The risks of injection anesthesia in dentistry

The article intends to study the risks of performing injection anesthesia for dentists experiencing chronic fatigue syndrome. Materials and methods used: The survey was conducted from August to November 2019 at various dental clinics of Moscow, with 308 dentists having filled in the questionnaire. Information source: The “Questionnaire on Assessing Injection Security and Chronic Fatigue Syndrome” was offered to dentists from clinics representing different types of ownership and contained 88 questions. Results: 97,14% of the respondents were feeling anxious while performing local anesthesia, yet, regrettably, 14,28% of them had to refer the patient to a dental surgeon for this procedure. 17,14% (n=53) of the 308 respondents noted that they had to confront the patient’s general condition worsening significantly due to a local anesthetic injection prior to the start of dental treatment. The mistakes made mostly had to do with anesthetic choice (26,73%), needle choice (12%), and needle breakage (3,78%). 17,14 per cent of dentists had the experience of confronting grave, even fatal outcomes of anesthesia. The majority of dentists (74,29%) work from 41,2 to 57,7 hours weekly. The risk of developing chronic fatigue syndrome was assessed as high in 11,43% of all cases. Conclusion: Given the absence of prophylaxis in 45,71% of cases related to anesthetic injection and the increased concentration of vasoconstrictor in the anesthetic in 88,57% of all instances, keeping records of complications caused by injection anesthesia is recommended.

Computer-Controlled Local Anesthesia Complication: Surgical Retrieval of a Broken Dental Needle in Noncooperative Autistic Paediatric Patient

The article describes an unusual case of retrieval of 8 mm fragment of a broken 30-gauge 21 mm dental needle in a 6 y.o. noncooperative autistic male patient. The needle of a computer-controlled local anesthesia device was broken during an attempt to administer local anesthetic, in order to perform conservative treatment of teeth 55 and 54 by a pedodontist. Despite the fact that the patient was under nitrous oxide sedation, an unexpected movement of the patient occurred and resulted in needle breakage. Due to the lack of patient cooperation, the surgical retrieval of a broken needle was performed under general anesthesia as part of one-day surgery procedures. The purpose of the article is to emphasize careful decision-making in proper choice of dental instruments during treatment of noncooperative paediatric patients even under sedation and to suggest dentists to carry out treatment of such patients under general anesthesia.

Broken Spinal Needle in a Morbidly Obese Parturient Presenting for Urgent Cesarean Section

Neuraxial anesthesia has become the preferred method of anesthesia for nonemergent cesarean delivery and cases where regional anesthesia is not contraindicated. Multiple cases of broken spinal and epidural needles have been reported in the literature over the last several years; however, the specific incidence of needle breakage is still unknown. Less reliance on general anesthesia and increasing parturient body mass index (BMI) has likely contributed to more reports of broken needles during regional anesthesia for obstetric surgery. We describe a case of a broken spinal needle after attempted spinal anesthetic placement for cesarean delivery in a morbidly obese parturient, subsequent postoperative management, and current treatment recommendations.