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Biomedical subjects

J A Yagiela

Publications and source records attributed to J A Yagiela.

At least 19 recordsLinked to original sources
PubMed2000

Anesthesia and pain management.

Acute orofacial pain is usually managed by the administration of local anesthetics, systemic analgesics, or a combination of the two methods. In an emergency, intraoral maxillary nerve blockade is helpful for controlling pain in the midface, although infiltrations may be more suitable for discomfort originating from individual teeth or portions of the alveolar process. Mandibular anesthesia can be achieved by open or closed-mouth techniques for inferioral alveolar-lingual nerve blockade. Systemic pain relief is optimized by using full analgesic doses of NSAIDs, with opioids serving to increase the degree of analgesia if required, or to be used, often with acetaminophen, in patients intolerant to NSAIDs.

Analgesics↗
PubMed1999

Adverse drug interactions in dental practice. Professional and educational implications.

BACKGROUND: Rapid progress in dental pharmacotherapeutics requires that clinicians constantly update their knowledge of new drugs, drug interactions and useful therapeutic trends. This article is the first in a five-part series based on a 1998 International Association for Dental Research symposium entitled "Adverse Drug Interactions in Dentistry: Separating the Myths From the Facts." The goal of the series is to identify specific adverse drug interactions that are relevant to the therapeutic agents commonly used in general dental practice: analgesics, antibiotics, sedatives, local anesthetics and vasoconstrictors. METHODS: A group of dentist/clinical pharmacologists, with documented expertise in specific areas of dental therapeutics, reviewed the current literature regarding adverse drug interactions in dentistry. This expert panel evaluated the quality of information used to document these drug interactions and assess the severity of these drug reactions with respect to the drugs' use in dental practice. RESULTS: On the basis of the quality and severity of each reported interaction, the authors summarized the clinical importance of these drug interactions using a Significance Rating for Dental Drug Interactions. The participants presented their recommendations at the above-mentioned IADR symposium. CONCLUSIONS: Although thousands of drug interactions are described in the literature, the authors found many to be poorly documented or of minor importance to dental practitioners. For interactions that they determined to be relevant, the participants provided recommendations and precautions for preventing these potential complications. This article discusses the professional impact of drug interactions on dental practice; the classification and documentation of drug interactions; the determination of causality between drug interactions and adverse effects; risk factors; and unique characteristics of dental therapeutics. Subsequent articles will present specific summary recommendations for drug interactions associated with the use of antibiotics, analgesics, sedatives, and local anesthetics and vasoconstrictors. CLINICAL IMPLICATIONS: Although thousands of drug interactions have been reported in the literature, only a few are significantly associated with dental therapeutic agents. Avoiding these drug interactions will prevent potentially severe reactions in dental practice.

Adverse Drug Reaction Reporting Systems↗
PubMed1999

Adverse drug interactions in dental practice: interactions associated with vasoconstrictors. Part V of a series.

BACKGROUND: Adrenergic vasoconstrictors are commonly used by dentists to enhance the pain-relieving action of local anesthetics and to control local bleeding. Although normally considered safe for these applications, vasoconstrictors can participate in drug interactions that potentially are harmful to patients. METHODS: The faculty of a March 1998 symposium entitled "Adverse Drug Interactions in Dentistry: Separating the Myths From the Facts" extensively reviewed the literature on drug interactions. They then established a significance rating of alleged adverse drug interactions pertaining to dentistry, based on the quality of documentation and severity of effect. The author of this article focused on the adrenergic vasoconstrictors epinephrine and levonordefrin. RESULTS: Vasoconstrictor drug interactions involving tricyclic antidepressants, nonselective beta-adrenergic blocking drugs, certain general anesthetics and cocaine are well-documented in both humans and animals as having the potential for causing serious morbidity or death. Evidence for adverse interactions involving adrenergic neuronal blocking drugs, drugs with alpha-adrenergic blocking activity, local anesthetics and thyroid hormones is much less compelling, suggesting for the most part that clinically significant reactions may occur only when both the vasoconstrictor and the interacting drug are used in excessive doses. In the case of monoamine oxidase inhibitors, there is no credible evidence of a significant interaction with epinephrine or levonordefrin. CONCLUSIONS: Potentially serious adverse drug interactions involving adrenergic vasoconstrictors can occur in dental practice. In most circumstances, careful administration of small doses of vasoconstrictors and avoidance of gingival retraction cord containing epinephrine, coupled with monitoring of vita signs, will permit these drugs to be used with no risk or only minimally increased risk. Only in the case of cocaine intoxication must adrenergic vasoconstrictors be avoided completely. CLINICAL IMPLICATIONS: For optimal patient safety, dentists must recognize potential drug interactions involving adrenergic vasoconstrictors and modify their use of these agents accordingly.

Adrenergic Agents↗
PubMed1999

Office-based anesthesia in dentistry. Past, present, and future trends.

The history of office-based anesthesia dates back to the discovery of nitrous oxide and ether in the 1840s. In recent years, advances in intravenous anesthetic techniques and the rising costs of hospital-based services have combined to promote the practice of ambulatory anesthesia. Dental patients who may benefit from office-based anesthesia include patients undergoing stressful procedures, fearful patients, medically or behaviorally challenged patients, young children, and patients with a history of gagging or local anesthesia problems. The future of office-based anesthesia in dentistry appears bright. Its development, however, will be influenced by organized dentistry, medical anesthesia, and other groups interested in pain and anxiety control, and state legislatures reacting to public demands for both safe and cost-effective anesthesia care.

Ambulatory Surgical Procedures↗
PubMed1995

Prophylactic antibiotics: cardiac and prosthetic considerations.

The administration of antibiotics in dentistry to prevent systemic disease should be based on a rational consideration of both the anticipated benefits of such practice and the potential risks. In the case of patients susceptible to infective endocarditis, the routine use of prophylactic antibiotics is justified for high-risk patients and for procedures likely to cause significant bacteremia; in the case of patients with prosthetic joints, it is not.

Amoxicillin↗
PubMed1989

Effect of midazolam pretreatment on the intravenous toxicity of lidocaine with and without epinephrine in rats.

The effect of the benzodiazepine midazolam on the intravenous toxicity of lidocaine with and without epinephrine was studied in male Sprague-Dawley rats. Test rats with and control rats without midazolam premedication (2.5 mg/kg intraperitoneally, 10% of the median dose that caused loss of the righting reflex in a third group of rats) were given 2% lidocaine with and without 10 micrograms/ml epinephrine intravenously in doses sufficient to construct log-dose response curves for both convulsant and lethal responses. In control rats the median convulsant dose (CD50) of lidocaine was 15.2 mg/kg given alone and 10.9 mg/kg with epinephrine (a statistically significant difference); respective values for the median lethal dose (LD50) were 26.4 and 18.5 mg/kg (also statistically significant). While epinephrine enhanced lidocaine seizure activity and lethality by approximately 50%, midazolam almost completely prevented lidocaine-induced convulsions but had no significant effect on mortality.

Animals↗
PubMed1988

The use of amide local anesthetics in patients susceptible to malignant hyperthermia.

The use of amide local anesthetics in dental patients presumed to be susceptible to malignant hyperthermia (MH) is controversial. A literature review of 17 recent dental publications and their reference citations revealed that the recommendation to avoid local anesthetics of the amide type in dental treatment of MH-susceptible (MHS) patients is based on in vitro muscle investigations, unpublished communications, and a single case report suggestive of MH. Therefore, a survey of members of the Malignant Hyperthermia Association of the United States designed to determine what, if any, MH-like reactions have occurred in patients with MHS receiving dental treatment was conducted. Of a total of 307 MHS respondents, 36 (12%) reported adverse reactions to dental care. Only one respondent, however, reported symptoms suspicious of MH (fever, muscle pain) in which the administration of amide local anesthetics appeared to be closely linked. Fifty-six (18%) of the respondents have had difficulty obtaining routine dental care since being identified as MHS; this includes 27 who have been refused dental treatment or have had to undergo operative procedures without the benefit of local anesthesia. These results support the conclusions that amide local anesthetics may be administered to MHS patients without significant risk and that currently the diagnosis of MH susceptibility can adversely affect the quality of dental care.

Adolescent↗
PubMed1988

Hypertensive response to levonordefrin in a patient receiving propranolol: report of case.

Propranolol is a commonly used drug; of new and refilled prescriptions, it ranked no. 1 in 1984 and no. 2 in 1985. Medical conditions for its use include angina pectoris, myocardial infarction, hypertension, cardiac dysrhythmias, hypertrophic subaortic stenosis, migraine headache, hyperthyroidism, and pheochromocytoma. Almost all dental practitioners will treat a patient receiving propranolol for one of these conditions. The following recommendations seem appropriate at this time: The patient should continue to receive propranolol during dental treatment. Sudden withdrawal of the beta-blocker will cost the patient the benefit of propranolol therapy and may lead to acute myocardial ischemia. Acute stress should be minimized, as hypertensive responses may also be caused by endogenously released epinephrine. Short appointments scheduled in the morning, possibly with conscious sedation, should be considered. The dosage of adrenergic vasoconstrictors should be limited and gingival retraction cord containing epinephrine avoided entirely. The blood pressure should be taken approximately 5 minutes after local anesthesia is administered to determine if a systemic response has occurred. In the unlikely event of a hypertensive emergency, a rapidly acting, short-duration antihypertensive drug, such as the alpha-blocker phentolamine (Regitine, 5 mg intravenously) should be administered. Sublingual nitroglycerin (Nitrostat, 0.4 mg) may be useful as a nonparenteral alternative. These recommendations apply to other nonselective beta-blockers, including nadolol (Corgard) and timolol (Blocadren). They may also apply to labetalol (Normodyne, Trandate), a nonselective beta-antagonist with some alpha-blocking activity and to pindolol (Visken), a beta-blocker with some intrinsic beta 2-agonistic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

A custom restraining device for small animals.

A full-body restraining device was constructed that permits the short-term recording of physiologic data (respiration, electrocardiogram, arterial blood pressure, and electroencephalogram) in unanesthetized rats. A plaster cast of a freshly killed 160 g rat was made and cut to yield a base and two side pieces. Using the assembled cast as a custom tray, an alginate impression of the rat was taken. Replicas of the cast pieces were then made of plastic. Animals to be tested were anesthetized briefly, placed in the restraining device, and allowed to waken. Results with 400 animals demonstrate the feasibility of recording physiologic data during acute studies in conscious rats.

Animals↗
PubMed1985

Drug interactions and vasoconstrictors used in local anesthetic solutions.

This study examined widely advertised interactions between sympathomimetic amine vasoconstrictors currently used in dental local anesthetic solutions and MAO inhibitors (phenelzine, 5 mg/kg), phenothiazines (chlorpromazine, 2 mg/kg), and tricyclic antidepressants (desipramine, 2 mg/kg). Twelve greyhound dogs premedicated with morphine and anesthetized with urethane and alpha-chloralose were prepared for physiologic recordings. During a control period, the dogs received bolus injections of epinephrine, norepinephrine, and levonordefrin sufficient to construct log-linear dose-response curves for each agent. Commercial anesthetic solutions, with and without the vasoconstrictors, were also used. The dose-response curves were then reproduced 1 hour after the administration of a drug interactant. Cardiovascular responses were not influenced by the coadministration of local anesthetics or by the prior administration of phenelzine. Chlorpromazine ameliorated pressor responses to norepinephrine and levonordephrin and reversed the hypertensive effect of high-dose epinephrine. Desipramine significantly increased vasoconstrictor potencies, particularly those of levonordefrin and norepinephrine, which were multiplied more than sixfold.

Anesthetics, Local↗
PubMed1982

Mechanism of epinephrine enhancement of lidocaine-induced skeletal muscle necrosis.

Epinephrine significantly increases lidocaine-induced skeletal muscle necrosis, even in low concentrations that elicit no damage by themselves. Inasmuch as isoproterenol had no influence on lidocaine myotoxicity, a direct effect of epinephrine on muscle fibers is unlikely. Two vasoconstrictors with dissimilar mechanisms of action, phenylephrine and felypressin, duplicated the potentiating effect of epinephrine on fiber destruction in direct relation to their ability to retard lidocaine absorption from the tissue. It is concluded that the augmentation of muscle necrosis caused by epinephrine is largely due to its ability to increase exposure of skeletal muscle to the local anesthetic.

Animals↗
PubMed1981

Comparison of myotoxic effects of lidocaine with epinephrine in rats and humans.

Myotoxic effects of 2% lidocaine with 1:100,000 epinephrine were evaluated in rats and humans. Sprague-Dawley rats were give injections in the left gastrocnemius muscle of 0.5 ml of the lidocaine preparation or a control vehicle; they were killed in groups of four at 0, 8, 24, and 48 hours. Blood samples were taken for serum enzyme determinations, and muscle specimens were removed and processed for histologic evaluation. In eight patients undergoing radical neck dissection, 1.8 ml of lidocaine with epinephrine or its control was injected into the sternocleidomastoid muscle approximately 18 hours before surgery. Patients' muscle specimens obtained at surgery were handled similarly to those of the rat. Serum creatine kinase, aspartate aminotransferase, and alanine aminotransferase activities were markedly elevated in the rat at 8 hours in the experimental group, but not in the control group. Histologically, control injections elicited no damage in the rat other than a mild inflammatory reaction along the presumptive needle track. Lidocaine with epinephrine, however, destroyed most of the muscle in which it was injected. Myonecrosis was qualitatively similar in humans. The rat provides a good model for the study of local anesthetic-induced myonecrosis.

Alanine Transaminase↗