Joseph A. Giovannitti

Needle Phobia: Etiology, Adverse Consequences, and Patient Management

Needle phobia has profound health, dental, societal, and legal implications, and severe psychological, social, and physiologic consequences. There is genetic evidence for the physiologic response to needle puncture, and a significant familial psychological component, showing evidence of inheritance. Needle phobia is also a learned behavior. The dental practitioner must recognize patients with needle phobia before the administration of local anesthetics to identify patients who are potentially reactive and to prevent untoward sequelae. Needle phobia is highly associated with avoidance behavior, and the dentist must exhibit compassion and respect. To avoid bradycardia, hypotension, unconsciousness, convulsions, and possibly asystole, oral premedication with benzodiazepines or other antianxiety agents must be considered for patients who are needle phobic. Management of needle phobiaeinduced syncope includes perioperative monitoring, oxygen administration, positioning, atropine, and vasopressors.

Pharmacology of Intravenous Sedative/Anesthetic Medications Used in Oral Surgery

This article provides an overview of historical and current sedative agents available to the dentist anesthetist. The surgeon is given rational choices for sedation and the individualization of drug selection for each patient. Total intravenous anesthesia is becoming increasingly popular for dental sedation because of the availability of ultra-short-acting drugs and computerized infusion technology. Levels of sedation are more easily achieved and maintained, and recovery is enhanced, which gives the operator extreme, moment-to-moment control of the anesthetic experience and improves patient outcomes.

Pharmacology of Local Anesthetics Used in Oral Surgery

This article provides a comprehensive review of the pharmacology of local anesthetics as a class, and provides details of the individual drugs available in dental cartridges. Maximum recommended doses of local anesthetics and vasoconstrictors are presented for healthy adult and pediatric patients, and for patients with cardiovascular system impairments. Various complications and reasons for failure of local anesthesia effectiveness are discussed, and current and future trends in local anesthesia are presented to provide an overview of current research in local anesthesia.

Adult Airway Evaluation in Oral Surgery

Patients with a history of difficult intubation or with conditions associated with difficult airway should be approached with organized primary and secondary plans for airway management. When these potential problems are detected, patient safety may be improved with use of advanced airway management techniques and equipment. Additionally, patient referral for consultation and/or management at facilities where advanced airway management practitioners and equipment are available may be beneficial in some cases.

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.

Management of Allergy and Anaphylaxis During Oral Surgery

Minor and major allergic reactions occur during oral and maxillofacial treatment. Immediate diagnosis and pharmacologic intervention are imperative. Signs and symptoms may be variable. The early administration of epinephrine is critical.