complications.","authors":"Nobuhito Kamekura,&nbsp;Takayuki Hojo,&nbsp;Yukie Nitta,&nbsp;Yuri Hase,&nbsp;Toshiaki Fujisawa","doi":"10.2344/anpr-68-02-07","DOIUrl":"https://doi.org/10.2344/anpr-68-02-07","url":null,"abstract":"<p><p>Rett syndrome (RTT) is a rare genetic disorder that can present challenges in airway management during general anesthesia. This is a case report involving a 23-year-old woman with RTT who received an intubated general anesthetic 3 times for dental treatment. The patient also had severe scoliosis, was bedridden, and had dysphagia. These contributing factors likely led to the development of postoperative respiratory complications including pneumonia after the first case. As a result, several changes were incorporated into the 2 subsequent anesthetic plans in efforts to reduce the risk of such complications. Despite these measures, the patient was suspected of having bronchitis postoperatively after the second anesthetic, although the third occurred uneventfully. Anesthetic management alterations included use of desflurane for anesthetic maintenance and postoperatively delaying oral intake and instituting active postural changes.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 3","pages":"163-167"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500316/pdf/i0003-3006-68-3-163.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic Impact of Drug Interactions With Epinephrine and Antipsychotics Under General Anesthesia With Propofol.","authors":"Yoshiki Shionoya,&nbsp;Eishi Nakamura,&nbsp;Gentaro Tsujimoto,&nbsp;Takayuki Koyata,&nbsp;Asako Yasuda,&nbsp;Kiminari Nakamura,&nbsp;Katsuhisa Sunada","doi":"10.2344/anpr-68-02-01","DOIUrl":"https://doi.org/10.2344/anpr-68-02-01","url":null,"abstract":"<p><strong>Objective: </strong>Antipsychotic drugs exhibit α-1 adrenergic receptor-blocking activity. When epinephrine and antipsychotic drugs are administered in combination, β-2 adrenergic effects are thought to predominate and induce hypotension. This study aimed to assess hemodynamic parameters in patients regularly taking antipsychotics who were administered epinephrine-containing lidocaine under general anesthesia in a dental setting.</p><p><strong>Methods: </strong>Thirty patients taking typical and/or atypical antipsychotics and scheduled for dental procedures under general anesthesia were enrolled. Five minutes after tracheal intubation, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and percutaneous oxygen saturation (SpO2) measurements were taken. The SBP, DBP, HR, and SpO2 measurements were repeated 2, 4, 6, 8, and 10 minutes after the injection of 1.8 mL of 2% lidocaine (36 mg) with 1:80,000 epinephrine (22.5 mcg) via buccal infiltration.</p><p><strong>Results: </strong>Differences between the baseline measurements and those of each time point were analyzed using Dunnett test, and no statistically significant changes were observed.</p><p><strong>Conclusions: </strong>Our findings demonstrate that the use of epinephrine at a clinically relevant dose of 22.5 mcg for dental treatment under general anesthesia is unlikely to affect the hemodynamic parameters of patients taking antipsychotic medications.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 3","pages":"141-145"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500315/pdf/i0003-3006-68-3-141.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of Modern Insulin Pumps and the Perioperative Management of the Type 1 Diabetic Patient for Ambulatory Dental Surgery.","authors":"Philip M Yen,&nbsp;Andrew S Young","doi":"10.2344/anpr-68-03-16","DOIUrl":"https://doi.org/10.2344/anpr-68-03-16","url":null,"abstract":"<p><p>The use of continuous insulin pump systems for effective management of glycemic control in the patient with type 1 diabetes mellitus (T1DM) is steadily increasing. Although the types of devices and their respective manufacturers vary, insulin pumps all utilize similar underlying concepts based on the delivery of exogenous insulin to patients with T1DM in manners that more closely approximate the normal biologic function and performance of the pancreas. As insulin pumps becomes more commonplace and their use more widespread, the sedation or anesthesia provider must ensure familiarity with the basic knowledge of pump function and the various perioperative management considerations. This review provides a concise overview of the pathophysiology of T1DM, introduces foundational aspects of common insulin pump systems, and discusses several general recommendations regarding the perioperative management of insulin pumps during dental surgeries.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 3","pages":"180-187"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500319/pdf/i0003-3006-68-3-180.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Case Series of Anesthetic Patients With Epiglottic Cysts.","authors":"Kazumi Takaishi, Ryo Otsuka, Shigeki Josephluke Fujiwara, Satoru Eguchi, Shinji Kawahito, Hiroshi Kitahata","doi":"10.2344/anpr-68-01-01","DOIUrl":"10.2344/anpr-68-01-01","url":null,"abstract":"<p><p>Previously undiagnosed or asymptomatic epiglottic cysts may be coincidentally detected during intubation. This retrospective case series identified undiagnosed epiglottic cysts that were discovered during intubation in 4 patients who underwent oral surgery under general anesthesia at our hospital during a 6-year period. Including 2 additional cases, 1 previously diagnosed and 1 detected during preoperative imaging, epiglottic cysts were observed in 6 of 1112 cases (0.54%) total. Among the undiagnosed epiglottic cyst cases, mild dyspnea on effort or snoring was reported in 2 patients, but all others were asymptomatic. Upon discovering previously undiagnosed epiglottic cysts during intubation, it is essential to proceed cautiously, remain alert for potential airway management difficulties, and avoid injuring or rupturing the cysts. In addition, any available preoperative imaging should be reviewed as information pertinent to the airway and any abnormalities may be useful. This report discusses the anesthetic care of 6 patients with epiglottic cysts that were previously known or initially discovered during intubation.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 3","pages":"168-177"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500314/pdf/i0003-3006-68-3-168.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Culture of Safety: Why Reinvent the Wheel?","authors":"Kyle J Kramer","doi":"10.2344/anpr-68-03-14","DOIUrl":"https://doi.org/10.2344/anpr-68-03-14","url":null,"abstract":"No patient should die in the dental office. With few exceptions, deep sedation and general anesthesia for dentistry is performed in the office-based environment on patients without significant medical compromise while moderate sedation is provided for a wider range of patients. Those patients with undue risks are routinely referred to a hospital or surgery center, so patient deaths in the dental office should be exceptionally rare. Yet in mid-July, a story involving the death of a dental patient circulated throughout the national news, sadly marking the second such report that month. Consistent with most initial news releases covering these types of incidents, the article shared only sparse information centered on secondand third-hand accounts, leading to ample speculation among professionals and the public alike. Little could be gained in terms of appreciating any likely causes or contributing factors. It was not even clear if the anesthesia provider was a dentist, physician, or nurse. Notably, had either of these tragedies occurred in a hospital, the stories would almost certainly not have been featured in the news. Although the true occurrence rate of substantial morbidity and mortality tied to sedation or general anesthesia in the dental office is virtually impossible to ascertain accurately, conservative estimates approach 1 event every 6 weeks based on historical information derived from closed claims databases. However, the rate is likely higher, perhaps averaging more than 1 event per month, as such databases fail to encompass all providers utilizing sedation and general anesthesia for dental treatment. Simply put, this is an ongoing issue that rests squarely on all our shoulders, even if a number of these deaths occur while the patient is under the care of a physician or nurse. Typically, discussion of such a delicate subject is fraught with potential political and legal implications. There is no question that the presence of conflicts of interest, both real and perceived, often muddy the waters further. My intent is not to discuss the more controversial issues, like training requirements, licensure, or supervision (ie, who should be permitted to do what), but rather to draw attention to the gaping flaws within our current system that should provide professional oversight and guidance, ultimately to effect continuing improvement. The concept of evidence-based medicine has been around for quite some time, originating in the 19th century. Adoption and integration into dentistry has been slow, although momentum is undeniable. Sadly, it is almost impossible to apply an evidence-based approach effectively to the ongoing issues of sedation and general anesthesia-related morbidity and mortality in dentistry due to the absence of comprehensive data. Dentistry lacks a clear concise accounting of not only the numerator (ie, number of adverse anesthesia outcomes) but also the overall denominator (ie, how many cases each of moderate sedation, deep s","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 3","pages":"131-132"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500321/pdf/i0003-3006-68-3-131.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexpected Anesthetic Circuit Leak Attributed to Improper Use of a Tube Holder: A Case Report.","authors":"Naotaka Kishimoto,&nbsp;Akiko Otsuka,&nbsp;Tatsuru Tsurumaki,&nbsp;Kenji Seo","doi":"10.2344/anpr-68-02-02","DOIUrl":"https://doi.org/10.2344/anpr-68-02-02","url":null,"abstract":"<p><p>Leaks involving the anesthesia circuit can cause significant complications including hypoxia and hypoventilation. We present a case of a circuit leak caused by damage to the corrugated tubing attributed to improper use of the tube holder. A 58-year-old male was scheduled for resection of a palatal tumor under an intubated general anesthetic. After successful nasotracheal intubation, the anesthesiologist inserted the corrugated tubing of the anesthetic circuit into the tube holder. A leaking sound was heard and a tear in the corrugated tubing was promptly discovered. The corrugated tubing of the anesthetic circuit presumably tore because it was inserted into the groove of the tube holder at an inappropriate angle with excessive force. Anesthesiologists should be aware of potential leaks if the anesthesia circuit is damaged, which may be caused by improper use of tube holders.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 3","pages":"154-157"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500317/pdf/i0003-3006-68-3-154.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Safety and Hemostatic Efficacy of Topical Epinephrine in Children Receiving Zirconia Crowns.","authors":"Afsoon Fazeli,&nbsp;Travis M Nelson,&nbsp;Mir Sohail Fazeli,&nbsp;Yvonne S Lin,&nbsp;JoAnna Scott","doi":"10.2344/anpr-68-02-05","DOIUrl":"https://doi.org/10.2344/anpr-68-02-05","url":null,"abstract":"<p><strong>Objective: </strong>The primary aim of this study was to determine the cardiovascular safety of topical racemic epinephrine pellets by measuring heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure in children receiving dental care under general anesthesia. The secondary aim was to assess clinical efficacy by measuring time to reach adequate hemostasis.</p><p><strong>Methods: </strong>For this pilot study utilizing a split-mouth randomized design, 13 patients requiring prefabricated zirconia crowns on both primary maxillary first molars were recruited. Patients received continuous infusions of propofol and remifentanil with 50-70% inhaled nitrous oxide and oxygen. After randomization and tooth preparation, either saline pellets (control) or racemic epinephrine pellets (experimental) were applied directly to gingival tissue. Vital signs were recorded for 5 minutes. The procedure was repeated on the contralateral side using the alternative (control or experimental) treatment.</p><p><strong>Results: </strong>Topical racemic epinephrine compared to saline produced a significantly larger decrease in mean diastolic blood pressure (-11.1% vs -3.9%; P < .01) and mean arterial pressure (-8.1% vs -2.1%; P < .01), although all noted decreases in cardiovascular variables were clinically insignificant. All experimental treatment teeth achieved adequate hemostasis after 2.2 minutes. Only 5 of the 13 control treatment teeth achieved adequate hemostasis during the 5-minute observation period (1.6 vs 4.2 minutes; P = .01).</p><p><strong>Conclusion: </strong>Overall, we conclude that use of topical racemic epinephrine pellets did not result in adverse cardiovascular effects and hemostasis was reached more quickly and predictably compared to saline pellets.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 3","pages":"133-140"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500323/pdf/i0003-3006-68-3-133.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}