PubMed · 347981
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F M McCarthy. Monitoring in dentistry--an overview.. https://pubmed.ncbi.nlm.nih.gov/347981/
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This paper reviews three recent decisions of the Judicial Committee of the Privy Council on appeal from decisions of the Professional Conduct Committee of the General Dental Council, in which questions of general anaesthesia, sedation and resuscitation were raised. The recommendations of the Poswillo Report on general anaesthesia, sedation and resuscitation in dentistry of March 1990 are considered with respect to these three cases, and an assessment made as to whether or not the incidents which gave rise to them would have occurred had the recommendations been implemented. The implications of the Poswillo Report for the maintenance of professional standards of conduct by the General Dental Council in relation to the use of general anaesthesia, sedation and resuscitation are discussed.
We studied the discrepancy in the results published on the dependence of the duration of pulpal nerve anesthesia on the concentration of epinephrine in 2% lidocaine. The increase in pain threshold of the pulpal nerve was measured before and after injection of lidocaine alone and lidocaine with epinephrine concentrations of 1:200,000, 1:100,000, or 1:50,000 into the mucobuccal aspect adjacent to the apex of the maxillary right incisor. The study was done in a random manner with a double-blind crossover design. The pulpal nerve was stimulated with negative rectangular electrical pulses of up to -167 V with 100 Hz and a pulse width of 0.6 msec. The results show a relationship between the 1:200,000 and 1:100,000 epinephrine concentrations and the success and duration of anesthesia. The onset of anesthesia was independent of the catecholamine content of the solution.
This article reviews the main contraindications of vasoconstrictors in cardiac patients, notably unstable angina, recent myocardial infarction, recent coronary artery bypass surgery, refractory arrhythmias, untreated or uncontrolled hypertension, and untreated or uncontrolled congestive heart failure. Extensive survey of the literature has been completed, giving specific guidelines for a rational use of vasoconstrictors in this category of medically compromised patients.