Journal of dental anesthesia and pain medicine最新文献

{"title":"Safety and efficacy of remimazolam in sedation dentistry: a scoping review.","authors":"Toru Yamamoto, Takutoshi Inoue, Naotaka Kishimoto, Kenji Seo","doi":"10.17245/jdapm.2025.25.1.15","DOIUrl":"10.17245/jdapm.2025.25.1.15","url":null,"abstract":"<p><p>This review aims to evaluate the safety of remimazolam for intravenous sedation during dental treatment and oral surgery. The protocol was registered in the Open Science Framework (registration DOI: 10.17605/OSF.IO/RFPSZ), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Literature searches and screenings were conducted using PubMed and the Cochrane database, with additional records manually reviewed from various sources. The selected studies, published in English, investigated the safety of remimazolam for sedation in dental and oral surgery. An initial search identified 20 studies, of which five prospective studies met the inclusion criteria. All included studies used an initial bolus administration of remimazolam. Primary outcomes assessed were the sedation success rate, incidence of adverse effects, onset time, awakening time, recovery time, and postoperative side effects. This scoping review indicates that all studies validated the superiority of remimazolam over other sedatives for dental treatment and oral surgery. The development and research of innovative technologies to reduce dental pain and anxiety presents opportunities for interdisciplinary collaboration and improved patient care in dental practice. Future clinical studies should focus on determining the optimal timing for additional dosing and discontinuation when remimazolam is administered continuously.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 1","pages":"15-22"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412179","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":"Accuracy of continuous and real-time total hemoglobin during bimaxillary orthognathic surgery.","authors":"Cheul-Hong Kim, Ji-Young Yoon, Giyoung Yun, Hee Young Kim, Eun-Jung Kim","doi":"10.17245/jdapm.2025.25.1.23","DOIUrl":"10.17245/jdapm.2025.25.1.23","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative hemoglobin (Hb) monitoring is critical for ensuring patient safety during bimaxillary orthognathic surgery. Intraoperative Hb monitoring performed using portable devices with arterial blood samples is invasive, is time-consuming, and lacks the ability to provide real-time information. This retrospective study investigated the correlation between continuous and real-time total Hb (SpHb) using a Masimo Radical 7 device and Hb levels derived by portable devices during bimaxillary orthognathic surgery.</p><p><strong>Methods: </strong>Patients who underwent elective bimaxillary orthognathic surgery were enrolled. The correlation between SpHb and laboratory Hb (Lab-Hb) was evaluated immediately after the induction of anesthesia (T1) and at surgical closure (T2) and compared with postoperative Hb.</p><p><strong>Results: </strong>Eighty-eight patients were included. The correlation coefficients between SpHb and Lab-Hb were 0.795 and 0.859 at T1 and T2, respectively. The correlation coefficient between Lab-Hb at T2 and postoperative Hb was 0.918. A Bland-Altman analysis of the Lab-Hb at T2 and postoperative Hb showed a mean bias of 0.49.</p><p><strong>Conclusion: </strong>In conclusion, here we demonstrated acceptable accuracy of the SpHb measured by the Masimo Radical 7 device during bimaxillary orthognathic surgery. However, SpHb is valuable as an adjunct value to Lab-Hb and a substitute for Hb monitoring due to its wide limits of agreement. These findings suggest that SpHb can help guide the timing of invasive blood sampling for Hb measurements, which may facilitate earlier intervention and treatment.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 1","pages":"23-32"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412157","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":"Recovery of sedation and psychomotor and equilibrium functions following remimazolam anesthesia with or without flumazenil: a randomized, double-blind, controlled trial.","authors":"Mariko (Mariko Iimura) Suzuki, Kyotaro Koshika, Tatsuya Ichinohe","doi":"10.17245/jdapm.2025.25.1.55","DOIUrl":"10.17245/jdapm.2025.25.1.55","url":null,"abstract":"<p><strong>Background: </strong>Prompt awakening and sufficient recovery of psychomotor and equilibrium functions are important for day surgery. Flumazenil accelerates recovery of consciousness after remimazolam anesthesia, but its effects on psychomotor and equilibrium functions are not well known. The purpose of this study was to determine whether flumazenil improves time to recovery, psychomotor, and equilibrium functions in subjects undergoing remimazolam anesthesia.</p><p><strong>Methods: </strong>The design was a single-center, double-blind, randomized, controlled trial. Inclusion criteria were patients aged 18-64 years scheduled for oral surgery under remimazolam anesthesia, with American Society of Anesthesiologists physical status I or II. The predictor variable was the use of a reversal agent (flumazenil group) versus placebo (non-flumazenil group). The primary outcome variable was recovery from sedation measured using the Modified Observer's Alertness/Sedation (MOAA/S) scale for wakefulness. Secondary outcome variables were psychomotor function measured using the Trieger Dot Test (number of dots missed [NDM], maximum distance of dots missed [MDDM]), and the digit symbol substitution test (DSST), as well as equilibrium function measured using the timed up and go test (TUG), and gravimetric area and speed. Statistical analyses were performed using the Mann-Whitney U test, χ² test, Student's t-test, two-way ANOVA, and Bonferroni correction. P-values < 0.05 were considered significant.</p><p><strong>Results: </strong>Sixty-eight subjects were included (male: 33, female: 35). The mean time from extubation to an MOAA/S score of 5 (minutes) was 6.5 (1.5-10.5) in the flumazenil group and 13.5 (6.8-19.3) in the non-flumazenil group (P = 0.01). There was no significant difference in the recovery of psychomotor and balance functions between the two groups. However, the following measurements were significantly increased compared to baseline: NDM (P < 0.001) and DSST (P < 0.001) at 30 minutes, MDDM (P < 0.001), TUG (P < 0.001), and gravimetric speed (P < 0.001) at 60 minutes, and gravimetric area (P = 0.03) at 90 minutes.</p><p><strong>Conclusion: </strong>Administration of flumazenil after remimazolam anesthesia resulted in faster recovery of consciousness, but it did not affect the recovery of psychomotor and equilibrium functions. The time until patients were safe to return home was 120 minutes. Flumazenil did not improve the time until it was safe for patients to return home.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"25 1","pages":"55-65"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412177","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 evaluation of the influence of the palatal root length on the efficacy of maxillary buccal infiltration by open and closed mouth technique: a randomized control trial.","authors":"Yogesh K M, Srirekha A, Champa C, Suditi Pal, Aditya Narayanan, Lipika Jain","doi":"10.17245/jdapm.2024.24.6.407","DOIUrl":"10.17245/jdapm.2024.24.6.407","url":null,"abstract":"<p><strong>Background: </strong>Maxillary molars are commonly anesthetized via buccal infiltration. A patient's mouth opening during maxillary buccal infiltration can influence dental treatment. Hence, this study aimed to evaluate and compare the influence of palatal root length on the efficacy of 2% lidocaine in 1:80000 adrenaline for maxillary buccal infiltration (MBI) between the open- and closed-mouth techniques.</p><p><strong>Methods: </strong>Sixty patients were selected based on inclusion and exclusion criteria. The intensity of pre-operative pain was measured using a visual analog scale (VAS). Samples were randomly divided using the chit method, with odd numbers in group 1 and multiples of two in group 2. In group 1 (n = 30), MBI was performed using the open-mouth technique, and in group 2 (n = 30), MBI was performed using the closed-mouth technique. Five minutes after injection, electric pulp testing was performed. For a negative response, patients were asked to rate their level of discomfort using the VAS. The palatal root length was measured after opening the access point using an apex locator. The groups were evaluated for patient discomfort using VAS.</p><p><strong>Results: </strong>Results were analyzed using the Wilcoxon signed-rank test and Mann-Whitney test. A comparison of MBI between the open- and closed-mouth techniques showed that the closed-mouth technique had significantly better efficacy than the open-mouth technique when the palatal root length was greater than 19 mm (P < 0.05).</p><p><strong>Conclusion: </strong>Within the limitations of the study, when the palatal root length was greater than 19 mm, the closed-mouth technique resulted in less patient discomfort, improved visibility, and better needle penetration.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 6","pages":"407-414"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857371","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":"Articaine buccal infiltration and lidocaine intraosseous anesthesia in carious mandibular molars.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.17245/jdapm.2024.24.6.431","DOIUrl":"10.17245/jdapm.2024.24.6.431","url":null,"abstract":"","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 6","pages":"431-432"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857369","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":"Screen-based telesimulation training for medical emergencies in dental clinics.","authors":"Naotaka Kishimoto, Toru Yamamoto, Simon D Tran, Takuro Sanuki, Kenji Seo","doi":"10.17245/jdapm.2024.24.6.427","DOIUrl":"10.17245/jdapm.2024.24.6.427","url":null,"abstract":"","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 6","pages":"427-430"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857469","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 local anesthesia with cryotherapy on teeth with molar incisal hypomineralization: a randomized control trial.","authors":"Faizal C Peedikayil, Soni Kottayi, Athira Aravind, Aswathi Sreedharan, Athul Ramesh","doi":"10.17245/jdapm.2024.24.6.385","DOIUrl":"10.17245/jdapm.2024.24.6.385","url":null,"abstract":"<p><strong>Background: </strong>Tooth hypersensitivity presents a significant clinical challenge in managing molar-incisal hypomineralization (MIH), potentially compromising the effectiveness of restorative treatments. Cryotherapy has emerged as a promising approach to reduce pain and inflammation. This study aimed to evaluate and compare the effects of cryotherapy as an adjuvant to nerve blocks in reducing operative pain and sensitivity in patients.</p><p><strong>Methods: </strong>A split-mouth randomized controlled trial was conducted in 28 patients with MIH of the right and left lower molars. ie, 56 teeth. Group (1) control group (n = 28) was administered an Inferior Alveolar Nerve block and group (2) was administered cryotherapy spray after the Inferior Alveolar Nerve block. The Visual Analog Scale (VAS) and Legs, Activity, Cry, Consolability (FLACC) scales were used to compare intraoperative pain. The Mann-Whitney U test was used to test the significance across the study groups, and the chi-square test was used to compare success rates between the two groups; a value of less than 0.05 was considered significant.</p><p><strong>Results: </strong>For VAS scale, the mean value in Group A is 8.89 ± 0.79, whereas in Group B, the values are 4.71 ± 1.46. For the FLACC scale, Group A scores were 7.14 ± 1.04, and Group B scores were 4.48 ± 1.37. When intergroup values were compared, the FLACC and VAS scores were statistically significant at P < 0.001.</p><p><strong>Conclusion: </strong>Within the limitations of this study, applying cryotherapy to tooth surfaces following an Inferior Alveolar Nerve block effectively reduces pain and sensitivity in teeth affected by MIH.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 6","pages":"385-393"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857464","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":"Severe bilateral subcutaneous emphysema after prophylactic treatment: a case report.","authors":"Yong-Seung Kim, Joonyoung Huh, Hoon Myoung, Soung Min Kim, Mi Hyun Seo","doi":"10.17245/jdapm.2024.24.6.421","DOIUrl":"10.17245/jdapm.2024.24.6.421","url":null,"abstract":"<p><p>Subcutaneous emphysema is the accumulation of gas or air in loose subcutaneous connective tissue. The use of air-driven handpieces in dental procedures is a common iatrogenic cause of intraoral mucogingival barrier disruption by high-pressure air. This case report describes a 60-year-old woman who underwent prophylactic periodontal treatment with an air-abrasive device and subsequently developed severe bilateral subcutaneous emphysema, extending from the temporal region to the thoracic and mediastinal spaces. Subcutaneous emphysema was suspected based on clinical examination, and paranasal CT was performed for definitive diagnosis. Chest CT was conducted for further evaluation, followed by consultation with the Department of Thoracic Surgery. The patient was admitted for supportive care and prophylactic antibiotics. After 4 days of hospitalization, the symptoms had nearly resolved, and a follow-up paranasal CT showed significant air resorption. The patient was discharged without complications. Although generally benign and self-limiting, subcutaneous emphysema can lead to serious complications such as systemic infection, pneumothorax, and air embolism. This case highlights the importance of prompt diagnosis and appropriate management to prevent further complications.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 6","pages":"421-425"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857470","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":"Adrenaline dilution in dental local anesthetic: a preliminary study to prevent coring in cartridges.","authors":"Takutoshi Inoue, Toru Yamamoto","doi":"10.17245/jdapm.2024.24.6.415","DOIUrl":"10.17245/jdapm.2024.24.6.415","url":null,"abstract":"<p><p>Many patients with underlying medical conditions are treated with local anesthetics in dental clinics. Dental local anesthetic cartridges contain the vasoconstrictor adrenaline, which can affect the cardiovascular system. For this reason, the adrenaline in the cartridge (2% lidocaine + 1:80,000 adrenaline) is sometimes diluted in order to avoid hemodynamic changes in these patients. However, at the same time, considerations have to be made for coring. Coring is a process in which a piece of rubber is scraped off when a needle is inserted into a rubber stopper, and the rubber is mixed with the drug solution. Particles generated during the coring process contaminate local anesthetic solutions. In this study, we closely observed the puncture site of a 33G dental needle inside a cartridge to investigate a safe dilution method that considers coring. The puncture site was located within 1.50 ± 0.08 mm (mean ± SD) of the diameter from the center of the rubber stopper of the cartridge head. Punctures were made with a 0.75-mm outer diameter metal needle outside the 1.50-mm diameter range from the center of the rubber stopper to reduce the overlap between puncture sites and minimize the risk of coring. After discarding half of the cartridge, 2% lidocaine without adrenaline was injected by piercing the end of the rubber stopper at the cartridge head with a 22-27G metal needle (outer diameter approximately 0.4-0.7 mm). This method minimizes the risk of rubber displacement and coring while ensuring a safe and effective dilution process. Providing a safer method for adrenaline dilution reduces the risk of coring and contamination in dental anesthetic cartridges.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 6","pages":"415-420"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857434","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":"Effect of vasoconstriction by dexmedetomidine in the mandible of rat.","authors":"Hikaru Sato, Shota Abe, Kimiharu Ambe, Shinya Yamazaki, Hiroyoshi Kawaai","doi":"10.17245/jdapm.2024.24.6.375","DOIUrl":"10.17245/jdapm.2024.24.6.375","url":null,"abstract":"<p><strong>Background: </strong>In recent years, dexmedetomidine (DEX) has been proposed as a useful vasoconstrictor for local anesthesia because it is less effective in circulation than clonidine of antihypertensive drugs. In addition, DEX is expected to act as a vasoconstrictor during local anesthesia. However, histomorphometric studies demonstrating that DEX exerts vasoconstrictive effects are lacking. This study aimed to clarify whether DEX exerts a histomorphologically vasoconstrictive effect on blood vessels in the mandible of rats.</p><p><strong>Methods: </strong>A total of 12 male Wistar rats were used. General anesthesia was induced and maintained using sevoflurane. Normal saline (0.2 ml) was injected on the left side of the jaw (DEX (-) effect site) and 0.2 ml normal saline containing 12.5 µg/ml DEX was injected on the right side of the jaw (DEX (+) effect site). The puncture point was located on the mesial side of the first molar, 1 mm away from the gingival sulcus. Following decalcification, the specimens were paraffinized and sagittally sliced into 20 µm-thick sections, followed by staining with anti-α smooth muscle actin antibody. The intravascular lumen area was measured in the oral mucosa, periodontal ligament, mandibular bone above the root apex, mandibular bone below the root apex, and dental pulp. The unpaired t-test was used for statistical analysis, and a P value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Compared to the DEX (-) effect site, the intravascular lumen area in the oral mucosa and periodontal ligament of the DEX (+) effect site was significantly decreased. No significant difference was observed in the intravascular lumen area between the DEX (-) and DEX (-) effect sites in the mandibular bone above and below the root apex and dental pulp.</p><p><strong>Conclusion: </strong>A direct vasoconstrictive effect of DEX was not observed in the intravascular lumen of the mandibular bone above and below the root apex and dental pulp; however, it was observed in the oral mucosa and periodontal ligament.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"24 6","pages":"375-383"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857463","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}