An evaluation of cardiorespiratory effects of posture in the dental outpatient

Mortality and morbidity with outpatient anesthesia: the Massachusetts experience

PURPOSE

This study documented the incidence of mortality and morbidity for outpatient anesthesia delivered by oral and maxillofacial surgeons in Massachusetts.

MATERIALS AND METHODS

A questionnaire was mailed to the 151 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons, and all members responded. Information regarding the incidence of specific anesthetic morbidity was reported for 1 year (1994), and the incidence of mortality for 5 years (1990 to 1994) was requested.

RESULTS

Approximately 1,500,000 patients underwent office treatment in the 5-year period without an office anesthetic death. The most common complication was syncope occurring in 1 of every 142 patients receiving local anesthesia. In patients undergoing general anesthesia, laryngospasm occurred 10 times more frequently than bronchospasm. The incidence of other specific anesthetic complications are documented.

CONCLUSION

The results of this study suggest that the incidence of death associated with office anesthesia, although small initially, has decreased.

Morbidity and mortality with outpatient anesthesia: the Massachusetts experience

All 147 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons responded to an anesthesia survey. They had treated 416,561 patients during 1989. This article reports the results of the survey and specific untoward anesthetic events as recalled by these practitioners. Use of various anesthetic agents in 1989 and 1984 are compared.

The efficacy of the laryngeal reflex in conscious sedation

The Jorgensen technique and nitrous oxide-oxygen sedation were evaluated for the risk of aspiration. Volunteers and patients were studied in the supine, semisupine, and Trendelenburg positions. Aspiration occurred in a single patient under the Jorgensen technique and could be related to the presence of a narcotic in the mixture. The incidence of tracheal soiling was lower than that with other intravenous techniques and could be attributed to the use of the semisupine position or the baseline concept of narcotic dosage in the Jorgensen technique. In the nitrous oxide-oxygen sedation technique, aspiration was not noted. The study suggests that use of a narcotic in an intravenous sedative technique increases the hazard of aspiration.

Human cardiorespiratory and analgesic effects of intravenous diazepam and local anesthesia

The only clinically detectable cardiovascular changes after intravenous diazepam administration are a moderate fall in systolic blood pressure and a rise in pulse rate. But it will produce significant cardiovascular changes, principally the lowering of total peripheral resistance and stroke volume. The drug has a long history of safety but is not totally innocuous. It is suggested that if diazepam is used in combination with methohexital, consideration should be given to the additive effects on total peripheral resistance.