C. Richard Bennett

Inadvertent brainstem anesthesia following extraoral trigeminal V2–V3 blocks

Total brainstem anesthesia with respiratory arrest followed extraoral trigeminal V2-V3 diagnostic nerve blocks for trigeminal neuralgia using a combination of 0.25 percent Bupivacaine, Sarapin, and triamcinolone. While an untoward reaction to either the Sarapin or triamcinolone cannot be ruled out, the most probable cause for this problem was the inadvertent intrathecal injection of Bupivacaine since the reaction can be explained on the basis of a local anesthetic effect. No such effect has been attributed to either of the other components of the mixture. Proper monitoring and prompt attention permitted attenuation of this potentially life-threatening complication.

Production of local anesthesia by jet injection: A clinical study

Abstract A clinical survey of 500 cases indicates that the SyriJet Mark II jet injector is useful in providing topical anesthesia in all areas of the oral cavity. However, it was found not to be applicable for anesthetizing the posterior superior alveolar, inferior alveolar, or incisive nerves.

Physostigmine reversal of drug-induced paradoxical excitement

Paradoxical excitement associated with intravenous conscious-sedation in a patient undergoing dental surgery was successfully reversed with 1.0 mg physostigmine. Physostigmine is felt to have exerted this effect by 2 mechanisms: the re-establishment of homeostasis in the CNS via augmented cholinergic pathways with the net result being thalamacocortical excitation, and cholinergically-mediated increase in cerebral blood flow increasing the rate of redistribution of the intravenous sedative agents used. The most commonly encountered side-effects of physostigmine used to reverse parodoxical excitement, emergence delirium, or prolonged narcosis are bradycardia, nausea, and/or vomiting. The incidence of these side-effects is low in doses, below 2.0 mg/70 kg. body weight.

Cardiorespiratory effects of meperidine, diazepam, and methohexital conscious sedation

The effects of conscious sedation on the respiratory and cardiovascular systems of seven healthy volunteers were studied. With mean dosages of meperidine, 0.41 mg/kg, diazepam, 0.13 mg/kg, and methohexital titrated incrementally to effect, there were statistically significant changes in PaO2, PaCO2, and arterial blood pH, and no statistically significant change in cardiac output as determined by arterial blood gas analysis and impedance cardiac output monitoring. No clinically significant changes were observed in cardiorespiratory function, and all patients were conscious according to the definition proposed by the American Dental Society of Anesthesiology. The variation in PaO2 showed only marginal statistical significance. There was no clinical indication for supplemental oxygen.

Stress-induced hypertensive reaction in a patient receiving monoamine oxidase inhibitors: Report of a case

A case illustrating the potential for hypertensive crisis in the ambulatory dental patient under treatment with monoamine oxidase inhibitors is presented. It is somewhat unique in that it appears to contradict much of the literature, which states that circulating, endogenous catecholamines are not expected to be a factor in initiating this potentially severe complication. Since this patient had not taken any food or drink prior to the appointment, it may be conjectured that endogenous catecholamines released as a result of stress and dental pain initiated the crisis.

A clinical evaluation of fentanyl for outpatient sedation in dentistry

Abstract The results of a clinical study conducted to evaluate the efficacy of fentanyl citrate (Sublimaze) for preoperative sedation in dentistry are presented. Fentanyl in combination with diazepam and methohexital produced an excellent sedative-analgesic-amnesic effect. Aspects of the study included patient and operator acceptance, and evaluation of changes in vital signs and complications.

Use of scopolamine for dental anesthesia and analgesia techniques

A review of the English literature on the pharmacologic effects of scopolamine is presented and indications for the current use of the drug in dental anesthesia and analgesia are evaluated. The authors conclude that the role of scopolamine in the production of conscious sedation for outpatient dental surgery should be reevaluated in the light of contemporary findings.

A clinical evaluation of innovar and innostat for outpatient sedation in dentistry

Abstract An open study was conducted to compare the relative efficacies of Innovar and Innostat in the production of preoperative sedation for dental outpatients. Parameters examined included a global evaluation by the operator, treatment observation, including subjective pain, mental attitude, patient awareness, motor performance, eyelid position, and ability to communicate. Vital signs were monitored throughout all procedures and remained stable and within normal limits in all instances. Although the drugs proved both safe and effective during surgical procedures, bothersome postoperative complications contraindicate their use in dental outpatients.

Extrapyramidal reactions after the use of innovar for ambulatory dental patients.

Abstract A case is presented in which extrapyramidal symptoms appeared in a dental outpatient after intravenous administration of Innovar. In addition to a detailed description of the extrapyramidal system, symptomatology and management of the case are presented. The dentists obligation to assume the responsibility for care of the patient is stressed.