Intravenous conscious sedation in children for outpatient dentistry. Related Articles Intravenous conscious sedation in children for outpatient dentistry. Br Dent J. 2007 Sep 22;203(6):323-31 Authors: Mikhael MS, Wray S, Robb ND The use of general anaesthesia for dental treatment in the NHS outside hospitals has changed over time. Although deaths are uncommon during or immediately after general anaesthesia for dental treatment, they are more likely to occur than with other methods of pain and anxiety reduction, such as local anaesthesia and conscious sedation. Inquiries into recent anaesthetic deaths in dental practice have been critical of the standard of care provided in areas such as pre-operative assessment, monitoring, resuscitation and transfer to specialist critical care facilities. PMID: 17891082 [PubMed - indexed for MEDLINE] Comparison of a bolus of fentanyl with an infusion of alfentanil during targe... Related Articles Comparison of a bolus of fentanyl with an infusion of alfentanil during target-controlled propofol infusion in third molar extraction under conscious sedation. J Oral Maxillofac Surg. 2006 Nov;64(11):1577-82 Authors: Kwak HJ, Kim JY, Kwak YL, Park WS, Lee KC PURPOSE: This study was designed to compare hemodynamic changes, respiratory depression, and patient satisfaction between a bolus of fentanyl and an infusion of alfentanil during target-controlled propofol infusion in third molar extraction under conscious sedation. PATIENTS AND METHODS: Forty patients were randomly assigned to receive either a bolus of fentanyl (n = 24) or an infusion of alfentanil (n = 16) in combination with target-controlled propofol infusion. Hemodynamic changes, respiratory depression, sedation, and cooperation scores were recorded during surgery and patient satisfaction scores were assessed after surgery. RESULTS: Changes in mean blood pressure, heart rate, or oxygen saturation within and between the groups were not significant throughout the procedure. There were no significant differences in sedation, cooperation, and patient satisfaction scores between the 2 groups. CONCLUSION: Because there was no difference in hemodynamic variables and patient satisfaction scores between a bolus of fentanyl and an infusion of alfentanil during target-controlled propofol infusion, both combinations are suitable for conscious sedation in third molar extraction. PMID: 17052581 [PubMed - indexed for MEDLINE] Target-controlled infusion of propofol for fibreoptic intubation. Related Articles Target-controlled infusion of propofol for fibreoptic intubation. Eur J Anaesthesiol. 2003 Jul;20(7):565-9 Authors: Knolle E, Oehmke MJ, Gustorff B, Hellwagner K, Kress HG BACKGROUND AND OBJECTIVE: In a retrospective study, we examined the suitability of a departmental clinical protocol for anaesthesia induction with target-controlled infusion of propofol developed for fibreoptic intubation in spontaneously breathing patients scheduled for outpatient oral surgery at the dental clinic of the Vienna University Hospital. METHODS: Propofol was administered using target-controlled infusion (Diprifusor) at increasing target plasma concentrations starting at 2.5 microg mL(-1). After 10 min, an intravenous dose of alfentanil (5-10 microg kg(-1)) was given for pain reduction. After a further 2 min, the patient was evaluated for response to auditory stimulation. If unresponsive, fibreoptic intubation was performed, otherwise the target concentration was increased by 0.2 microg mL(-1) every 2 min until non-responsiveness was attained. RESULTS: Tracheal intubation was successful in all patients without any haemodynamic instability. However, one patient required facemask ventilation for 2 min. No patient was aware of intubation. The plasma concentration required for non-responsiveness was 2.8 +/- 0.4 microg mL(-1) (mean +/- SD). CONCLUSIONS: When using a target-controlled infusion of propofol, fibreoptic intubation can be performed with complete amnesia of the procedure for the patient. However, assisted ventilation of the lungs may be necessary as spontaneous ventilation may cease. PMID: 12884991 [PubMed - indexed for MEDLINE] Outpatient third molar surgery under local anaesthesia and conscious sedation... Related Articles Outpatient third molar surgery under local anaesthesia and conscious sedation using patient-controlled analgesia with alfentanil. Singapore Dent J. 2000 Dec;23(1 Suppl):23-8 Authors: Goh BT, Sim KM, Marzella ML We examined the feasibility of intraoperative conscious sedation employing patient-controlled analgesia with alfentanil (PCA-alfentanil) in 20 adult outpatients undergoing third molar surgery under local anaesthesia. A loading dose of intravenous alfentanil 15 mg/kg was administered immediately before local anaesthetic administration using 2% lignocaine with 1:80,000 adrenaline. This was followed by a background alfentanil infusion of 0.05 mg/kg/min. On demand alfentanil doses were 4 mg/kg with lockout intervals of 3 minutes. All patients were mildly sedated, easily aroused verbally and co-operative throughout the surgery. None experienced any cardiovascular or respiratory complications related to PCA-alfentanil. Immediate postoperative complications included nausea, vomiting and pruritus. High patient comfort and acceptance scores suggest that the use of PCA-alfentanil can be a useful adjunct to local anaesthesia in adult outpatients undergoing third molar surgery. PMID: 11699359 [PubMed - indexed for MEDLINE] Comparison of patient-controlled sedation with propofol and alfentanil for th... Related Articles Comparison of patient-controlled sedation with propofol and alfentanil for third molar surgery--preliminary results of a pilot study. Singapore Dent J. 2000 Dec;23(1 Suppl):18-22 Authors: Tan WK, Tan JM, Chan O Propofol and alfentanil are commonly used for sedation and pain control. A preliminary study to compare the usefulness of these drugs was carried out in ten healthy patients requiring bilateral wisdom tooth surgery. The operations were done in two appointments with the patient receiving a different drug on each occasion. Anxiety levels were recorded on visual analogue scales pre and post-operatively. Both agents caused a decrease in anxiety scores, with propofol causing a more significant reduction. Vomiting and nausea with alfentanil was noted in three patients. Propofol also had an amnesic effect which alfentanil did not have. In conclusion, propofol would appear to be the drug of choice within the limitations of this pilot study. PMID: 11699358 [PubMed - indexed for MEDLINE] Tracheal intubation of outpatients with and without muscle relaxants. Related Articles Tracheal intubation of outpatients with and without muscle relaxants. Can J Anaesth. 2000 May;47(5):427-32 Authors: Collins L, Prentice J, Vaghadia H PURPOSE: To compare intubating conditions and postoperative myalgias in outpatients after intubation with propofol/alfentanil compared with propofol/alfentanil/succinylcholine with and without precurarisation with d-tubocurarine. METHODS: 144 ASA I-II ambulatory patients for dental extraction under anesthesia were studied. Subjects received either 3 mg d-tubocurarine (Group II) or saline (Groups I, III) i.v. prior to induction of anesthesia with 20 microg x kg(-1) alfentanil and 2.5 mg x kg(-1) propofol followed by 1.5 mg x kg(-1) succinylcholine (II and III) or saline 0.9% (I) for muscle relaxation. The ease of airway management and the postoperative incidence, severity and distribution of muscle pains were examined. RESULTS: Intubation was successful in all patients and there were no differences in jaw mobility, ease of bag-mask ventilation, visualization of the vocal cords or cord position. Limb movement was more common during intubation in Group I (37.5%) than in Group III (8.3%) or Group II (2%), P < 0.05. At home, VAS scores for myalgia were higher in Group III than in Group I and II. Neck myalgia was more common in Group II (72%) than in Groups II (44%) and I (41%), P < 0.05. Myalgias were also more common in Group III patients (P < 0.05). CONCLUSION: Acceptable intubating conditions were achieved with propofol and alfentanil alone. Succinylcholine reduced limb movement during intubation but was associated with postoperative myalgias for up to five days. Precurarisation with tubocurarine reduced the severity of succinylcholine myalgia. PMID: 10831199 [PubMed - indexed for MEDLINE] Alfentanil for intubation under halothane anaesthesia in children. Related Articles Alfentanil for intubation under halothane anaesthesia in children. Paediatr Anaesth. 1999;9(6):491-4 Authors: NG KP, Wang CY Intubating conditions under halothane anaesthesia aided with alfentanil 20 micrograms.kg-1 were compared with suxamethonium 2 mg.kg-1 in 40 children presenting for day dental procedures. The condition of vocal cords, jaw relaxation and presence of movement and coughing were scored to give the overall intubating conditions. Successful intubation was achieved in 100% of the suxamethonium group and 94.7% of the alfentanil group. The cardiovascular response to intubation was attenuated in the alfentanil group. Some 43.7% of those receiving suxamethonium developed myalgia the day after surgery compared with 0% in the alfentanil group (P < 0.01). PMID: 10597551 [PubMed - indexed for MEDLINE] Balanced pre-emptive analgesia: does it work? A double-blind, controlled stud... Related Articles Balanced pre-emptive analgesia: does it work? A double-blind, controlled study in bilaterally symmetrical oral surgery. Br J Anaesth. 1998 Nov;81(5):727-30 Authors: Campbell WI, Kendrick RW, Fee JP We studied 32 patients undergoing bilateral symmetrical lower third molar surgery under general anaesthesia to determine if the combined effects of pre-emptive local anaesthetic block using 0.5% bupivacaine, together with i.v. tenoxicam and alfentanil had any benefits over postoperative administration. Patients acted as their own controls and were allocated randomly to have surgery start on one side, the second side always being the pre-emptive side. Difference in pain intensity between the two sides was determined using visual analogue scales completed by each individual at 6 h, and at 1, 3 and 6 days after operation. A long-form McGill pain questionnaire was also used to assess difference in pain intensity between the two sides on the morning after surgery. There was no significant difference in pain intensity at any time after surgery. Our findings indicate that the combined use of pre-emptive analgesia from 0.5% bupivacaine, tenoxicam and alfentanil did not reduce postoperative pain intensity in patients undergoing molar exodontia. PMID: 10193284 [PubMed - indexed for MEDLINE] Pharmacokinetic-pharmacodynamic modelling of the analgesic effect of alfentan... Related Articles Pharmacokinetic-pharmacodynamic modelling of the analgesic effect of alfentanil in the rat using tooth pulp evoked potentials. J Pharmacol Toxicol Methods. 1998 Feb;39(1):19-27 Authors: Cox EH, Langemeijer MW, Danhof M The purpose of the present study was to develop an animal model for the investigation of the concentration-effect relationship of alfentanil using tooth pulp evoked potentials (TPEP). Six chronically instrumented, freely moving rats received a computer-controlled intravenous infusion of alfentanil resulting in seven pseudo-steady-state blood concentration levels, each maintained for 30 min. At each concentration level, the tooth pulp of the rat upper incisor was electrically stimulated in a time-randomized order with different current intensities (400-800 microA, 1 msec duration) and the electroencephalogram (EEG) was recorded concomitantly. Arterial blood samples were collected serially and assayed for alfentanil using RIA. Repetitive evoked EEG responses were averaged per stimulus intensity and per session. The decrease of the area under the negative peak 15 msec after stimulation (% of preadministration value) was used as pharmacological endpoint. The concentration-TPEP effect of alfentanil was investigated by nonlinear mixed effect modeling (NONMEM). When the observed TPEP effect was plotted versus the alfentanil blood concentration no hysteresis or proteresis was observed, and the two could directly be related to each other on the basis of the sigmoidal Emax pharmacodynamic model. The (population) pharmacodynamic estimates were (+/-S.E.): Emax = 108 +/- 10%, EC50 = 24 +/- 17 ng/ml, Hill factor = 0.81 +/- 0.37. A large interindividual variability for EC50 (omegaEC50) of 164 +/- 107% was observed. The residual variability was 14 +/- 10%. It is concluded that the TPEP is a useful tool for the systematic investigation of the concentration-analgesic effect relationship of centrally acting analgesics in the freely moving rat. PMID: 9596144 [PubMed - indexed for MEDLINE] Effect of antiemetic therapy on recovery and hospital discharge time. A doubl... Related Articles Effect of antiemetic therapy on recovery and hospital discharge time. A double-blind assessment of ondansetron, droperidol, and placebo in pediatric patients undergoing ambulatory surgery. Anesthesiology. 1995 Nov;83(5):956-60 Authors: Davis PJ, McGowan FX, Landsman I, Maloney K, Hoffmann P BACKGROUND: Postoperative nausea and vomiting continue to be a significant problem for pediatric ambulatory surgery patients. Although ondansetron has been demonstrated to be effective in the prophylactic treatment of postoperative nausea and vomiting (surrogate end point) no one has demonstrated a benefit of antiemetic therapy on patient recovery, postanesthesia care unit length of stay, and hospital length of stay (nonsurrogate end points). In a double-blind manner, the effects of ondansetron, droperidol, and placebo on the incidence of emesis, postanesthesia care unit stay, and hospital discharge time were evaluated in children undergoing dental surgery. METHODS: The subjects were 102 children aged 2-8 years undergoing complete dental restoration. All patients received midazolam before undergoing inhalation induction of anesthesia with N2O/O2 and halothane. Anesthesia was maintained with N2O/O2 and alfentanil. Patients were then randomized to receive ondansetron (0.1 mg/kg), droperidol (75 micrograms/kg), or placebo (normal saline) in a double-blind fashion. At the conclusion of the anesthesia, a trained nurse observer assessed patient recovery and recorded the time patients met specified criteria for postanesthesia care unit and hospital discharge as well as episodes of emesis in the hospital and at home during the first 24 hr after surgery. RESULTS: Ninety-five patients completed the study. The three antiemetic groups were similar with respect to age, weight, length of surgery, dose of alfentanil, and route of preanesthetic medication. The 24-hr incidence of emesis was significantly less with ondansetron (9%) than with placebo (35%) or droperidol (32%). Ondansetron-treated patients had significantly shorter hospital stays than droperidol-treated patients, but recovery parameters were similar between the ondansetron- and placebo-treated patients. CONCLUSIONS: Ondansetron is an effective prophylactic antiemetic agent for children undergoing dental surgery. Compared with droperidol, ondansetron decreases the length of hospital stay, but compared to placebo, there were no differences in the patient recovery parameters. PMID: 7486180 [PubMed - indexed for MEDLINE] Propofol as the sole agent for paediatric day case dental surgery. Related Articles Propofol as the sole agent for paediatric day case dental surgery. Anaesthesia. 1995 Mar;50(3):269 Authors: Lake AP PMID: 7772179 [PubMed - indexed for MEDLINE] Propofol infusion technique for outpatient general anesthesia. Related Articles Propofol infusion technique for outpatient general anesthesia. J Oral Maxillofac Surg. 1995 Feb;53(2):124-8; discussion 129-30 Authors: Candelaria LM, Smith RK PURPOSE: The purpose was to evaluate the suitability of a continuous propofol infusion in combination with alfentanil for outpatient general anesthesia in an oral and maxillofacial surgery practice. MATERIALS AND METHODS: Twenty-seven ASA 1 patients were selected to undergo oral and maxillofacial surgery outpatient procedures of short duration. Induction of anesthesia was accomplished with 1 mg/kg intravenous (i.v.) propofol and 10 micrograms/kg i.v. alfentanil. Local anesthesia was administered. General anesthesia was maintained with a continuous infusion of 150 micrograms/kg/min of propofol. Various physical and psychomotor responses were recorded during induction, maintenance, emergence, and recovery. RESULTS: Anesthesia was successfully induced in all patients with single, slowly titrated, bolus doses of 1 mg/kg of propofol and 10 micrograms/kg of alfentanil. Induction of general anesthesia occurred in less than 1 minute in all cases and no excitatory phenomena, tremor, or hypertonus were observed. Maintenance of anesthesia was adequately accomplished and cardiovascular parameters remained within acceptable limits throughout the procedure. The average length of surgery was 22 minutes. Movement to surgical stimulus was minimal and easily managed with additional local anesthetic and/or a 10-mg bolus of propofol. Time to eye opening was approximately 5 minutes from the discontinuation of the propofol infusion. No emergence phenomena were observed. All patients were ready for discharge with baseline psychomotor activity within 30 minutes following the end of the procedure. The average total dose of propofol was 350 mg and the average dose of alfentanil was 750 micrograms. CONCLUSION: This anesthetic technique has numerous advantages with minimal side effects, and should be considered for routine use for outpatient general anesthesia in oral and maxillofacial surgery. PMID: 7830177 [PubMed - indexed for MEDLINE] [Continuous administration of mivacurium for short procedures. Delayed onset ... Related Articles [Continuous administration of mivacurium for short procedures. Delayed onset and recovery from neuromuscular blockade] Ann Fr Anesth Reanim. 1995;14(6):467-71 Authors: Pellissier D, Bruder N, Mokart D, Quilichini D, Camatte S, Blache JL, Fran&#xE7;ois G OBJECTIVE: To assess the delays of onset and spontaneous recovery from neuromuscular block produced by mivacurium administered by continuous infusion for short procedure requiring a deep relaxation. STUDY DESIGN: Prospective open non comparative study. PATIENTS: Twenty-nine class ASA I and II adults undergoing a stomatological procedure of short duration were included in the study. METHOD: General anaesthesia was obtained with a continuous infusion of propofol, supplemented with alfentanil and N2O-O2 mixture. Neuromuscular blockade, assessed with electromyography of the adductor pollicis muscle, was obtained with mivacurium (150 micrograms.kg-1). After restoration of 5% of neuromuscular transmission, mivacurium was administered by continuous infusion in order to maintain a blockade between 91 and 99%. RESULTS: The delay for decreasing twitch height by 95% was 2.9 +/- 1.0 min. The mean dose for maintenance of blockade was 10.9 +/- 1.5 micrograms.kg-1.min-1. The delay of spontaneous recovery from blockade was 10.2 min, 16.6 min and 21.3 min for obtaining 25, 75 and 95% twitchs respectively. The delay for the twitch increase from 25 to 75% was 6.6 min. DISCUSSION: Mivacurium in continuous infusion provides rapidly a deep and stable neuromuscular blockade followed by a rapid spontaneous restoration of neuromuscular transmission in patients with normal pseudocholinesterases. PMID: 8745969 [PubMed - indexed for MEDLINE] [Cervicofacial cellulitis of dental origin and tracheal intubation] Related Articles [Cervicofacial cellulitis of dental origin and tracheal intubation] Ann Fr Anesth Reanim. 1995;14(3):256-60 Authors: Reyford H, Boufflers E, Baralle MM, Telion C, Guermouche T, Menu H, Krivosic-Horber R OBJECTIVES: To evaluate the difficulty of intubation in relation with the localisation and spread of cervico-facial cellulitis of odontogenic origin and to recognize the optimal technique of intubation in such circumstances. STUDY DESIGN: Prospective clinical open study. PATIENTS: Hundred patients, including 16 children, undergoing surgical drainage of a cervico-facial cellulitis of odontogenic origin under general anesthesia were studied. METHODS: Difficulty of intubation was evaluated with the following four criteria: active mouth opening in the awake patient, Mallampati's classifying system, presence of trismus, clinical and radiological control of localisation and extension of the cellulitis (mandibular, maxillar or mouth floor). In case of a foreseen difficult intubation, a fibrescope was used in the awake patient. Otherwise the endotracheal tube was inserted after administration of propofol (3 mg.k-1) and alfentanil (10 to 20 micrograms.kg-1). A Cormack's grading was performed during intubation. RESULTS: Mouth opening depended on the localisation of the cellulitis. Trismus occurred more often with mandibular than maxillary localisations. Trismus and a Mallampati's class > 2 were associated with difficulty in intubation (Cormack's grade > 2), except in maxillary localisations. CONCLUSIONS: The localisation of cellulitis of odontogenic origin is responsible for the difficulty grade of intubation. Awake fibreoptic intubation should be systematically performed in patients with a floor of the mouth cellulitis to reduce the risk of rupture of the abscess by a laryngoscope blade. As trismus associated with mandibular localisations is not relieved by general anaesthesia, awake fibreoptic endotracheal intubation should be preferred. PMID: 7486294 [PubMed - indexed for MEDLINE] A comparison of propofol with methohexital and isoflurane in two general anes... Related Articles A comparison of propofol with methohexital and isoflurane in two general anesthetic techniques. J Oral Maxillofac Surg. 1993 Oct;51(10):1076-9; discussion 1079-80 Authors: Werner ME, Bach DE, Newhouse RF The purpose of this study was to compare two general anesthetic techniques involving oral intubation for use in outpatient third molar surgery. Fifty American Society of Anesthesiologists I or II patients were randomly allocated to two groups. Group 1 received methohexital, isoflurane, nitrous oxide, and alfentanil, while group 2 received propofol, alfentanil, and nitrous oxide. An analysis of the results showed that although the technique used in group 2 cost more, had a slightly longer induction time, and produced a similar duration of apnea, it did not cause significant hypotension (as previously reported), and had a significantly better overall recovery. It was concluded that the use of propofol in the outpatient surgery setting may be a valuable addition to the oral and maxillofacial surgeon's anesthetic armamentarium. PMID: 8410445 [PubMed - indexed for MEDLINE] Alfentanil in daycase anaesthesia. Assessment of a single dose on the quality... Related Articles Alfentanil in daycase anaesthesia. Assessment of a single dose on the quality of anaesthesia and recovery. Anaesthesia. 1993 Jun;48(6):476-81 Authors: Bagshaw ON, Singh P, Aitkenhead AR The effect of the addition of a single dose of 7 micrograms.kg-1 of alfentanil to a propofol/enflurane anaesthetic on the quality of anaesthesia and recovery was assessed. A total of 53 ASA grade 1 or 2 patients who underwent daycase dental surgery were allocated randomly to receive either alfentanil or saline. The study was blinded so that neither the anaesthetist nor the assessor was aware of which solution had been given. Patients in the alfentanil group took significantly longer to recommence spontaneous ventilation (p = 0.035). Both techniques provided good quality of anaesthesia. Postoperative morbidity was common (45% of patients), but there was no difference between the groups. The rate of recovery was similar in the two groups and no patient required hospital admission after the final assessment at 3 h. Drowsiness was only mild to moderate in both groups at 24 h. A single dose of alfentanil can be administered safely as part of a daycase anaesthetic without increasing morbidity, although there appears to be little advantage in doing so. PMID: 8322987 [PubMed - indexed for MEDLINE] Comparison of alfentanil with suxamethonium in facilitating nasotracheal intu... Related Articles Comparison of alfentanil with suxamethonium in facilitating nasotracheal intubation in day-case anaesthesia. Br J Anaesth. 1993 Jan;70(1):34-7 Authors: Alcock R, Peachey T, Lynch M, McEwan T We have performed a prospective study in 100 adults (ASA I or II) undergoing day-case dental extraction to compare the conditions for intubation and the postoperative sequelae of suxamethonium and alfentanil as adjuncts to propofol. The patients were allocated randomly to two groups comparable in age, sex and weight. Successful intubation was achieved in 100% of the suxamethonium group and 90% of the alfentanil group. Of the patients who received suxamethonium, 74% developed myalgia on the day after surgery, compared with 20% in the alfentanil group (P < 0.001). The proportion of patients who developed sore throat was also less in the alfentanil group than in the suxamethonium group (P < 0.05). The proportion of patients who complained of nausea in the two groups was not significantly different. We conclude that alfentanil, as an adjunct to propofol to facilitate tracheal intubation, is more acceptable to patients than suxamethonium in anaesthesia for day-case surgery. PMID: 8431329 [PubMed - indexed for MEDLINE] Recovery characteristics using isoflurane or propofol for maintenance of anae... Related Articles Recovery characteristics using isoflurane or propofol for maintenance of anaesthesia: a double-blind controlled trial. Anaesthesia. 1992 Jun;47(6):461-6 Authors: Marshall CA, Jones RM, Bajorek PK, Cashman JN We studied 114 female patients (ASA 1 or 2) who were within 20% of ideal body weight and who were scheduled to undergo gynaecological laparoscopy which required supplementation with an opioid (groups IA and PA), or dental procedures which did not require opioid supplementation (groups IO and PO). A computerised package of psychomotor tests was performed before surgery. Anaesthesia was induced with propofol 2.5 mg.kg-1 and all patients received atracurium 0.3 mg.kg-1 and 67% nitrous oxide in oxygen. Patients in group IA received isoflurane 1% (inspired), and alfentanil 10 micrograms.kg-1 as a bolus and 10 micrograms.kg-1.h-1 as an infusion. Patients in group PA received propofol 9 mg.kg-1.h-1 as an infusion, decreasing to 6 mg.kg-1.h-1 after 15 min, together with alfentanil 10 micrograms.kg-1.h-1. Patients in groups IO and PO received isoflurane and propofol in the regimens described for groups IA and PA, but without alfentanil. Recovery was assessed by a blinded observer who recorded times to awakening (eye opening) and orientation (giving date of birth), and who repeated the psychomotor tests at 1, 3 and 5 h. Linear analogue scales of mood, nausea and pain were obtained and other side effects were noted in the succeeding 48 h. A matched control group of 25 females (who were not anaesthetised) underwent psychomotor testing on four occasions in order to assess the 'learning effect' of repeated recovery testing. The analysis of recovery tests did not assume a normal distribution.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 1535485 [PubMed - indexed for MEDLINE] Anesthesia for temporomandibular arthroplasty in a quadriplegic patient: a ca... Related Articles Anesthesia for temporomandibular arthroplasty in a quadriplegic patient: a case report. Anesth Pain Control Dent. 1992;1(3):153-6 Authors: Roelofse JA, Morkel JA A 41-year-old male quadriplegic patient with bilateral TMJ ankylosis was admitted for surgery under general anesthesia. Preoperative tests showed abnormal lung function and a low total serum calcium level. Premedication consisted of diazepam 10 mg orally and glycopyrrolate 0.2 mg intramuscularly 90 minutes before the start of the operation. Because of an inability to open the mouth more than 0.5 cm, a nasal fiberoptic endoscopic intubation was done under sedation and local anesthesia. For maintenance of anesthesia the patient received nitrous oxide 50% in oxygen, halothane, and alfentanil. No muscle relaxant was administered. The 2-hour operation was completed uneventfully and the patient needed no ventilatory support afterward. Major anesthetic problems of spinal injury patients can be compared to those with cervical cord transection. The stage that the condition has reached determines the dominant anesthetic problems. The chronic stage (greater than 3 months postinjury, as in this patient) is usually characterized by sympathetic overactivity. Anesthetic problems during this stage may include risk of hyperkalemia from succinylcholine, cardiovascular instability and autonomic hyperreflexia, impaired thermoregulation, anemia, chronic infections, risk of hypercalcemia, and alveolar hypoventilation. None of these problems was encountered in this patient. A surprising finding was that the low serum calcium concentration did not influence the anesthetic outcome. PMID: 1422289 [PubMed - indexed for MEDLINE] Alfentanil with methohexitone in paediatric dental anaesthesia. Related Articles Alfentanil with methohexitone in paediatric dental anaesthesia. J Dent. 1991 Jun;19(3):192-4 Authors: Burtles R Children recovering from intravenous methohexitone anaesthesia given for simple dental extractions frequently cry, or are restless and confused, during emergence from anaesthesia. This is disturbing for parents and other children. In an attempt to resolve this problem various doses of alfentanil (2.5, 5.0, 7.5 and 10 micrograms/kg) were added to a standard intravenous dose of methohexitone (2 mg/kg), with the effects being assessed by comparison with a control group who received methohexitone only. The incidence of crying recorded was significantly lower in the group receiving the highest alfentanil supplement (10 micrograms/kg), when compared with the incidence in the group given lower doses of alfentanil or methohexitone alone. Among those who cried, there was a significant delay in onset in the high alfentanil dose group. No adverse effects were observed. PMID: 1939823 [PubMed - indexed for MEDLINE] [Local articaine infiltration combined with an intravenous analgesic for oral... Related Articles [Local articaine infiltration combined with an intravenous analgesic for oral surgery on patients at risk] Chir Dent Fr. 1991 May 23;61(566):25-9 Authors: Lefevre B, Lepine J, Perrin D, Malka G PMID: 1830538 [PubMed - indexed for MEDLINE] [Ambulatory vigil anesthesia for implant surgery] Related Articles [Ambulatory vigil anesthesia for implant surgery] J Parodontol. 1991 May;10(2):235-7 Authors: Charlton D, Herbeau C, Renouard F The length of certain implant surgery operation as well as their precision requires the complete cooperation of patients. The vigilambulant anesthesia, regularly used in other medical specialties, ensures in total security, anxiolism, sedation, analgesia and amnesia for patients. The presence of an anesthesist having at his disposal all the material and all drugs for anesthesia and reanimation gives the surgeon an unequalled operatory comfort. PMID: 2072285 [PubMed - indexed for MEDLINE] Propofol for anesthesia in a patient susceptible to malignant hyperthermia. Related Articles Propofol for anesthesia in a patient susceptible to malignant hyperthermia. Anesth Prog. 1991 May-Jun;38(3):96-8 Authors: Rosenberg MB Propofol may be a useful anesthetic in the management of malignant hyperthermia patients. It appears not to trigger malignant hyperthermia while providing stress-free conditions. This case report, along with a small number of others, documents the safe use of propofol for this patient population. PMID: 1839946 [PubMed - indexed for MEDLINE] Local anaesthesia with intravenous analgesia as an alternative to general ana... Related Articles Local anaesthesia with intravenous analgesia as an alternative to general anaesthesia for medically compromised patients undergoing oral surgery. A retrospective study of sixty-two cases. SAAD Dig. 1991 Apr;8(1-2):12-8 Authors: Lef&#xE8;vre B The purpose of this retrospective study was to evaluate the combined use of intravenous analgesia, with a potent opiate alone, supplemented by local anaesthesia as an alternative to general anaesthesia for medically compromised patients. Sixty-two in-patients, aged between 32 and 80 years, with an ASA physical status of III and IV, were involved in this study. The local anesthetic used was 4% articain with epinephrine (1:200,000) and narcotic analgesics were Fentanyl or Alfentanil. Surgical procedures included multiple dental extractions, cystectomy and the removal of impacted teeth. All patients completed the surgery without deeper anaesthesia and mostly enjoyed a comfortable intraoperative period. Only one respiratory depression was observed, but quickly reversed. Other adverse effects were few and without consequences, hemodynamic changes remained in tolerable limits. In conclusion this anaesthetic technique can be a suitable alternative to general anaesthesia in oral surgery for high-risk patients. PMID: 1833835 [PubMed - indexed for MEDLINE] Continuous alfentanil infusion in pediatric patients undergoing general anest... Related Articles Continuous alfentanil infusion in pediatric patients undergoing general anesthesia for complete oral restoration. J Clin Anesth. 1991 Mar-Apr;3(2):125-30 Authors: Davis PJ, Chopyk JB, Nazif M, Cook DR STUDY OBJECTIVE: To study the safety and efficacy of continuous alfentanil infusions in children. DESIGN: Randomized open study. SETTING: Outpatient pediatric anesthesia at a university medical center. PATIENTS: Forty pediatric patients aged 2 to 12 years about to undergo anesthesia for complete oral restoration. INTERVENTIONS: Twenty patients were anesthetized with halothane and nitrous oxide (N2O), and 20 patients were anesthetized with N2O and a 100 micrograms/kg bolus of alfentanil followed by a continuous alfentanil infusion. MEASUREMENTS AND MAIN RESULTS: Hemodynamic measurements, emergence times, and postoperative side effects were measured. Hemodynamic stability was maintained in both groups. Although children emerged faster and were extubated earlier when anesthetized with alfentanil, they required longer times until they could be discharged from the outpatient anesthesia area. Children anesthetized with alfentanil had a higher occurrence of postoperative emesis compared with children anesthetized with halothane. These differences, however, were not statistically significant. CONCLUSIONS: Alfentanil appears to be a safe anesthetic. The reason for prolonged discharge time in the alfentanil-anesthetized patient is unclear, but it may be related to postoperative vomiting. PMID: 2039639 [PubMed - indexed for MEDLINE] A review of the opioid analgesics fentanyl, alfentanil, and sufentanil. Related Articles A review of the opioid analgesics fentanyl, alfentanil, and sufentanil. Compendium. 1991 Mar;12(3):184-7 Authors: Wedell D, Hersh EV Ultra-short-acting, potent, injectable narcotic agents are important drugs in general anesthetic regimens. These drugs are gaining popularity as both general anesthetic and intravenous sedation agents in oral and maxillofacial surgery. This paper will review the properties of fentanyl, alfentanil, and sufentanil. PMID: 1677612 [PubMed - indexed for MEDLINE] [A rare cause of difficult intratracheal intubation: Langenbeck's disease] Related Articles [A rare cause of difficult intratracheal intubation: Langenbeck's disease] Ann Fr Anesth Reanim. 1991;10(3):297-300 Authors: Carpentier JP, Sadania JB, Carjuzaa A A case of difficult tracheal intubation due to insufficient mouth opening once anaesthesia had been induced is described. At the pre-anaesthetic visit, the 47-year-old female patient had painless restricted mouth opening (two fingers' breadth), dental malpositions, and slight lateral mandibular deviation. Cervical spine movements were normal. She was ranked 3 on the Mallampati scale. The anaesthetic technique preserved spontaneous breathing (induction with propofol 1.5 mg.kg-1 and alfentanil 15 micrograms.kg-1). Manual ventilation was impossible. An oral cannula could not be inserted. As intubation by the normal route was impossible, the retromolar approach had to be used. Several attempts were required for successful intubation by this route. At the end of surgery, the patient was extubated without any difficulties. Postoperative investigations revealed hypertrophic coronoid processes. In this condition, the mandible is jammed by hitting the maxilla, especially when mandibular lifting manoeuvres are used to facilitate manual ventilation and tracheal intubation. Clinical and paraclinical predictors of difficult tracheal intubation seem to be unreliable in such dynamic abnormalities of mouth opening. PMID: 1854057 [PubMed - indexed for MEDLINE] Steady-state infusions of opioids in human. II. Concentration-effect relation... Related Articles Steady-state infusions of opioids in human. II. Concentration-effect relationships and therapeutic margins. Pain. 1990 Oct;43(1):69-79 Authors: Hill HF, Chapman CR, Saeger LS, Bjurstrom R, Walter MH, Schoene RB, Kippes M We used computer-controlled individually tailored infusions to study relationships between plasma drug concentration and opioid effects, and to evaluate the therapeutic margins of alfentanil, fentanyl and morphine in human subjects. In order to compare the 3 drugs, we infused each opioid to 3 different steady-state target plasma concentrations during separate 8 h test periods so that concentration-effect curves could be defined for each opioid and subject. Dental electrical stimulation produced a consistent degree of baseline experimental pain, and we measured the influence of increasing plasma opioid concentrations on pain intensity and the magnitude of pain-related evoked potentials. We also quantified ventilatory function and subjective side-effects during baseline (no drug), at the 3 target plasma concentrations with each drug. Finally, we measured actual plasma opioid concentrations during each phase of the infusion period. This procedure allowed us to calculate for each opioid the plasma concentration required to produce a 50% decrease in reported pain intensity and evoked potential amplitude (IC50). Subsequent calculation of side-effect magnitudes at the analgesic IC50s permitted direct comparisons of therapeutic margins between alfentanil, fentanyl and morphine. We found a robust relationship between plasma drug concentration and analgesic, ventilatory, and subjective-effect magnitudes for each opioid in this study. We conclude that the magnitudes of individual side-effects associated with equianalgesic, steady-state plasma concentrations of these 3 mu receptor-selective opioids do not differ across drugs. PMID: 2177537 [PubMed - indexed for MEDLINE] Profiles of opioid analgesia in humans after intravenous bolus administration... Related Articles Profiles of opioid analgesia in humans after intravenous bolus administration: alfentanil, fentanyl and morphine compared on experimental pain. Pain. 1990 Oct;43(1):47-55 Authors: Chapman CR, Hill HF, Saeger L, Gavrin J This report examines the relationship of plasma drug concentration to analgesic effect following bolus doses of alfentanil, fentanyl and morphine and assesses individual differences in analgesic response among volunteers. We predicted that the 3 opioids would yield disparate analgesic profiles because their physicochemical and pharmacokinetic characteristics differ. Ten healthy volunteers received intravenous bolus doses of either alfentanil, fentanyl, morphine or normal saline on different days. We stimulated their teeth electrically and measured brain evoked potential (EP) and pain report (PR) repeatedly over 2 h to assess analgesic effect. Concurrently, we drew 18 blood samples to assess opioid plasma concentrations during the test period. The relationship between opioid plasma concentration and analgesic effect was well defined for alfentanil but ambiguous for morphine. Fentanyl exhibited a marked hysteresis. We observed noteworthy individual differences in analgesic response with all 3 drugs but these differences were greatest for morphine and least for alfentanil. Inter- and intrasubject variability in analgesic response across drugs is related to the physicochemical properties of the drugs tested. PMID: 1980537 [PubMed - indexed for MEDLINE] Comparison of three techniques on time to awakening, time to orientation and ... Related Articles Comparison of three techniques on time to awakening, time to orientation and incidence of nausea and vomiting using alfentanil in balanced anesthesia in an outpatient surgical setting. AANA J. 1990 Jun;58(3):241-7 Authors: Campbell LC, Weis FR Maximizing patient safety and comfort while minimizing adverse sequelae are continuing anesthetic challenges. The purpose of this study was to examine three anesthetic techniques utilizing alfentanil with regard to time to awakening, time to orientation and incidence of nausea and vomiting. Surgical procedures were limited to knee arthroscopy, laparoscopy and dental extractions. Unpremedicated ASA I/II outpatients (n = 74) between the ages of 18 and 59 were randomly assigned to one of three groups: Group I: alfentanil + 67% N2O + 33% O2 Group II: alfentanil + 67% N2O + 33% O2 + droperidol 0.015 mg/kg Group III: alfentanil + 100% O2 + 0.7% isoflurane Anesthesia was induced with alfentanil 40 micrograms/kg, atracurium 0.4 mg/kg, thiamylal 4 mg/kg and 100% O2 and was maintained according to group assignment. The anesthetic was supplemented as clinically indicated with incremental boluses of alfentanil 10 micrograms/kg. Upon completion of surgery, muscle relaxation was reversed with edrophonium 0.75 mg/kg and atropine 0.015 mg/kg. Analyses indicated that the three groups were comparable in terms of potentially confounding variables including gender, race, surgical procedure, age, percent of ideal body weight, case length and dose of alfentanil in micrograms/kg/hr. Time to awakening was significantly shorter in the two N2O groups by approximately 1.5 minutes, as compared to the O2 and isoflurane group (p = .0060). Time to orientation was significantly shorter in the N2O groups by approximately 1.5 minutes also, as compared to the O2 and isoflurane group (p = .0142). The two N2O groups did not differ significantly in either measure. The incidence of vomiting in the postanesthesia recovery room (PARR) indicated a significant difference (p = .0317) among groups with vomiting occurring 45.8% of the time in Group I, 28.8% of the time in Group II and 8% of the time in Group III. Total emetic score (nausea and vomiting) in the PARR indicated a significant difference (p = .03) among groups with symptoms occurring 50% of the time in Group I, 28% of the time in Group II, and 16% of the time in Group III. PMID: 2378239 [PubMed - indexed for MEDLINE] Alfentanil for general anesthesia in oral and maxillofacial surgery. Related Articles Alfentanil for general anesthesia in oral and maxillofacial surgery. J Oral Maxillofac Surg. 1989 Oct;47(10):1039-42 Authors: Edgin WA, Ford ML, Mansfield MJ This study evaluated alfentanil (Alfenta, Janssen Pharmaceutica, Piscataway, NJ) as an analgesic supplement to oxygen/nitrous oxide anesthesia for outpatient oral and maxillofacial surgical procedures. Fifty American Society of Anesthesiology (ASA) class I and II patients were induced and maintained with an established regimen. Parameters measured included anesthetic properties, orientation time, recovery time, and presence of side effects. The results indicated that alfentanil provides acceptable anesthesia with minimal recovery time, but occasional side effects such as nausea and vomiting occurred postoperatively. This drug, when properly used, is a welcome addition to other established general anesthetic agents in oral and maxillofacial surgery. PMID: 2795297 [PubMed - indexed for MEDLINE] Continuous infusion of methohexital and alfentanil hydrochloride for general ... Related Articles Continuous infusion of methohexital and alfentanil hydrochloride for general anesthesia in outpatient third molar surgery. J Oral Maxillofac Surg. 1989 Mar;47(3):233-7 Authors: Dachowski MT, Kalayjian R, Angelillo JC, Dolan EA Three anesthetic techniques were compared in this study: 1) Intermittent Brevital boluses supplemented with fentanyl and midazolam all titrated to patient movement, 2) constant infusion of Brevital supplemented with fentanyl and midazolam all delivered in calculated mg/kg doses based on total body weight, and 3) constant infusion of methohexital (Brevital) and alfentanil (Alfenta) supplemented by midazolam (Versed), droperidol, and glycopyrolate (Robinul) delivered in calculated mg/kg doses based on lean body mass. Nitrous oxide was delivered in all cases via nasal mask in a 30% to 50% concentration. The mean total dose of Brevital in group 1 (intermittent Brevital bolus) was 0.17 mg/kg/min (SD = 0.07), group 2 (Brevital infusion) was 0.23 mg/kg/min (SD = 0.06), and group 3 (alfentanil/Brevital infusion) was 0.12 mg/kg/min (SD = 0.07). Mean total dose of alfentanil in group 3 equaled 1.58 mcg/kg/min (SD = 0.73). In group 1, 94% of the patients experienced moderate to severe movement intraoperatively. Twenty-three percent of the patients in group 2, and only 7% of group 3 exhibited moderate to severe movement. Emergence in group 3 averaged 4.5 minutes (SD = 1.6). Three patients (7%) in group 3 had postoperative nausea. Additional subjective findings in group 3 included easier airway maintenance during administration of the anesthetic, lack of unpleasant emergence phenomena such as crying, and prompt readiness for discharge. It was concluded that continuous alfentanil and Brevital infusion satisfied the objectives of safety, stability, predictability, and rapid recovery, while improving operating conditions (less patient movement) when compared with more traditional anesthetic techniques. PMID: 2493519 [PubMed - indexed for MEDLINE] Multicentre study of propofol in day case surgery. Related Articles Multicentre study of propofol in day case surgery. Anaesthesia. 1988 Mar;43 Suppl:70-3 Authors: Sanderson JH, Blades JF An open multicentre study that involved 879 patients was set up after the launch of propofol to examine its use outside of the clinical trial programme and within the context of a routine clinical setting. Propofol was assessed as the main anaesthetic agent for a range of day case surgery that included gynaecological, urogenital, body surface, orthopaedic and dental procedures. For the purposes of the study, supplementary agents were restricted to fentanyl, alfentanil or nitrous oxide; no volatile anaesthetics were allowed. Induction of anaesthesia was smooth; 91.6% of patients experienced no excitatory or other adverse effect. The mean duration of anaesthesia was 12 minutes 12 seconds and the mean dosage of propofol was 10.6 mg/kg/hour. Maintenance was uneventful in the large majority of patients. Pain on injection affected approximately 25% of patients and the incidence was reduced when large veins were used for injection. Recovery was rapid with a short interval of approximately 1 minute between awakening and orientation (time to giving correct date of birth). There was a low incidence of postoperative nausea and vomiting. PMID: 3259103 [PubMed - indexed for MEDLINE] Dose effects of alfentanil in human analgesia. Related Articles Dose effects of alfentanil in human analgesia. Clin Pharmacol Ther. 1986 Aug;40(2):178-86 Authors: Hill H, Walter MH, Saeger L, Sargur M, Sizemore W, Chapman CR Alfentanil, a rapidly acting opioid, was given in subanesthetic doses to 10 subjects in a laboratory setting. Analgesia was assessed from the subjects' responses to painful dental stimulation. A subjective pain report (PR) and brain evoked potential (EP) amplitude were obtained repeatedly before and after injection on each of 4 testing days, on which the following intravenous doses were administered: 0 (saline solution), 5, 10, and 15 micrograms/kg. Significant dose effects were observed for EP amplitude during but not beyond the distributional t1/2 of the drug, but significant effects on the PR extended beyond this time point. Mean volume of distribution, total body clearance, and distribution t1/2 did not differ significantly across the doses of alfentanil. Strong correlations between each effect measure and plasma drug concentration were observed at all doses and were significant at P less than 0.01. The EP scores tracked the distribution of alfentanil very closely, but the correlation between EP amplitude and plasma alfentanil concentration was lower during the elimination phase. In contrast, the PR effects closely tracked the elimination of alfentanil but not its distribution. These findings suggest that EP amplitude and the PR represent two different central effects in opioid analgesia. PMID: 3089670 [PubMed - indexed for MEDLINE] Alfentanil and isoflurane anaesthesia for day stay dental surgery. Related Articles Alfentanil and isoflurane anaesthesia for day stay dental surgery. Anaesthesia. 1985 Jul;40(7):702-3 Authors: Bali IM, Kendrick RW PMID: 4025782 [PubMed - indexed for MEDLINE] Controlled ventilation in dental outpatients. Controlled ventilation with atr... Related Articles Controlled ventilation in dental outpatients. Controlled ventilation with atracurium and alfentanil analgesia compared with halothane. Anaesthesia. 1985 Jan;40(1):3-7 Authors: Sale JP, Poobalasingam N, Dalal SD This study compares anaesthesia with controlled ventilation of the lungs with atracurium and alfentanil analgesia with halothane anaesthesia. Recovery time, the incidence of dysrhythmias and postoperative morbidity were evaluated. Anaesthesia with controlled ventilation was found to reduce significantly the incidence of cardiac dysrhythmias during dental surgery, and to produce a significantly more rapid recovery than halothane anaesthesia. The incidence of subjective postoperative complications is similar. It is concluded that controlled ventilation with atracurium and alfentanil is a suitable outpatient dental technique. PMID: 3918477 [PubMed - indexed for MEDLINE] A rabbit tooth-pulp assay to determine ED50 values and duration of action of ... Related Articles A rabbit tooth-pulp assay to determine ED50 values and duration of action of analgesics. J Pharmacol Methods. 1984 Apr;11(2):109-17 Authors: Wynn RL, El'Baghdady YM, Ford RD, Thut PD, Rudo FG The rabbit tooth-pulp assay is well established as a standard and reliable method to test for analgesic activity of drugs. Traditional methods to compare potencies of narcotic analgesics have been to establish ED50 values from rodent hot-plate and tail-flick tests. We describe a modification of the tooth-pulp assay with the use of a microcomputer to generate ED50 values based on "all or none" quantal responses and to evaluate durations of action, with the use of relatively few animals to test several drugs. The potencies of morphine, fentanyl, and alfentanil were established and compared to those from the mouse hot-plate assay. The rank order of potencies were the same and the absolute values were consistently lower. The ED50 value of pentazocine was determined with the tooth-pulp assay but could not be determined with the standard mouse hot-plate assay. The assay provides an additional, reliable, and sensitive method to generate ED50 values and to evaluate durations of action of narcotic analgesics. PMID: 6143857 [PubMed - indexed for MEDLINE]

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