Intracranial Air Embolism after Inferior Alveolar Nerve Block: A Case Report

Incidental findings of soft tissue gas in canine and feline thoracic computed tomographic examinations

Computed tomography (CT) is a commonly used modality in small animal veterinary medicine. Anecdotally, gas bubbles are frequently identified in small animals undergoing thoracic CT examination. The aim of this retrospective observational study was to record the occurrence and prevalence of vascular and extravascular gas in routine thoracic CT examinations in dogs and cats. Patients with any clinical signs of diseases   related to soft tissue gas were excluded. A total of 84 canine studies and 90 feline studies were included, detecting gas in 66.7% of all studies, with gas more likely to be detected in canine studies (75.0%) than in feline cases (58.9%) (P = 0.009). Canine studies were more likely to have gas detected in postcontrast studies than in precontrast studies (P = 0.016). Intravascular gas was detected in 65.5% of all included studies (75% canine and 56.7% feline). Extravascular gas was detected in 13.8% of all studies (14.3% canine, 13.3% feline), with gas detected in the vertebral canal of 8.62% of all studies (canine 11.9%, feline 5.56%) and within fascial planes in 5.75% of all studies (canine 2.38%, feline 8.89%). In conclusion, gas bubbles were identified in the majority of canine and feline thoracic CT studies without clinical evidence of a pathologic etiology.

Hyaluronidase following buccal infiltrations of articaine with epinephrine for anesthesia of mandibular first molars: A split-mouth, double-blind, placebo-controlled randomized clinical trial

BACKGROUND

Adjunctive hyaluronidase has been widely used for ophthalmic anesthesia; however, in Dentistry, very few studies are available so far. Thus, the present study aimed to evaluate anesthetic outcomes of adjunctive hyaluronidase administration following buccal infiltration of articaine with epinephrine for anesthesia of mandibular first molars.

MATERIAL AND METHODS

Twenty-eight patients received a buccal supraperiosteal infiltration of 4% articaine with 1:100,000 epinephrine for anesthesia of the mandibular first molars, in a split-mouth approach. Afterward, randomly and using the same technique, they received either 1.0 mL of hyaluronidase (150 UTR/mL) or a placebo solution. Considering patients' pain perceptions provoked by electric and mechanical stimulations, as well as using a pain scale, success rate, action onset time, duration of both pulpal and soft tissue anesthesia, and pain immediately after both punctures and on the 2nd day were assessed.

RESULTS

The pulpal anesthetic success rate was 85.7% for hyaluronidase and placebo groups. Soft tissue anesthesia showed a shorter action onset time and a longer duration when hyaluronidase was used; however, there was no difference between the groups regarding action onset time and duration of pulpal anesthesia. Pain at the puncture sites did not differ between the groups, regardless of the time point evaluated.

CONCLUSIONS

Adjunctive hyaluronidase following buccal infiltration of articaine with epinephrine for mandibular first molars seems not to provide any advantage in anesthetic outcomes in which the nerve fibers are intraosseous (i.e., pulpal anesthesia). On the other hand, soft tissue anesthesia may be improved substantially by using this pharmacological strategy. Key words:Hyaluronidase, local anesthesia, dentistry.