Comparison of Oropharyngeal Oxygen Pooling and Suctioning During Intubated and Nonintubated Dental Office-Based Anesthesia (original) (raw)
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Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2002
Purpose One hundred percent O2 is used routinely for preoxy-genation and induction of anesthesia. The higher the O2 concentration the faster is the development of atelectasis, an important cause of impaired pulmonary gas exchange during general anesthesia (GA). We evaluated the effect of ventilation with 0.4FiO2 in air, 0.4FiO2 in N2O and 100% O2 following intubation on the development of impaired gas exchange. Methods Twenty-seven patients aged 18–40 yr, undergoing elective laparoscopic cholecystectomy were administered 100% O2 for preoxygenation (three minutes) and ventilation by mask (two minutes). Following intubation these patients were randomly divided into three groups of nine each and ventilated either with 0.4FiO2 in air, 0.4FiO2 in N2O or 100% O2. Arterial blood gases were obtained before preoxygenation and 30 min following intubation for PaO2 analysis. Subsequently PaO2/FiO2 ratios were calculated. Results were analyzed with Student’s t test and one-way ANOVA. P value of ≤ 0.05 was considered significant. Results Ventilation of the lungs with O2 in air (FiO2 0.4) significantly improved the PaO2/FiO2 ratio from baseline, while 0.4FiO2 in N2O or 100% O2 worsened the ratio (558 ± 47vs 472 ± 28, 365 ± 34vs 472 ± 22 and 351 ± 23 vs 477 ± 28 respectively; P < 0.05). Conclusion Ventilation of lungs with O2 in air (FiO2 0.4) improves gas exchange in young healthy patients during GA. Objectif Cent pour cent d’O2 sont utilisés habituellement pour la préoxygénation et l’induction de l’anesthésie. Plus la concentration d’O2 est élevée, plus vite peut se développer l’atélectasie, une cause importante d’anomalie des échanges gazeux pulmonaires pendant l’anesthésie générale (AG). Nous avons évalué l’effet de la ventilation avec uneFiO2 de 0,4 dans de l’air,FiO2 de 0,4 dans du N2O et 100 % d’O2 après l’intubation quand apparaissent les anomalie des échanges gazeux. Méthode Vingt-sept patients de 18–40 ans, devant subir une cholé-cystectomie laparoscopique non urgente ont reçu 100 % d’O2 pour la préoxygénation, pendant trois minutes, et la ventilation au masque, pendant deux minutes. Après l’intubation, ces patients ont été répartis de façon aléatoire en trois groupes de neuf et ventilés avec 0,4FiO2 dans de l’air ou 0,4FiO2 dans du N2O ou 100% d’O2. La gazométrie du sang artériel a été obtenue pendant la préoxygénation et 30 min après l’intubation pour l’analyse de la PaO2. Par la suite, les ratios PaO2/FiO2 ont été calculés. Les résultats ont été analysés selon le test t de Student et une analyse de variance à une voie. Une valeur de P ≤ 0,05 a été considérée comme significative. Résultats La ventilation pulmonaire avec de l’O2 dans de l’air (FiO2 de 0,4) a sensiblement amélioré le ratio PaO2/FiO2, comparativement aux données de base, tandis que 0,4FiO2 dans du N2O ou 100 % d’O2 l’ont altéré (558 ± 47vs 472 ± 28, 365 ± 34 vs 472 ± 22 et 351 ± 23 vs 477 ± 28 respectivement; P < 0,05). Conclusion La ventilation pulmonaire avec de l’O2 dans de l’air (FiO2 0,4) améliore les échanges gazeux chez les jeunes patients pendant l’AG.
BioMed Research International, 2016
Aim. To evaluate the effectiveness and the tolerability of the nitrous oxide sedation for dental treatment on a large pediatric sample constituting precooperative, fearful, and disabled patients.Methods. 472 noncooperating patients (aged 4 to 17) were treated under conscious sedation. The following data were calculated: average age; gender distribution; success/failure; adverse effects; number of treatments; kind of dental procedure undertaken; number of dental procedures for each working session; number of working sessions for each patient; differences between males and females and between healthy and disabled patients in relation to success; success in relation to age; and level of cooperation using Venham score.Results. 688 conscious sedations were carried out. The success was 86.3%. Adverse effects occurred in 2.5%. 1317 dental procedures were performed. In relation to the success, there was a statistically significant difference between healthy and disabled patients. Sex and ag...
Saudi Journal of Oral and Dental Research
To evaluate the management of patients initially refusing care and their treatment under conscious sedation by the inhalation of Equimolar Mixture of Oxygen-Nitrous Oxide in the Department of Paediatric Dentistry at the Faculty of dental medicine in Monastir. Settings and Design: A 5 years retrospective study. Methods and Material: Dental session's treatment under conscious sedation were done once a week. Data for only one operator was collected. Data entry was performed using SPSS statistical software. Quantitative variables were expressed by their mean and standard deviation and categorical variables by their number and frequency. Differences with P-value < 0.05 were recorded as statistically significant. Results: The sample represents 161 patients (226 care sessions), the majority of patients treated under conscious sedation are aged between 3 and 30 years. The mean age is 8.02 years with a standard deviation of 4.591 years. The most represented age group is that of 5-14 years with 74% of the total number. The category of the most treated patients in our study were disabled patients with 49%, then young children with 36% and anxious patients with 13%. The category of occasional indications related to the act represents only 3%. Recruitment was mostly performed within the Department of Paediatric Dentistry. Extractions represent 40%, no serious side-effects were observed. The success rate was 93.2%. Conclusions: Since it is carried out in a Paediatric Dentistry department, this study provides a vision of conscious sedation benefits with young patients requiring this specific treatment. Keywords: Conscious sedation, Inhalation of equimolar mixture of oxygen and nitrous oxide, Paediatric Dentistry. Key Messages: Nitrous oxide inhalation sedation (N2O/O2) can improve cooperation for pediatric dental procedures, and the clinical efficacy of this technique is sufficient and predictable in most cases. Nitrous oxide inhalation sedation (N2O/O2) can be considered safe, practical and effective both for pediatric very young and fearful patients with low pain tolerance and for patients with intellectual disability.
2018
Background: The aim of our study was to compare the hemodynamic responses and adverse events associated with nasotracheal intubation (NTI) using a fiberoptic bronchoscope (FOB) and a direct laryngoscope (DLS) in children undergoing general anesthesia for outpatient dental surgery. Methods: Eighty children (aged 5–15 years) were scheduled to undergo outpatient dental surgery under general anesthesia and of these children those who required NTI were included. Results: NTI was significantly longer in the FOB group (P = 0.03). In both groups, systolic blood pressure (SBP) and heart rate (HR) significantly decreased after the induction of anesthesia when compared with the baseline values. SBP was significantly higher in both groups at intubation and 1 and 3 min after intubation when compared with postinduction. SBP significantly increased in the DLS group compared with the FOB group at intubation and 1 min after intubation. HR was significantly increased at intubation and 1 min after int...
Anesthesia Progress, 2014
In this study, a mechanical model was applied in order to replicate potential surgical fire conditions in an oxygen-enriched environment with and without high-volume suction typical for dental surgical applications. During 41 trials, 3 combustion events were measured: an audible pop, a visible flash of light, and full ignition. In at least 11 of 21 trials without suction, all 3 conditions were observed, sometimes with an extent of fire that required early termination of the experimental trial. By contrast, in 18 of 20 with-suction trials, ignition did not occur at all, and in the 2 cases where ignition did occur, the fire was qualitatively a much smaller, candle-like flame. Statistically comparing these 3 combustion events in the no-suction versus with-suction trials, ignition (P = .0005), audible pop (P = .0211), and flash (P = .0092) were all significantly more likely in the no-suction condition. These results suggest a possible significant and new element to be added to existing ...
The Effect of Leaving Dentures in Place on Bag-Mask Ventilation at Induction of General Anesthesia
Anesthesia & Analgesia, 2007
W ith the aging population and with 60% of those over 65 years old edentulous, the optimum timing for denture removal before anesthesia and surgery should be determined. One axiom among anesthesiologists is that it is more difficult to bag-mask ventilate an edentulate patient than one with intact dentition. However, studies have not specifically evaluated this. The current prospective, randomized, controlled trial evaluated the effect of leaving dentures in place during bag-mask ventilation at induction of general anesthesia. After induction of anesthesia, when verbal contact was lost, the patient was allocated to the dentures-in or denturesout group, that is, dentures were left in place or they were removed. At this point, bag-mask ventilation was attempted. The end point for successful ventilation was defined as an endtidal CO 2 trace increasing to 20 mm Hg and back to baseline. If this was achieved at total fresh gas flow of 3 L/min and adjustable pressure limiting (APL) value at 20 cm H 2 O, bagmask ventilation was considered to be easy. If not, a predetermined protocol was followed to ensure adequate bag-mask ventilation. The primary outcome was success of bag-mask ventilation. The study included 84 patients in the dentures-in group and 81 in the dentures-out group. The groups were comparable in age, sex, body mass index, denture type, anesthetic induction drugs, and use of neuromuscular blockade. Adequate bag-mask ventilation was possible in 61 (73%) of the 84 of the dentures-in group compared with 40 (49%) of 81 of those in the dentures-out group.There was a substantial difference in the secondary outcomes also (increased fresh gas flow to 6 L/min, closure of APL valve to 30 cm H 2 O, oxygen flush valve used, oropharyngeal airway used, 2-person technique required). Increasing body mass index independent of advancing age did not significantly affect the ease of manual ventilation.
Annals of Medical Research, 2021
Aim: The purpose of our study was to compare the McGrath MAC videolaryngoscope (VL) with the Macintosh direct laryngoscope (DL) for the efficacy during nasotracheal intubation (NTI) in patients undergoing dental surgery. Material and Methods: In total, 70 American Society of Anesthesiologist physical status (ASA) I-II patients who underwent elective dental surgery requiring NTI were included in this study. The patients were divided to two groups based on intubation using McGrath MAC VL (n=35) and Macintosh DL (n=35). The patients were monitored via electrocardiography (ECG), noninvasive arterial pressure, and peripheral oxygen saturation (SpO2) after they were taken to the operating room. Preoxygenation was performed with face mask for at least 3 minutes with 100 % O2. In addition, 2 mg/kg propofol and 1 μg/kg fentanyl were administered for anesthesia induction, and 0,6 mg/kg rocuronium was administered for muscular relaxation. NTI was performed 3 minutes after rocuronium injection ...
International Journal of Pediatric Otorhinolaryngology, 2011
Airway fires are a well-described and potentially devastating complication of oropharyngeal surgery. However, the actual factors required to ignite the fire have never been well-delineated in the medical literature. In this study, we used a mechanical model to assess the oxygen parameters necessary to cause an oropharyngeal fire.An electrosurgical unit (Bovie) was grounded to a whole raw chicken and a 6.0 endotracheal tube (ETT) was inserted into the cranial end of the degutted central cavity. Oxygen (O2) was then titrated through the ETT tube at varying concentrations, with flow rates varying from 10 to 15 L/min. Electrocautery (at a setting of 15 W) was performed on tissue in the central cavity of the chicken near the ETT. All trials were repeated twice to ensure accuracy. Positive test results were quantified by the time required to obtain ignition of any part of the mechanical setup and time required to produce a sustained flame. A test was considered negative if no ignition could be obtained after four minutes of direct electrocautery.At an O2 concentration of 100% and a flow rate of 15 L/min, ignition with a sustained flame was obtained between 15 and 30 s after initiation of electrocautery. At 100% O2 at 10 L/min, ignition was obtained at 70 s with immediate sustained flame. At an O2 concentration of 60%, ignition occurred at 25 s and sustained fire after 60 s. At an O2 concentration of 50% ignition with a sustained flame occurred between 128 and 184 s. At an O2 concentration of 45%, neither ignition nor sustained flames could be obtained in any trial.Operating room fires remain a genuine danger when performing oropharyngeal surgery where electrocautery is performed in an oxygen-enriched environment. In our study, higher O2 flow rates with higher FiO2 correlated with quicker ignition in the chicken cavity. A fire was easily obtained when using 100% O2; as the O2 concentration decreases, longer exposure to electrocautery is required for ignition. Below 50% O2 we were unable to obtain ignition. Our study is the first to examine the relative risk of ignition and sustained fire in a mechanical model of oropharyngeal surgery. Decreasing the fraction of inspired O2 (FiO2) to less than 50% may substantially decrease the risk of airway fire during oropharyngeal surgery.