Journal of dental anesthesia and pain medicine最新文献

{"title":"Comparative evaluation of the effectiveness and acceptance of intranasal dexmedetomidine and intranasal midazolam for sedation in children aged 5-8 years using a mucosal atomizer device: a randomized controlled clinical study.","authors":"Yash Lalwani, Bhavna Dave, Lipsa Shah","doi":"10.17245/jdapm.2025.25.2.109","DOIUrl":"10.17245/jdapm.2025.25.2.109","url":null,"abstract":"<p><strong>Background: </strong>Patient age, preoperative anxiety, dental requirement, risks associated with pharmaceutical management, safety, parental expectations, and cost influence the choice of pharmacological behavior management. Thus, this randomized controlled clinical study aimed to compare the effectiveness and acceptance of intranasal dexmedetomidine and midazolam for sedation in children aged 5-8 years using a mucosal atomizer device (MAD).</p><p><strong>Methods: </strong>A total of 48 participants with Frankl's II behavior were randomly divided into two groups: Group I received intranasal midazolam (0.25 mg/kg), and Group II received intranasal dexmedetomidine (1.5 µg/kg). The primary outcomes assessed were drug acceptance, onset and effectiveness of sedation, and pre-and post-treatment anxiety levels. Secondary measures were also evaluated pre- and post-treatment.</p><p><strong>Results: </strong>Intranasal dexmedetomidine demonstrated significantly better drug acceptance (P < 0.001). Midazolam had a faster onset but was less effective than dexmedetomidine (P < 0.001). Additionally, dexmedetomidine exhibited better anxiolytic properties than midazolam (P < 0.001).</p><p><strong>Conclusion: </strong>Dexmedetomidine was better accepted by children aged 5-8 years, was more effective, and had superior anxiolytic properties compared with midazolam.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 2","pages":"109-122"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813292","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":"Electronic health record associations in patients self-reporting to be difficult to anesthetize.","authors":"Robert D Bowers, Wei Shi, Chandler Pendleton, Shareef Dabdoub, Jennifer Sukalski, Olivia C Bartholomew, Christopher T Hogden","doi":"10.17245/jdapm.2025.25.2.97","DOIUrl":"10.17245/jdapm.2025.25.2.97","url":null,"abstract":"<p><strong>Background: </strong>Patients who report to be difficult to anesthetize for dental procedures are commonly encountered. Determining their frequency and shared characteristics could improve understanding of pain management failures.</p><p><strong>Methods: </strong>Categorical and continuous variables of 24 demographic, medical history, and dental history variables were compared in a deidentified cross-sectional study using electronic health records (EHR) of patients at the University of Iowa College of Dentistry. Individuals who self-reported to be difficult to anesthetize in their dental health history form were compared to those who reported no complications with local anesthesia. Descriptive, univariate regression, and multivariable regression statistical analyses were completed on the demographic, medical history, and dental history EHR variables.</p><p><strong>Results: </strong>A total of 12,400 deidentified patient records met the inclusion criteria with a 11.4% (n = 1,411) prevalence of difficult to anesthetize self-reports. Eight categorical variables were found to have statistically significant (95% confidence interval [CI]) adjusted odds ratios (AOR) in the multivariable regression of difficult to anesthetize reporting patients: female gender (AOR = 1.61, 95% CI: 1.32-1.96, P < 0.001), dental fear (AOR = 3.60, 95% CI: 3.01-4.31, P < 0.001), mental health disorders (AOR = 1.21, 95% CI: 1.00-1.46, P < 0.045), problems with general anesthesia (AOR = 1.46, 95% CI: 1.11-1.89, P = 0.005), neurological/nerve disorders (AOR = 1.30, 95% CI: 1.05-1.60, P = 0.015), temporomandibular joint clicking/popping (AOR = 1.31, 95% CI: 1.08-1.60, P = 0.006), needle anxiety (AOR = 29.03, 95% CI: 23.80-35.52, P < 0.001), and history of root canal treatment (AOR 0.82, 95% CI: 0.68-0.99, P = 0.035).</p><p><strong>Conclusion: </strong>A clinically relevant percentage of patients self-reported being difficult to anesthetize for dental procedures. The relationship between local anesthesia inadequacies and variables such as female gender, dental fear, mental health, and neurological disorders requires further investigation. The use of evidence-based local anesthesia approaches and communication practices is suggested to minimize pain experienced and subsequent fear of dental care.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 2","pages":"97-108"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813296","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":"Airway evaluation and management in a patient with a tracheal tumor undergoing oral and neck reconstructive surgery.","authors":"Tomoaki Ujita, Toru Yamamoto, Yutaka Tanaka, Naotaka Kishimoto, Kenji Seo","doi":"10.17245/jdapm.2025.25.2.139","DOIUrl":"10.17245/jdapm.2025.25.2.139","url":null,"abstract":"","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 2","pages":"139-142"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813286","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":"Anesthesia management for dental procedures in a patient with 1p36 deletion syndrome: a case report.","authors":"Nedim Çekmen, Edvin Bihorac, Mert Nur","doi":"10.17245/jdapm.2025.25.2.133","DOIUrl":"10.17245/jdapm.2025.25.2.133","url":null,"abstract":"<p><p>1p36 deletion syndrome is characterized by a genetic deletion that frequently causes central nervous system, craniofacial, cardiac, and musculoskeletal anomalies. Perioperative management of patients with 1p36 deletion syndrome presents unique challenges due to multiple anomalies and potential complications. We present the successful anesthetic management of a 16-year-old patient diagnosed with 1p36 deletion syndrome who underwent general anesthesia for multiple dental procedures, including dental fillings, extractions, and tartar removal. The patient had micrognathia, hypotonia, flat eyebrows, a short neck, inability to sit without support, absence of speech and self-care skills, limited ability to follow simple commands, and poor cooperation. These factors increase the risk of difficult mask ventilation and intubation. To minimize aspiration risk, we successfully intubated the patient using rapid-sequence induction and intubation (RSII) method with cricoid pressure. A perioperative multidisciplinary team approach and comprehensive preoperative evaluation are crucial due to the existing anomalies, developmental and motor delays, and potential airway complications associated with this syndrome.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 2","pages":"133-137"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813288","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":"Anesthesiologists could be the most suitable clinicians to screen for latent diseases in autistic patients requiring dental general anesthesia.","authors":"Shinichiro Kira, Chiharu Arai","doi":"10.17245/jdapm.2025.25.2.143","DOIUrl":"10.17245/jdapm.2025.25.2.143","url":null,"abstract":"","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 2","pages":"143-145"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813290","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":"Analysis of the effect of fentanyl dosage used in patient-controlled analgesia for pain management after oral cancer surgery: a retrospective observational study.","authors":"Kyung Nam Park, Seung-Hwa Ryoo, Myong-Hwan Karm, Hyun Jeong Kim, Kwang-Suk Seo","doi":"10.17245/jdapm.2025.25.1.43","DOIUrl":"10.17245/jdapm.2025.25.1.43","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain management is challenging in patients with oral cancer, especially those undergoing reconstructive surgery. Patient-controlled analgesia (PCA) is widely used, and fentanyl (FTN) concentration adjustments may improve pain control. This study aimed to evaluate the effects of FTN PCA concentration and reconstructive surgery on postoperative pain in patients with oral cancer.</p><p><strong>Methods: </strong>This retrospective observational study analyzed 140 patients with oral cancer who underwent surgery under general anesthesia. Patients were categorized based on FTN PCA dosage (FTN 700 mcg and ketorolac 150 mg vs. FTN 1400 mcg and ketorolac 150 mg). Pain was assessed using the visual analog scale (VAS) at multiple time points postoperatively (0, 12, 24, 36, 48, 60, and 72 h). PCA usage patterns, including demand count, delivery count, and delivery/demand ratios, were compared across subgroups. Missing data were imputed using linear interpolation.</p><p><strong>Results: </strong>PCA usage and pain control were evaluated between the FTN 700 mcg (N = 40) and 1400 mcg (N = 100) groups, stratified by reconstruction status. Demographic characteristics showed no significant difference. In the reconstructive surgery subgroup, patients in the FTN 1400 mcg group showed lower PCA refill counts (1.45 ± 0.69 vs. 1.61 ± 0.58) and fewer delivery counts (17.1 ± 21.3 vs. 25.1 ± 28.5) compared to those in the FTN 700 mcg group, achieving similar or superior pain control with fewer interventions. Similarly, patients without reconstructive surgery in the FTN 1400 mcg group demonstrated lower PCA refill counts, shorter PCA usage times, and fewer delivery counts. VAS scores decreased consistently over time across all groups but remained higher in the reconstruction groups. Logistic regression analysis revealed that patients with reconstructive surgery in the FTN 1400 mcg group were more likely to achieve a VAS score of ≤ 3.0 at 72 h postoperatively (P = 0.022). These findings indicate FTN 1400 mcg's superiority in managing postoperative pain.</p><p><strong>Conclusion: </strong>Comparing FTN PCA dosages, 1400 mcg demonstrated superior pain control to 700 mcg in patients undergoing oral cancer surgery, particularly those who underwent reconstructive surgery. This finding underscores the importance of optimizing FTN dosages to enhance postoperative pain management, reduce PCA-related demands, and achieve better patient outcomes.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 1","pages":"43-53"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412159","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":"Comparative efficacy of different video laryngoscopy types in difficult tracheal intubation cases: a randomized crossover manikin study.","authors":"Kyotaro Koshika, Wataru Hashimoto, Ai Nakakuki, Kanako Yajima, Tatsuya Ichinohe","doi":"10.17245/jdapm.2025.25.1.33","DOIUrl":"10.17245/jdapm.2025.25.1.33","url":null,"abstract":"<p><strong>Background: </strong>Video laryngoscopy is beneficial in difficult airway intubation; however, various factors complicate the process. These devices come in different designs, and their usefulness may vary by type. In this study, we compared the effectiveness of several video laryngoscopic. instruments across three simulated difficult intubation scenarios using manikin models.</p><p><strong>Methods: </strong>Training simulators for tracheal intubation were set to four conditions: (i) Normal (mouth opening: 50 mm, normal neck); (ii) Head tilt disorder (mouth opening: 50 mm, rigid neck); (iii) Trismus (mouth opening: 20 mm, normal neck); and (iv) Head tilt disorder + trismus (mouth opening: 20 mm, rigid neck). Seventeen dental anesthesiologists attempted oral tracheal intubation using the following video laryngoscopes: Airway Scope; McGRATH (Normal blade [size 3]); McGRATH (X-blade); and i-view. Evaluated parameters included total intubation time, glottic visualization time, tube induction time, success rate, and difficulty grading of tracheal intubation (Cormack-Lehane classification and the Numerical Rating Scale [NRS]). Statistical analysis was conducted using mixed models, incorporating two-way ANOVA, Tukey's test, two-way ANOVA without repeated measures, and Kruskal-Wallis test, with P < 0.05 deemed statistically significant.</p><p><strong>Results: </strong>Intubation time using i-view was significantly longer for head tilt disorder and trismus compared to other video laryngoscopes (head tilt disorder: P < 0.001 for all, trismus: P = 0.021 vs. Airway Scope, P = 0.028 vs. X-blade). The Cormack-Lehane grade was notably high (P = 0.001) for tracheal intubation with i-view in the head tilt disorder scenario, with intubation failing in three cases. In the combined situation of head tilt disorder and trismus, intubation time with Airway Scope was shorter (P < 0.001 vs. X-blade), achieving a success rate of 100%. However, all attempts with i-view were unsuccessful. The NRS score was significantly higher for i-view compared to the other video laryngoscopes (P < 0.001).</p><p><strong>Conclusion: </strong>Video laryngoscopy effectiveness varies by type in difficult tracheal intubation cases. The Airway Scope or McGRATH instrument appears more suitable for such cases, as indicated by the metrics of intubation time, success rate, and difficulty level.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 1","pages":"33-42"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412169","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":"Retrospective analysis of a decade of general anesthesia for dental treatment in patients with disabilities at a regional university dental hospital in South Korea.","authors":"Sooil Shin","doi":"10.17245/jdapm.2025.25.1.67","DOIUrl":"10.17245/jdapm.2025.25.1.67","url":null,"abstract":"<p><strong>Background: </strong>General anesthesia (GA) in dentistry is crucial for managing patients with special needs, enabling comprehensive care for individuals who cannot tolerate conventional procedures. This study aimed to analyze the demographic characteristics and trends in dental treatments performed under GA.</p><p><strong>Methods: </strong>A retrospective analysis of 2,458 dental treatments performed under GA at Dankook University Jukjeon Dental Hospital was conducted between January 2015 and October 2024. Data on sex, age, GA duration, and type of disability were collected and analyzed.</p><p><strong>Results: </strong>Of the 2,458 cases, 89.5% (2,199) involved patients with disabilities. Male patients accounted for 60.0% of the total cohort, and 61.3% of patients with disabilities were male. The mean age of patients was 34.1 ± 13.4 years, with younger patients more frequently treated under GA. Intellectual disabilities were the most prevalent (56.3%) followed by autism spectrum disorder (14.6%). The average GA duration was 174.8 ± 61.5 minutes, with longer durations observed in patients with disabilities (177.2 ± 61.1 minutes).</p><p><strong>Conclusion: </strong>The increasing demand for GA, particularly among patients with disabilities, underscores the need for tailored guidelines and enhanced education on dental treatment performed under GA. These findings provide a foundation for future policy development.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 1","pages":"67-76"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412178","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":"Anesthesia management for dental procedures in a patient with aromatic L-amino acid decarboxylase deficiency: a case report.","authors":"Edvin Bihorac, Akkan Mahmud, Ahmed Uslu, Nedim Çekmen","doi":"10.17245/jdapm.2025.25.1.77","DOIUrl":"10.17245/jdapm.2025.25.1.77","url":null,"abstract":"<p><p>Aromatic L-amino acid decarboxylase deficiency (AADCD) is a rare autosomal recessive neurometabolic synthesis disease with sympathetic autoregulation deficiency. Perioperative management of AADCD presents unique challenges due to autonomic dysfunction, impaired sympathetic regulation of heart rate, and potential airway complications. Herein, we report the successful anesthetic management of a 14-year-old male patient with AADCD under total intravenous anesthesia during extensive dental procedures. We applied the rapid sequence induction and intubation method with cricoid pressure to minimize the risk of pulmonary aspiration due to the potential difficulty in mask ventilation and intubation, limited mouth opening, microcephaly, micrognathia, and poor cooperation. Intubation was performed without any complications. Due to the autonomic dysfunction, potential airway complications, and developmental, mental, and motor delays in this disorder, perioperative management requires a multidisciplinary approach with comprehensive preoperative evaluation.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 1","pages":"77-82"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412167","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":"Efficacy of intranasal sedation for pediatric dental procedures: a systematic review and meta-analysis.","authors":"Kavitha Swaminathan, Sushmita Shan, Monika Sri Ss, Apathsakayan Renugalakshmi, Ramanathan Ravi, Selvakumar Haridoss","doi":"10.17245/jdapm.2025.25.1.1","DOIUrl":"10.17245/jdapm.2025.25.1.1","url":null,"abstract":"<p><p>Dental fear and anxiety management in children is considered one of the biggest challenges in pediatric dentistry. Intranasal sedation is a promising technique for managing unco-operative pediatric patients with rapid onset, ease of administration, and minimal invasiveness. We aimed to review the efficacy, onset time, duration, and behavioral success of intranasal sedation agents in pediatric dental procedures and identify the most effective regimens for clinical practice. This systematic review followed the PRISMA 2020 guidelines and included randomized controlled trials (RCTs) assessing intranasal sedation in children undergoing dental procedures. Primary outcomes were onset time, duration of sedation, and sedation success rates. The inclusion criteria were applied through search in six databases. Risk of bias was evaluated using the Cochrane RoB 2 tool. Meta-analyses were carried out using RevMan software, where pooled odds ratios and weighted mean differences were calculated on efficacy outcomes. Eighteen RCTs fulfilled the inclusion criteria, where intranasal agents such as midazolam, ketamine, dexmedetomidine, and their combinations were used. Meta analyses demonstrated intranasal sedation generally has a faster onset (moderate heterogeneity, I² = 40%) and is associated with greater success rates for achieving sedation than other methods. A combination of midazolam with ketamine or dexmedetomidine provided better results for both onset and behavioral success. The duration of sedation appears equivalent to oral or intravenous routes. Overall risk of bias was moderate due to blinding and selective reporting concerns. Midazolam, especially when combined with ketamine or dexmedetomidine, yielded promising results in relation to rapid onset and success of sedation. However, further large-scale RCTs are necessary to standardize dosing protocols and ensure that these findings are validated and optimized for clinical applications.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 1","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412172","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}