ABSTRACT
The purpose of this article was to determine if pediatric dental treatment under general anesthesia utilizing orotracheal intubation takes longer than using nasotracheal intubation techniques. Twenty-six American Society of Anesthesiologists Physical Status Classification I and II pediatric dental patients, ages 2-8 years treated under general anesthesia, were assigned to 1 of 2 groups: (a) nasotracheal intubation (control, n = 13), (b) orotracheal intubation (experimental, n = 13). Times for intubation, radiographic imaging, and dental procedures, as well as total case time were quantified. Data were collected on airway difficulty, numbers of providers needed for intubation, intubation attempts, and intubation trauma. There was a significant difference in mean intubation time (oral = 2.1 minutes versus nasal = 6.3 minutes; p < .01). There was no difference in mean radiograph time (oral = 4.2 minutes versus nasal = 3.4 minutes; p = .144), and overall radiograph image quality was not affected. There was no difference in dental procedure time ( p = .603) or total case time ( p = .695). Additional providers were needed for intubation and more attempts were required for nasotracheal intubation versus orotracheal intubation (6 additional providers/22 attempts vs 0 additional providers/15 attempts, p < .01 and p < .05, respectively). Nine of 13 nasotracheal intubations were rated as traumatic (69%) versus 0 of 13 for orotracheal intubations (0%) ( p < .01). In 7/9 orotracheal intubation cases (78%), the tube was not moved during treatment ( p < .01). Orotracheal intubation does not increase case time, does not interfere with radiographic imaging, and is less traumatic for the patient when performed by physician anesthesiologists, emergency and pediatric medicine physician residents, certified registered nurse anesthetists, and student nurse anesthetists, all with variable nasotracheal intubation experience.
Subject(s)
Anesthesia, Dental/methods , Anesthesia, General/methods , Anesthesiologists , Internship and Residency , Intubation, Intratracheal/methods , Nurse Anesthetists , Oral Surgical Procedures , Students, Nursing , Anesthesia, Dental/adverse effects , Anesthesia, General/adverse effects , Child , Child, Preschool , Clinical Competence , Female , Humans , Intubation, Intratracheal/adverse effects , Male , Operative Time , Oral Surgical Procedures/adverse effects , Pilot Projects , Time FactorsABSTRACT
Several attempts have been made to mask the bitter taste of oral formulations, but none have been made for injectable formulations. This study aims to mask the bitter taste of dental lidocaine HCl (LID) injection using hydroxypropyl-ß-cyclodextrin (HP-ß-CD) and sodium saccharin. Inclusion complexes of LID and HP-ß-CD were prepared by the solution method in 1:1 and 1:2 M ratios. Inclusion complexes in solution were studied using phase solubility in phosphate buffer solutions (pH 8, 9, and 10). Freeze-dried inclusion complexes were characterized using differential scanning calorimetry (DSC), X-ray, Fourier transform infrared (FT-IR), nuclear magnetic resonance (NMR), scanning electron microscopy (SEM), and in vitro release. Injectable formulations were prepared using inclusion complexes and characterized for stability and for taste using an Alpha MOS ASTREE electronic tongue (ETongue). The association constants of HP-ß-CD with lidocaine-free base and its ionized form were found to be 26.23 ± 0.00025 and 0.8694 ± 0.00045 M(-1), respectively. Characterization studies confirmed the formation of stable inclusion complexes of LID and HP-ß-CD. Injectable formulations were found to be stable for up to 6 months at 4°C, 25°C, and 40°C. The taste evaluation study indicated that HP-ß-CD (1:1 and 1:2 M ratios) significantly improved the bitter taste of LID injectable formulation. In conclusion, inclusion complex in the 1:1 M ratio with 0.09% sodium saccharin was considered to be optimum in masking the bitter taste of LID.
Subject(s)
Lidocaine/chemistry , 2-Hydroxypropyl-beta-cyclodextrin , Anesthesia, Dental/methods , Chemistry, Pharmaceutical/methods , Drug Compounding/methods , Injections/methods , Saccharin/chemistry , Solubility , Taste , beta-Cyclodextrins/chemistryABSTRACT
BACKGROUND: The pulpectomy is an underutilized treatment modality for severely infected primary teeth. CASE DESCRIPTION: The author presents two pulpectomy cases that were filled with Vitapex. CLINICAL IMPLICATIONS: Vitapex is an excellent filling material for primary tooth pulpectomies. Its clinical characteristics and ease of use may make the pulpectomy procedure a more-attractive alternative to extraction.
