Introduction of a new patient monitoring system during dental procedures: pulse oximetry.

This paper describes three cases of early detection of hypoxia with pulse oximeter during intravenous sedation. In the main study group over 40 patients were monitored by pulse oximetry during large dental operation under i.v.-sedation. Diazepam with soybean oily solvent and midazolam were used as intravenous sedative agents in this study. The first signs of hypoxia were seen by pulse oximetry. In three healthy patients some periods of remarkable hypoxia was detected and those cases are reported in this paper. Two of the patients were treated by a surgical operation and one patient underwent large conservative dental treatment under sedation because of dental care phobia. During the dental treatment period external oxygen was added for all these three patients to avoid more complications as a result of hypoxia. Two of the patients received an injection of benzodiazepine antagonist, too. One patient needed further follow up but non of these patients developed any additional complications. As a conclusion pulse oximetric monitoring was found to be extremely sensitive as a predictor for coming complications as well as allowing early intervention in ventilation problems.

Lidocaine and prilocaine with vasoconstrictors as cause for cardiovascular reactions. A pulse oximetric study. Preliminary report.

MATERIALS AND METHODS: Cardiovascular effects of two local anesthetic agent solutions containing 2% lidocaine with 1:80,000 epinephrine (LE) and 3% prilocaine with 0.54 microgram/ml felypressine (PF) used separately and in combination were observed. We made 38 separate monitoring sessions (30 minutes each) with healthy voluntary dental students. Participants were monitored with Cardiocap multiparameter physiological monitor. The monitored values were heart rate, systolic and diastolic blood pressure, SaO2 and peripheral blood flow. Values were registered into computer memory for further analysis. Group 1 received 7.2 ml of PF to the buccal sulcus just distal of the second upper right molar and 7.2 ml of LE to the left buccal sulcus ten minutes later. Group 2 had the same injection positions but they received 3.6 ml of PF to both sides of maxilla and then, ten minutes later, 3.6 ml of LE to each side. RESULTS: There were no radical changes in systolic or diastolic blood pressure. The blood oxygen saturation values were constant and the displayed SaO2 values were between 96-98% during the measurement period. Mean heart rate decreased about 10 beats/min after PF injection and increased about 10 beats/min after injection of LE in both groups. The peripheral blood flow (pbf) was the most sensitive parameter in our measurements. In general, pbf diminished in the period preceding the injection. It showed lowest values during the injection phases in both groups. CONCLUSIONS: Despite large doses of local anesthetics SaO2, systolic and diastolic blood pressure showed no clinically important changes, which suggests that local anesthetics have only a minimal effect on parameters mentioned above. This means that if the effect of one local anesthesia preparate (PF) is not sufficient, it is possible to safely reinforce the anesthesia with another substance (LE) in young healthy patients. Additionally, heart rate and pbf demonstrated quite clearly the symphatetic stimulation effect of the stress of injection and the stimulating action of epinephrine was seen clearly in heart rate values in both groups.

Introduction of a new patient monitoring system during dental procedures: pulse oximetry.

This paper describes three cases of early detection of hypoxia with pulse oximeter during intravenous sedation. In the main study group over 40 patients were monitored by pulse oximetry during large dental operation under iv-sedation. Diatsepam with soybean oily solvent and midatsolam were used as intravenous sedative agents in this study. The first signs of hypoxia were seen by pulse oximetry. In three healthy patients some periods of remarkable hypoxia was detected and those cases are reported in this paper. Two of the patients were treated by a surgical operation and one patient underwent large conservative dental treatment under sedation because of dental care fobia. During the dental treatment period external oxygen was added for all these three patients to avoid more complications as a result of hypoxia. Two of the patients received an injection of bentsodiatsepine antagonist, too. One patient needed further follow up but non of these patients developed any additional complications. As a conclusion pulse oximetric monitoring was found to be extremely sensitive as a predictor for coming complications as well as allowing early intervention in ventilation problems.

Expression of intermediate filaments in human tongue mucosa.

The specific inflammatory lesions of the human tongue, namely fissured tongue and geographic tongue, have been found to differ clinically and histologically from each other and from healthy appearing tongue (control). In this study we describe expression of cytokeratin, vimentin and desmin intermediate filaments in these tongue forms. The most important findings were seen in fissured tongue; strong positive staining of cytokeratin proteins indicate the incomplete keratinization of the epithelium, vimentin staining was irregular indicating subepithelial edema and desmin expression showed the destruction of the uppermost muscle cells. The corresponding changes of geographic tongue were similar but slight when compared with those of fissured tongue. Different immunohistochemical methods can supplement the information obtained from tongue biopsies by conventional methods and lead to a better understanding of the morphology of the tongue mucosa.