Journal of Dental Anesthesia and Pain Medicine.2017;17(1):79-80. doi:10.17245/jdapm.2017.17.1.79
Journal of Dental Anesthesia and Pain Medicine
to Present ISSN: 2383-9309
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Journal of Dental Anesthesia and Pain Medicine.2017;17(1):71-76. doi:10.17245/jdapm.2017.17.1.71
Drug-induced sleep endoscopy (DISE) is used to identify areas of upper airway obstruction, which occurs when patients with obstructive sleep apnea (OSA) snore. DISE enables effective diagnosis and appropriate treatment of the obstruction site. Among surgical treatment methods for OSA, maxillomandibular advancement surgery (MMA) is performed to move a jaw forward; the surgery has a high success rate for OSA treatment. In DISE, anesthetics such as propofol and midazolam must be administered to induce snoring while the patient is deeply sedated for an accurate diagnosis to be made. When inducing deep sedation in a patient with OSA, airway obstruction may increase, causing oxygen saturation to drop; airway interventions are necessary in such cases. Effective DISE and MMA surgery can be performed by administering propofol through target-controlled infusion while monitoring the bispectral index (BIS).
Airway Obstruction ; Anesthetics ; Deep Sedation ; Diagnosis ; Endoscopy* ; Humans ; Jaw ; Midazolam ; Oxygen ; Propofol ; Sleep Apnea, Obstructive* ; Snoring
Airway Obstruction ; Anesthetics ; Deep Sedation ; Diagnosis ; Endoscopy* ; Humans ; Jaw ; Midazolam ; Oxygen ; Propofol ; Sleep Apnea, Obstructive* ; Snoring
Journal of Dental Anesthesia and Pain Medicine.2017;17(1):65-69. doi:10.17245/jdapm.2017.17.1.65
Patients with severe gag reflex (SGR) have difficulty getting the treatment they require in local clinics, and many tend to postpone the start of their treatment. To address this problem, dentists have used behavioral techniques and/or pharmacological techniques for treatment. Among the pharmacological methods available, propofol IV sedation is preferred over general anesthesia because it is a simpler procedure. Propofol in combination with remifentanil is characterized by stable sedative effects and quick recovery, leading to a deep sedation. Remifentanil acts to reduce the pain caused by lipid-soluble propofol on injection. The synergistic effects of propofol-remifentanil include reduction in the total amount of drug required to achieve a desired sedation level and anti-emetic effects. In this case report, we outline how the use of propofol-remifentanil IV sedation enabled us to successfully complete a wide range of dental treatments in a patient with SGR.
Anesthesia, General ; Antiemetics ; Deep Sedation ; Dental Care ; Dentists ; Gagging ; Humans ; Hypnotics and Sedatives ; Propofol ; Reflex*
Anesthesia, General ; Antiemetics ; Deep Sedation ; Dental Care ; Dentists ; Gagging ; Humans ; Hypnotics and Sedatives ; Propofol ; Reflex*
Journal of Dental Anesthesia and Pain Medicine.2017;17(1):61-64. doi:10.17245/jdapm.2017.17.1.61
Nasotracheal intubation is generally a useful maxillofacial surgery that provides good surgical access for intraoral procedures. When nasotracheal intubation is difficult, laryngeal mask airway (LMA) insertion can be performed, and the flexible LMA™ (FLMA) is also useful for anesthetic management. However, the FLMA provides limited access to the mouth, which restricts the insertion of instrumentation and confines the surgical field available. Here, we present our experience using the FLMA airway management for dental treatment cases involving difficulty with intubation.
Airway Management ; Anesthesia, General ; Dental Care ; Intubation* ; Laryngeal Masks* ; Mouth ; Surgery, Oral
Airway Management ; Anesthesia, General ; Dental Care ; Intubation* ; Laryngeal Masks* ; Mouth ; Surgery, Oral
Journal of Dental Anesthesia and Pain Medicine.2017;17(1):55-59. doi:10.17245/jdapm.2017.17.1.55
Digital dentistry has influenced many dental procedures, such as three-dimensional (3D) diagnosis and treatment planning, surgical splints, and prosthetic treatments. Patient-specific protective appliances (PSPAs) prevent dental injury during endotracheal intubation. However, the required laboratory work takes time, and there is the possibility of tooth extraction while obtaining the dental impression. In this technical report, we utilized new digital technology for creating PSPAs, using direct intraoral scanners and 3D printers for dental cast fabrication.
Dentistry ; Diagnosis ; Intubation, Intratracheal* ; Printing, Three-Dimensional* ; Splints ; Tooth Extraction
Dentistry ; Diagnosis ; Intubation, Intratracheal* ; Printing, Three-Dimensional* ; Splints ; Tooth Extraction
Journal of Dental Anesthesia and Pain Medicine.2017;17(1):47-53. doi:10.17245/jdapm.2017.17.1.47
BACKGROUND: Every patient who undergoes mandibular third molar surgery is concerned about post-operative pain. Indeed, previous researchers have used various methods to treat such pain. This study aimed to assess the effectiveness of sublingual injection of dexamethasone (8 mg) to treat post-operative pain after mandibular third molar surgery. METHOD: This was a randomized, double-blind, split-mouth, clinical trial, involving 48 healthy patients who required surgical removal of two mandibular third molars with similar bilateral positions. All operations were performed by the same experienced surgeon. The patients were randomized into a study group (8 mg dexamethasone injection) and a placebo group (normal saline injection). Both interventions were injected into the sublingual space immediately after local anesthesia, 30 min before the first incision. The study group received an 8 mg dexamethasone injection, while the placebo group received a normal saline injection. The wash period between the patients' two operations was 3 to 4 weeks. Pain was assessed by recording the number of analgesic tablets (rescue drug) consumed, as well as by noting the patients' responses to the visual analog scale (VAS) on the first, second, and third days after surgery. RESULTS: The study group differed significantly from the placebo group in terms of VAS score and analgesic consumption. CONCLUSION: Dexamethasone (8 mg), injected sublingually, significantly eased post-operative pain after surgical removal of the mandibular third molar.
Administration, Sublingual ; Anesthesia, Local ; Dexamethasone* ; Humans ; Methods ; Molar, Third* ; Pain, Postoperative ; Tablets ; Tooth, Impacted ; Visual Analog Scale
Administration, Sublingual ; Anesthesia, Local ; Dexamethasone* ; Humans ; Methods ; Molar, Third* ; Pain, Postoperative ; Tablets ; Tooth, Impacted ; Visual Analog Scale
Propofol protects against oxidative-stress-induced COS-7 cell apoptosis by inducing autophagy.
Journal of Dental Anesthesia and Pain Medicine.2017;17(1):37-46. doi:10.17245/jdapm.2017.17.1.37
BACKGROUND: In oxidative stress, reactive oxygen species (ROS) production contributes to cellular dysfunction and initiates the apoptotic cascade. Autophagy is considered the mechanism that decreases ROS concentration and oxidative damage. Propofol shows antioxidant properties, but the mechanisms underlying the effect of propofol preconditioning (PPC) on oxidative injury remain unclear. Therefore, we investigated whether PPC protects against cell damage from hydrogen peroxide (H₂O₂)-induced oxidative stress and influences cellular autophagy. METHOD: COS-7 cells were randomly divided into the following groups: control, cells were incubated in normoxia (5% CO₂, 21% O₂, and 74% N₂) for 24 h without propofol; H₂O₂, cells were exposed to H₂O₂ (400 µM) for 2 h; PPC + H₂O₂, cells pretreated with propofol were exposed to H₂O₂; and 3-methyladenine (3-MA) + PPC + H₂O₂, cells pretreated with 3-MA (1 mM) for 1 h and propofol were exposed to H₂O₂. Cell viability was determined using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide thiazolyl blue (MTT) reduction. Apoptosis was determined using Hoechst 33342 staining and fluorescence microscopy. The relationship between PPC and autophagy was detected using western blot analysis. RESULTS: Cell viability decreased more significantly in the H₂O₂ group than in the control group, but it was improved by PPC (100 µM). Pretreatment with propofol effectively decreased H₂O₂-induced COS-7 cell apoptosis. However, pretreatment with 3-MA inhibited the protective effect of propofol during apoptosis. Western blot analysis showed that the level of autophagy-related proteins was higher in the PPC + H₂O₂ group than that in the H2O2 group. CONCLUSION: PPC has a protective effect on H₂O₂-induced COS-7 cell apoptosis, which is mediated by autophagy activation.
Animals ; Apoptosis* ; Autophagy* ; Blotting, Western ; Cell Survival ; COS Cells* ; Hydrogen Peroxide ; Methods ; Microscopy, Fluorescence ; Oxidative Stress ; Propofol* ; Reactive Oxygen Species
Animals ; Apoptosis* ; Autophagy* ; Blotting, Western ; Cell Survival ; COS Cells* ; Hydrogen Peroxide ; Methods ; Microscopy, Fluorescence ; Oxidative Stress ; Propofol* ; Reactive Oxygen Species
Journal of Dental Anesthesia and Pain Medicine.2017;17(1):29-35. doi:10.17245/jdapm.2017.17.1.29
BACKGROUND: No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior alveolar nerve block for surgery on impacted lower third molars. METHOD: This study was conducted at the Faculty of Dentistry, Mahidol University in Bangkok, Thailand. The randomized, single-blind, comparative split-mouth study was carried out in patients with symmetrically impacted lower third molars, as identified on panoramic radiographs. Each patient underwent surgery for the removal of the lower third molars by the same surgeon under local anesthesia at two separate visits, 3 weeks apart. The onset and duration of local anesthesia, intra-operative pain, surgical duration, and number of additional anesthetics administered were recorded. RESULTS: The subjective and objective onset of action for the local anesthetics showed statistically significant differences (P < 0.05). However, the intra-operative pain, surgical duration, duration of local anesthesia, and number of additional anesthetics administered did not show statistically significant differences. CONCLUSION: The use of 4% articaine for the inferior alveolar nerve block was clinically more effective in the onset of subjective and objective anesthesia as compared with the use of 4% lidocaine. Based on the pain scores from the visual analogue scale, 4% lidocaine provided more analgesia during the procedure, and patients noted less intra-operative pain than with 4% articaine; however, the difference was not clinically significant.
Analgesia ; Anesthesia ; Anesthesia, Local ; Anesthetics ; Anesthetics, Local ; Carticaine* ; Dentistry ; Epinephrine ; Humans ; Lidocaine* ; Mandibular Nerve* ; Methods ; Molar, Third* ; Nerve Block ; Thailand ; Visual Analog Scale
Analgesia ; Anesthesia ; Anesthesia, Local ; Anesthetics ; Anesthetics, Local ; Carticaine* ; Dentistry ; Epinephrine ; Humans ; Lidocaine* ; Mandibular Nerve* ; Methods ; Molar, Third* ; Nerve Block ; Thailand ; Visual Analog Scale
Propofol protects human keratinocytes from oxidative stress via autophagy expression.
Journal of Dental Anesthesia and Pain Medicine.2017;17(1):21-28. doi:10.17245/jdapm.2017.17.1.21
BACKGROUND: The skin consists of tightly connected keratinocytes, and prevents extensive water loss while simultaneously protecting against the entry of microbial pathogens. Excessive cellular levels of reactive oxygen species can induce cell apoptosis and also damage skin integrity. Propofol (2,6-diisopropylphenol) has antioxidant properties. In this study, we investigated how propofol influences intracellular autophagy and apoptotic cell death induced by oxidative stress in human keratinocytes. METHOD: The following groups were used for experimentation: control, cells were incubated under normoxia (5% CO₂, 21% O₂, and 74% N₂) without propofol; hydrogen peroxide (H₂O₂), cells were exposed to H₂O₂ (300 µM) for 2 h; propofol preconditioning (PPC)/H₂O₂, cells pretreated with propofol (100 µM) for 2 h were exposed to H₂O₂; and 3-methyladenine (3-MA)/PPC/H₂O₂, cells pretreated with 3-MA (1 mM) for 1 h and propofol were exposed to H₂O₂. Cell viability, apoptosis, and migration capability were evaluated. Relation to autophagy was detected by western blot analysis. RESULTS: Cell viability decreased significantly in the H₂O₂ group compared to that in the control group and was improved by propofol preconditioning. Propofol preconditioning effectively decreased H₂O₂-induced cell apoptosis and increased cell migration. However, pretreatment with 3-MA inhibited the protective effect of propofol on cell apoptosis. Autophagy was activated in the PPC/H₂O₂ group compared to that in the H₂O₂ group as demonstrated by western blot analysis and autophagosome staining. CONCLUSION: The results suggest that propofol preconditioning induces an endogenous cellular protective effect in human keratinocytes against oxidative stress through the activation of signaling pathways related to autophagy.
Apoptosis ; Autophagy* ; Blotting, Western ; Cell Death ; Cell Movement ; Cell Survival ; Humans* ; Hydrogen Peroxide ; Keratinocytes* ; Methods ; Oxidative Stress* ; Propofol* ; Reactive Oxygen Species ; Skin ; Water
Apoptosis ; Autophagy* ; Blotting, Western ; Cell Death ; Cell Movement ; Cell Survival ; Humans* ; Hydrogen Peroxide ; Keratinocytes* ; Methods ; Oxidative Stress* ; Propofol* ; Reactive Oxygen Species ; Skin ; Water
Journal of Dental Anesthesia and Pain Medicine.2017;17(1):13-20. doi:10.17245/jdapm.2017.17.1.13
Cleft palate is one of the most common congenital malformations of the oral and maxillofacial region, with an incidence rate of around 0.1%. Early surgical repair is the only method for treatment of a cleft lip and palate. However, because of the use of inhalation anesthesia in children and the physiological characteristics of the cleft palate itself combined with the particularities of cleft palate surgery, the incidence rate of postoperative emergence agitation (EA) in cleft palate surgery is significantly higher than in other types of interventions. The exact mechanism of EA is still unclear. Although restlessness after general anesthesia in children with cleft palate is self-limiting, its effects should be considered by clinicians. In this paper, the related literature on restlessness after surgery involving general anesthesia in recent years is summarized. This paper focuses on induction factors as well as prevention and treatment of postoperative restlessness in children with cleft palate after general anesthesia. The corresponding countermeasures to guide clinical practice are also presented in this paper.
Anesthesia, General* ; Anesthesia, Inhalation ; Child* ; Cleft Lip ; Cleft Palate* ; Dihydroergotamine ; Humans ; Incidence ; Methods ; Palate ; Psychomotor Agitation*
Anesthesia, General* ; Anesthesia, Inhalation ; Child* ; Cleft Lip ; Cleft Palate* ; Dihydroergotamine ; Humans ; Incidence ; Methods ; Palate ; Psychomotor Agitation*
Country
Republic of Korea
Publisher
ElectronicLinks
Editor-in-chief
Abbreviation
Journal of Dental Anesthesia and Pain Medicine
Vernacular Journal Title
ISSN
2383-9309
EISSN
Year Approved
2016
Current Indexing Status
Currently Indexed
Start Year
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