Accelerated Idioventricular Rhythm Following Intraoral Local Anesthetic Injection During General Anesthesia

Some anesthetic agents or adjunct medications administered during general anesthesia can cause an accelerated idioventricular rhythm (AIVR), which is associated with higher vagal tone and lower sympathetic activity. We encountered AIVR induced by vagal response to injection-related pain following local anesthetic infiltration into the oral mucosa during general anesthesia. A 48-year-old woman underwent extraction of a residual tooth root from the left maxillary sinus under general anesthesia. Routine preoperative electrocardiogram (ECG) was otherwise normal. Eight milliliters of 1% lidocaine (80 mg) with 1:100,000 epinephrine (80 μg) was infiltrated around the left maxillary molars over 20 seconds using a 23-gauge needle and firm pressure. Widened QRS complexes consistent with AIVR were observed for ∼60 seconds, followed by an atrioventricular junctional rhythm and the return of normal sinus rhythm. A cardiology consultation and 12-lead ECG in the operating room produced no additional concerns, so the operation continued with no complications. AIVR was presumably caused by activation of the trigeminocardiac reflex triggered by intense pain following rapid local anesthetic infiltration with a large gauge needle and firm pressure. Administration of local anesthetic should be performed cautiously when using a large gauge needle and avoid excessive pressure.

International transfer of knowledge: Training and education in craniomaxillofacial surgery. Contributing to humanitarian aid by teaching the teachers

The development of multiple international aid programs aims to offer health care according to basic quality standards to the global population. In many fields of Oral and Maxillofacial Surgery such as the treatment of head and neck tumours, complex or acquired malformations and craniomaxillofacial trauma, aid programs contribute to solve urgent needs although in the long term only the establishment at local or subregional levels of stable specialized healthcare networks including training of specialized health personnel will be able to contribute to achieving an adequate standard of care. In this paper we review our experience regarding the different efforts made to enhance education and training in the specialty at the European level by the EACMFS and at the global level by the IAOMS.

Reducing transmission of COVID-19 using a continuous negative pressure operative field barrier during oral maxillofacial surgery

Oral and maxillofacial surgery in patients with suspected or confirmed COVID-19, presents a high risk of exposure and cross contamination to the operative room personnel. We designed, simulated and implemented a continue negative pressure operative field barrier to provide an additional layer of protection, using standard equipment readily available in most operative rooms during oral and maxillofacial procedures.

Osseointegrated membranes based on electro-spun TiO2/hydroxyapatite/polyurethane for oral maxillofacial surgery

Membranes which have an osseointegration abilty are often selected as biomaterials in oral and maxillofacial surgery. Although these membranes are often the best option for certain uses, it is a challenge to create functionally attractive membranes. In this research, electro-spun titanium oxide (TiO2)/hydroxyapatite (HA)/polyurethane (PU) membranes were fabricated with different ratios of HA and TiO2: 100: 0, 70:30, 50:50, 30:70 and 0:100 w/w. The morphologies of the different mixtures were assessed with a Scanning Electron Microscope (SEM) and Field Emission Microscope (FESEM). Element analysis was performed with EDX. The physical properties of the water contact angles and mechanical strength were tested and the membranes cultured with osteoblasts to evaluate their biological functions, cell adhesion, viability, proliferation, alkaline phosphatase (ALP) activity, and calcium content. The results showed that the membranes with TiO₂ and HA had smaller fibers than those without TiO₂ and HA. The TiO2- and HA-including compounds showed the formation of particle aggregation on the surface of the fibers. They also had higher water contact angles, mechanical strength, and stiffness than those without TiO₂ and HA, and they had better cell adhesion, viability, proliferation, ALP activity and calcium content. The membrane with a 50:50 TiO₂:HA ratio had more unique biological functions than the others. Finally, our research demonstrated that osseointegrated membranes with 50:50 TiO2:HA are promising for oral and maxillofacial surgery.