Daniel L. Orr

Vascular penetration following intraligamental injection

The potential for inadvertant intravascular injection of a local anesthetic solution with the intraligament injection syringe is described. The spread of solution is radiographically demonstrated, and precautions during the use of the procedure are suggested.

Conversion phenomenon following general anesthesia.

Two cases have been presented that demonstrate a previously undescribed complication of general anesthesia, i.e., altered recovery of consciousness secondary to hysterical conversion reactions. This potential complication must be considered when an organic cause for the symptoms cannot be found in a psychologically unstable individual. A helpful diagnostic sign is described. Consultation with a psychiatrist is mandatory if immediate alleviation of the symptoms is not obtained by the anesthesiologist and/or the surgeon.

Methemoglobinemia secondary to over-the-counter Anbesol

BACKGROUND Methemoglobinemia is a potentially lethal condition which may result from exposure to benzocaine. It must be treated promptly, because it may cause a significant decrease in oxygen delivery to tissues and organs. CASE DESCRIPTION A 39-year-old caucasian man presented to the emergency department (ED) with dental pain. After a review of systems and a dental exam, an oxygen saturation of 90% was noted. The patient reported no previous cardiac or pulmonary pathology, but did report using a large amount of over-the-counter Anbesol. A second oxygen saturation measurement had fallen to 87%. An arterial blood gas sample was taken, and the patient was found to have high levels of methemoglobin. He was transferred to the critical care ED and treated with 2 mg/kg intravenous methylene blue. CLINICAL IMPLICATIONS Dentists must be aware of the possible lethal effects of benzocaine toxicity, including methemoglobinemia. It is important to recognize the signs and symptoms and act in a judicious manner.

Office Accreditation Experiences With 3 Accrediting Agencies and Suggestions for Changes in Private Oral and Maxillofacial Surgery Facility Evaluations

Historically, oral and maxillofacial surgeons have had considerable autonomy in operating their offices. Oral and maxillofacial surgeons have had a singular history of safety, training, and success in outpatient anesthesia in their offices. However, preventable patient morbidity and mortality in private office-based surgical facilities of a variety of professions have brought increased scrutiny to the office environment. The present report describes the experiences of 3 oral and maxillofacial surgeons with 3 accrediting agencies in obtaining office accreditation and offers recommendations to be considered for the future of our specialty in terms of private office certification.

Root Tip Recovery via Root Canal Instrumentation.

This article reviews 2 representative cases of root tip recovery by root canal instrumentation. Recommendations associated with the use of root canal instrumentation for root tip recovery within mandibular and maxillary alveoli are considered.

Pulseless Ventricular Tachycardia During Office-Based Anesthetic in a Four-Year-Old Child

A 4-year-old 16-kg boy presented for full mouth dental rehabilitation in a private pediatric dental office. The patient had no significant previous medical history. Upon sevoflurane induction by a dentist anesthesiologist, the patient converted from normal sinus rhythm to pulseless ventricular tachycardia. Advanced cardiac life support protocol was initiated. After 2 automatic external defibrillator shocks were delivered in conjunction with epinephrine administration, the patient returned to normal sinus rhythm. The patient was transported via emergency medical service paramedics to a local childrens hospital emergency room where he was observed uneventfully for 24 hours prior to discharge.

Regarding William T.G. Morton.

Anesthesiology 2013; 118:460-71 470 Correspondence deserved primacy for the discovery (to first observe and make known) of safe, reproducible, anesthesia. From my reading, it seems that Jackson was maniacally driven in his efforts to be recognized for any significant discovery and was willing to devote considerable time, energy, and resources to accomplish that goal, most often by usurping the efforts of others. Jackson tried to lay claim to era breakthroughs such as Beaumont’s gastric studies (1838), Morse’s telegraph (1844), Schonbein’s guncotton (1845), and finally, Morton’s ether (1846). Jackson was not a disinterested or objective source about Morton. elizabeth Whitman Morton was also not disinterested but was fully supportive of Morton as a husband and doctor until the end of her life. In 1896, Mrs. Morton shared many memories, including how seriously Morton took his medical studies, rising daily at 4:00 a.m. to study the boney anatomy of the skeleton in their bedroom before going to his dental practice. Later, for months, every spare hour was spent in experiment (with ether). Morton then observed humans, including himself, under ether’s influence nonsurgically before finally beginning to use it in his dental practice. Mrs. Morton described how she tried to dissuade Morton through the night October 15, 1846, from keeping his appointment at the ether Dome the next day. In her mind, the potential benefits of the planned experiment were far outweighed by the risks of failure, perhaps even the patient’s death, potentially followed by a charge of manslaughter. Finally, Mrs. Morton mentions her husband’s volunteerism providing anesthesia in the (Civil) War.3 Mrs. Morton does not seem to feel Dr. Morton was an antisocial narcissist. Regarding the authors’ statement that Morton was derelict in not further developing a specialty in anesthesiology, there were not specialties in anything at that time, although the surgeons and nonsurgeons were fairly distinct. The fact that it took nearly 100 yr for the specialty to be established in medicine is not due to Morton’s lack of interest. After ether Day, Morton continued to devote his clinical efforts to anesthesia-related activities, while Horace Wells, later acknowledged by the American Dental Association4 and American Medical Association5 as the discoverer of anesthesia, began other projects unrelated to anesthesia or dentistry after his December 1844 demonstration at the ether Dome. If indeed Morton was as narcissistic as the authors suggest, their statements such as: “...full of confidence and probably had an inflated self-image...”, “...expected the accolades to come ...quickly and easily...”, and “...there was little thought to providing pain relief during surgery as part of Morton’s own personal agenda...” might be valid. At this time, I remain unconvinced. With Treatment Recommendations. Circulation 2010; 122(16 Suppl 2):S250–75