Biomedical subjects
Publications and source records attributed to L D Trapp.
This article focuses on the elderly patient and developmentally disabled children and adults. Although many individuals in these groups can receive dental care with only the use of local anesthetic, this article focuses on those that require sedation or general anesthesia. Areas in which the management of these patients significantly differs from routine anesthesia are emphasized.
A plan for postoperative pain management in the compromised dental patient may be difficult to select. The optimal postoperative pain management strategy for the healthy patient is reviewed and important pharmacology discussed. Modifications to the optimal strategy for healthy patients are then elucidated for those patients who are compromised medically, physically or emotionally.
Explore the source record for details and available documents.
Children are not small adults. Many anatomic, physiologic, pathophysiologic, pharmacologic, and psychological differences exist that require alterations in routine adult anesthetic procedures. An appreciation of these differences and their implications for general anesthesia allow the anesthetist to prevent most morbidity and mortality during pedodontic anesthesia, reduce dental and anesthesia-related fears and phobias, and assuage parental anxiety.
Ketamine has been evaluated for convulsant properties in animals and humans with contradictory results. The present investigation evaluated the convulsant properties of ketamine in a previously unreported animal model. Two-day-old chicks were selected as test animals because they have incomplete blood-brain barriers and thus greater penetrance of xenobiotics affecting the central nervous system. Control and experimental animals were given a central nervous system stimulant, pentylenetetrazol (Medtrazol) at a dosage level (100 mg/kg) causing convulsions in 90% of animals. The effect of ketamine pretreatment was then observed for the: (1) number of animals convulsing; (2) time of onset of convulsions; and (3) mortality. Ketamine (100 mg/kg) significantly decreased the number of animals that convulsed and decreased mortality; 10 mg/kg of ketamine significantly prolonged the time of onset of convulsions. This study does not support the conclusion that ketamine is a convulsant. Ketamine has significant anticonvulsant properties in the young chick model.
Oral submucosal blood flow was measured at dental injection sites in anesthetized dogs and compared with subcutaneous blood flow. Blood flow was calculated from the measured half-time for clearance of radioactive xenon dissolved in saline. By this method, oral submucosal blood flow was much greater than subcutaneous blood flow and was comparable in magnitude to values reported for cerebral blood flow. Injection of a solution containing 1:100,000 epinephrine at the mandibular canal produce a delayed clearance of isotope which was three times as long as the clearance time for solutions without epinephrine.
Dental plaque was collected, dried, and weighed on a gold insert that fit into the buccal aspect of a posterior crown. The plaque weight was determined by calculating the difference between the postcollection insert weight and the precollection insert weight. This system for measurement of the dry weight of in vivo accumulated dental plaque was found to be a practical means of plaque quantification.
Explore the source record for details and available documents.
Four sets of 25 patients were given either 0, 0.25, 0.50, or 1.00 mg droperidol intravenously during deep intravenous sedation for dental surgery in a nonrandomly assigned, single-blind, prospective clinical trial. The control group experienced a 48% incidence of nausea or vomiting, while each of the experimental groups experienced a significantly lower incidence of nausea or vomiting (P = 0.0026). All nausea or vomiting occurred after the patients were discharged and appeared to be motion-related.
An anesthesia induction technique not widely utilized is described for a pediatric patient presenting with severe hemifacial hypertrophy, severe mental retardation, as well as a seizure disorder and other congenital anomalies. The anatomically and/or pathologically altered airway as well as other anomalies increase the risks of anesthesia.
Explore the source record for details and available documents.