scholarly journals Anesthetic Management of a Patient With Systemic Sclerosis and Microstomia

2020 ◽  
Vol 67 (1) ◽  
pp. 28-34
Author(s):  
Yoshiki Shionoya ◽  
Hatsuko Kamiga ◽  
Gentarou Tsujimoto ◽  
Eishi Nakamura ◽  
Kiminari Nakamura ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Respiratory Depression ◽  
Dental Treatment ◽  
Anesthetic Management ◽  
Moderate Sedation ◽  
Emergency Airway ◽  
Analgesic Effects ◽  
Anesthetic Agents ◽  
History Of ◽  
Skin Blood Vessels

Systemic sclerosis (SSc) is an autoimmune disease that can cause fibrosis in vital organs, often resulting in damage to the skin, blood vessels, gastrointestinal system, lungs, heart, and/or kidneys. Patients with SSc are also likely to develop microstomia, which can render dental treatment difficult and painful, thereby necessitating advanced anesthetic management. This is a case report of a 61-year-old woman with a history of SSc with microstomia, interstitial pneumonia, and gastroesophageal reflux disease in whom intravenous moderate sedation was performed using a combination of dexmedetomidine and ketamine for dental extractions. Both anesthetic agents are known to have analgesic effects while minimizing respiratory depression. Consequently, the increased discomfort caused by opening the patient's mouth and stretching the buccal mucosa was sufficiently managed, permitting an increase in maximum interincisal opening and completion of treatment without complications. Patients with SSc present with serious comorbidities that can negatively impact anesthetic management, so the implementation of an anesthetic plan that takes such risks into account is required. Furthermore, emergency airway management is likely to be difficult in patients with microstomia. For intravenous moderate sedation, combined use of dexmedetomidine and ketamine, which have analgesic effects while minimizing respiratory depression, may be particularly effective in patients with SSc and microstomia.

scholarly journals Intravenous Sedation in Arnold-Chiari Malformation With Respiratory Failure

2019 ◽  
Vol 66 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Yoshiki Shionoya ◽  
Eishi Nakamura ◽  
Takahiro Goi ◽  
Kiminari Nakamura ◽  
Katsuhisa Sunada
Keyword(s):  
Respiratory Failure ◽  
Respiratory Depression ◽  
Chiari Malformation ◽  
Dental Treatment ◽  
Anesthetic Management ◽  
Cranial Nerves ◽  
Intravenous Sedation ◽  
Type Ii ◽  
Neck Extension ◽  
Arnold Chiari Malformation

Type II Arnold-Chiari malformation (ACM) is an abnormality in which the cerebellum, pons, and medulla oblongata are displaced downward into the spinal cord. Type II ACM is often complicated by respiratory depression, sleep-disordered breathing, and deglutition disorder as a result of medullary dysfunction and impairment of the lower cranial nerves. Bending and stretching of the neck is restricted, and anesthetic management is problematic in patients with the disorder. We performed dental treatment twice under intravenous sedation in a patient with intellectual disability with type II ACM complicated by hypercapnic respiratory failure. Propofol was used for the first sedation procedure. Repeated bouts of respiratory depression occurred on that occasion, so the airway was managed manually by lifting the jaw. However, aspiration pneumonitis occurred postoperatively. A combination of dexmedetomidine and midazolam was used for sedation on the second occasion, and the intervention was completed uneventfully without any respiratory depression. Our experience with this patient highlights the need for selection of an agent for intravenous sedation that does not require neck extension and has minimal effect on respiration in patients with type II ACM, who are at high risk of respiratory depression and pulmonary aspiration.

scholarly journals Anesthetic Management by Laryngeal Mask Airway in a Patient With a History of Difficult Intubation Resulting in Dental Injuries

2015 ◽  
Vol 62 (1) ◽  
pp. 20-21 ◽  
Author(s):  
Yoshinao Asahi ◽  
Ryosuke Fujii ◽  
Naoko Usui ◽  
Hajime Kagamiuchi ◽  
Shiro Omichi ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
General Anesthesia ◽  
Difficult Intubation ◽  
Dental Treatment ◽  
Anesthetic Management ◽  
Laryngeal Mask ◽  
Respiratory Problems ◽  
History Of ◽  
Disabled Patients ◽  
Dental Injuries

Abstract Disabled patients may face respiratory problems during general anesthesia because of head and neck anomalies. We describe a case of dental treatment under general anesthesia using a laryngeal mask airway in a disabled patient who faced difficulty in endotracheal intubation on several occasions, 5 of which resulted in dental injuries.

scholarly journals Characterization of hospitalized patients who received naloxone while receiving opioids with or without gabapentinoids

2021 ◽  
Vol 11 (4) ◽  
pp. 225-230
Author(s):  
Payal H. Desai ◽  
Olesya Taylor ◽  
Kunal J. Shah ◽  
Kirk E. Evoy ◽  
Alyssa M. Peckham
Keyword(s):  
Respiratory Depression ◽  
Oral Morphine ◽  
Dose Intensity ◽  
Retrospective Chart Review ◽  
Medication Administration ◽  
Patient Specific ◽  
Analgesic Effects ◽  
Cns Depressant ◽  
History Of ◽  
Specific Factors

Abstract Introduction Gabapentin and pregabalin (gabapentinoids) can be given with opioids for opioid-sparing and adjuvant analgesic effects. In the context of certain comorbidities and high dosages, coadministration of these agents can lead to respiratory depression or oversedation, necessitating naloxone administration. Methods A retrospective chart review from January 2015 to December 2017 was conducted to include patients who received naloxone and opioids with or without gabapentinoids. Exclusion criteria included pregnancy or having received naloxone in the emergency department, intensive care, or pediatrics units. The primary outcome was to characterize differences between groups regarding comorbidities, history of renal or hepatic dysfunction, history of SUD, opioid tolerance, initiation and dose appropriateness of gabapentinoids, and dose intensity of gabapentinoids and opioids. Secondary outcomes were concomitant CNS depressant use and naloxone episodes for documented respiratory depression. Results Of 126 patients who met inclusion criteria, 36 received opioids and gabapentinoids (gabapentinoid group) and 90 received opioids alone (nongabapentinoid group). There were 136 naloxone episodes between the 2 groups. More than 50% of the naloxone episodes in the gabapentinoid group involved opioids of at least 90 oral morphine mg equivalents. Respiratory depression accounted for 39% and 15.8% of the naloxone episodes in the gabapentinoid and nongabapentinoid groups, respectively. Discussion There may be increased naloxone episodes among patients receiving opioids and gabapentinoids. Future studies are needed to evaluate the incremental risk of respiratory depression and oversedation as it pertains to concomitant medication administration and patient-specific factors.

scholarly journals Anesthetic Management of a Patient With a History of Rhabdomyolysis for Dental Treatment

2017 ◽  
Vol 64 (4) ◽  
pp. 251-252
Author(s):  
Hitomi Terasaki ◽  
Shinichi Ito
Keyword(s):  
Nitrous Oxide ◽  
General Anesthesia ◽  
Dental Treatment ◽  
Anesthetic Management ◽  
Fluid Management ◽  
Volatile Anesthetics ◽  
Electrolyte Balance ◽  
Rocuronium Bromide ◽  
History Of ◽  
Thiamylal Sodium

When general anesthesia is administered for patients considered at high risk for rhabdomyolysis, appropriate precautions are warranted. The use of suitable anesthetics, with attention to intravenous fluid management, electrolyte balance, respiration, and metabolism, should be addressed. We performed general anesthesia for dental treatment and biopsy for fibrous hyperplasia of the buccal mucosa in a patient with a history of rhabdomyolysis. We utilized thiamylal sodium, midazolam, rocuronium bromide, nitrous oxide, fentanyl, and remifentanil without using volatile anesthetics and propofol for this case. No complications of rhabdomyolysis were noted.

scholarly journals Antihistamines in Clinical Dentistry offering a Choice for Second Possibility in Reported Cases of Allergy to Local Anesthetics: Report of Two Cases and Literature Review

2014 ◽  
Vol 5 (1) ◽  
pp. 35-38
Author(s):  
Shahanavaj Imam Husen Khaji
Keyword(s):  
Literature Review ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Drug Allergy ◽  
Dental Treatment ◽  
Present Report ◽  
Chemical Structures ◽  
Anesthetic Agents ◽  
History Of ◽  
Treatment Procedures

ABSTRACT Drug allergy encompasses a spectrum of immunologically mediated hypersensitivity reaction with varying mechanisms and clinical presentation. Type of adverse drug reaction not only affects patient's quality of life, but may also lead to delayed treatment, unnecessary investigations and even mortality. The most effective strategy for the management of drug allergy is the avoidance or discontinuation of the offending drug. When available, alternative medications with unrelated chemical structures should be substituted. Patients who presents with history of allergy to local anesthetics are common in dental practices. In the present report, retrospective documented history of allergy to local anesthetics (lidocaine) in two patients (50 years/female, 35 years/male) were evaluated critically and needful dental treatment procedures were carried out using antihistamines pheniramine maleate: 22.75 mg/ml; DPH HCl: 1%) as local anesthetic agents. In both the cases, antihistamines proved to be beneficial, effective, devoid of complications. In conclusion, use of antihistaminic drugs in patients with documented history of allergy could be an alternative drug of choice having local anesthetic properties for minor dental treatment procedures in routine dental practice. How to cite this article Khaji SIH. Antihistamines in Clinical Dentistry offering a Choice for Second Possibility in Reported Cases of Allergy to Local Anesthetics: Report of Two Cases and Literature Review. Int J Head Neck Surg 2014;5(1):35-38.

scholarly journals Anesthetic Management of the Pregnant Patient: Part 1

2021 ◽  
Vol 68 (1) ◽  
pp. 52-62
Author(s):  
Jaimin Shin
Keyword(s):  
Dental Treatment ◽  
Anesthetic Management ◽  
Pregnant Patient ◽  
Developed Countries ◽  
Anesthetic Agents ◽  
Dental Procedures ◽  
Dental Patient ◽  
The Many ◽  
Dental Providers ◽  
The Impact

As delays in the age for a mother's first pregnancy continue to trend upward globally, particularly in developed countries, many pregnant patients are increasingly educated on the importance of obtaining dental care throughout their pregnancies. Guidelines set forth by the American Dental Association and the American College of Obstetrics and Gynecologists highlight the importance of dental treatment for optimizing maternal-fetal health across all trimesters, especially for emergent dental issues. The pregnant dental patient undergoes significant physiologic remodeling unique to each trimester, which may complicate treatment. Providing safe anxiety and pain control for dentistry can be further complicated if sedation or general anesthesia is required for the parturient. This is even more true when superimposed with increasingly prevalent underlying comorbidities like hypertension and diabetes. As dental providers, there is a clear need for continuing education on the many challenges associated with caring for pregnant patients due to this being an often overlooked subject in undergraduate and postgraduate dental education. Part 1 of this review will present the maternal and fetal physiologic considerations and the impact on patient management from an anesthetic perspective. Additional discussion focusing on common sedative and anesthetic agents used during dental procedures and their considerations will follow in Part 2.

scholarly journals Anesthetic Management of a Patient With Charcot-Marie-Tooth Disease

2016 ◽  
Vol 63 (2) ◽  
pp. 80-83 ◽  
Author(s):  
Naohiro Ohshita ◽  
Saeko Oka ◽  
Kaname Tsuji ◽  
Hiroaki Yoshida ◽  
Shosuke Morita ◽  
...  
Keyword(s):  
Anesthetic Management ◽  
Intravenous Sedation ◽  
General Anesthetic ◽  
Moderate Sedation ◽  
Charcot Marie Tooth ◽  
Charcot Marie Tooth Disease ◽  
Anesthetic Agents ◽  
Sensory Disorders ◽  
Hereditary Peripheral Neuropathy ◽  
Tooth Disease

Charcot-Marie-Tooth disease (CMTD) is a hereditary peripheral neuropathy and is characterized by progressive muscle atrophy and motor-sensory disorders in all 4 limbs. Most reports have indicated that major challenges with general anesthetic administration in CMTD patients are the appropriate use of nondepolarizing muscle relaxants and preparation for malignant hyperthermia in neuromuscular disease. Moderate sedation may be associated with the same complications as those of general anesthesia, as well as dysfunction of the autonomic nervous system, reduced perioperative respiratory function, difficulty in positioning, and sensitivity to intravenous anesthetic agents. We decided to use intravenous sedation in a CMTD patient and administered midazolam initially and propofol continuously, with total doses of 1.5 mg and 300 mg, respectively. Anesthesia was completed in 3 hours and 30 minutes without adverse events. We suggest that dental anesthetic treatment with propofol and midazolam may be effective for patients with CMTD.

scholarly journals Dexmedetomidine, Ketamine, and Midazolam for Oral Rehabilitation: A Case Report

2015 ◽  
Vol 62 (1) ◽  
pp. 25-30
Author(s):  
Bill W. S. Kim ◽  
Robert M. Peskin
Keyword(s):  
Case Report ◽  
Dental Treatment ◽  
Deep Sedation ◽  
Single Agent ◽  
Intravenous Sedation ◽  
Oral Rehabilitation ◽  
Anesthetic Agents ◽  
History Of ◽  
Sedation And Analgesia ◽  
Outpatient Settings

Abstract Intravenous sedation is frequently provided by anesthesiologists for phobic patients undergoing elective dental treatment in outpatient settings. Propofol is one of the most commonly used anesthetic agents that can result in apnea and respiratory depression, thereby posing potential difficulties with perioperative airway management. Dexmedetomidine has been utilized successfully in intravenous sedation for a wide variety of procedures and holds potential as an alternative to propofol in outpatient dental settings. However, as a single agent, it may not provide adequate depth of sedation and analgesia for oral rehabilitation. In this case report we demonstrate an effective alternative intravenous deep-sedation technique for an adult phobic patient undergoing oral rehabilitation utilizing 3 agents in combination: dexmedetomidine, ketamine, and midazolam. This combination of agents may be especially useful for those patients with a history of substance abuse, where administration of opioids may be undesirable or contraindicated.

Anesthesia for rabbits submitted to experimental surgeries: Report of a series of eight anesthesias

2020 ◽  
pp. 151-158
Author(s):  
Rafael Antonio Caldart Bedin ◽  
Maisa Schultz ◽  
Antonio Bedin
Keyword(s):  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Laboratory Animals ◽  
Average Weight ◽  
Anesthetic Induction ◽  
Anesthetic Agents ◽  
Reasonable Degree ◽  
Bioethical Debate ◽  
Precordial Stethoscope

Anesthesia for laboratory animals is a matter of biomedical concern and one of the most present dilemmas in the current bioethical debate. The use of anesthetic agents in experimental surgery aims at analgesia and restraining the animal, in order to achieve a reasonable degree of muscle relaxation and to produce sufficient analgesia. This practice requires the use of protocols for the administration of safe and efficient doses. Eight New Zealand rabbits were submitted to laparotomies demonstrating the surgical technique discipline of the local medical course. For pre-anesthetic medication, acepromazine 1 mg.kg-1 associated with ketamine 15 mg.kg-1 was used subcutaneously. Anesthesia was maintained with isoflurane and oxygen under a laryngeal mask in a Mapleson D anesthesia system and under spontaneous breathing. Hydration was performed with 10 ml.kg-1 saline every hour. A thermal mattress was used. Precordial stethoscope, pulse oximetry and clinical parameters were used for monitoring. For euthanasia, ketamine 10 mg.kg-1 associated with potassium chloride 19.1% 1 ml.kg-1 was used intravenously. The average weight of the rabbits was 2721.25 ± 275.01 grams and the duration of the anesthetic procedure was 120 ± 87 minutes. Discussion. In long-term anesthesia, such as laparotomies, the use of pre-anesthetic medication and then anesthetic induction by the combination of agents is recommended. However, anesthetic management requires monitoring to prevent insufficient or excessive doses from occurring.

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

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