An Investigation of the Long and Short Term Behavioral Effects of General Anesthesia on Pediatric Dental Patients With Autism.

Purpose: The purpose of this study was to compare the incidence of short and long term adverse behavioral effects of general anesthesia (GA) in healthy vs. moderate to severe autistic (ASD) children. Methods: Forty healthy and 37 ASD children, aged 3-17 years, undergoing GA for dental surgery participated in this study. Their anesthesia records were reviewed, and their parents answered telephone surveys to assess activity level, sleep disturbances, gastrointestinal disturbances, central nervous system effects, and respiratory depression. Three follow-up surveys were taken 8 h, 24 h, and 3 months post-surgery. Results: Four hundred fifty-five incidences of adverse behavioral effects occurred within 8 h post-surgery. Significantly more ASD patients had difficulty walking (P = 0.016) and nausea (P = 0.030), while more healthy children snored in the car ride home (P = 0.036) and talked about the dental surgery (P = 0.027). Three months post-discharge, sixASD patients acted in a way that concerned caregivers compared to 0 healthy patients, (P = 0.008). Incidence of adverse behavioral effects significantly decreased from 8 to 24 h overall. Conclusions: Most behavioral effects occur within 8 h post-surgery. There are potential long term adverse behavioral effects in ASD children from GA, but the chance is low and generally not long lasting.

A comparison of sedation-related events for two multiagent oral sedation regimens in pediatric dental patients.

PURPOSE: This study compared the incidence of adverse sedation-related events occurring with two different multiagent oral sedation regimens in pediatric dental patients. METHODS: Forty healthy patients (three to six years old), received either a sedation regimen of chloral hydrate, meperidine, and hydroxyzine with nitrous oxide (CH/M/H/N2O; N=19) or a regimen of midazolam, meperidine, and hydroxyzine with nitrous oxide (MZ/M/H/N2O; N=21). The two treating dentists answered a questionnaire regarding the perioperative period. Parents received two phone interviews at eight and 24 hours after sedation. Statistical analysis included chi-square, Pearson correlation coefficient, and t-test (P<.05). RESULTS: Children sedated with MZ/M/H/N2O showed a significant increase in hyperactivity during dental treatment, slurring/difficulty speaking, and difficulty walking postoperatively within eight hours after discharge. Children sedated with CH/M/H/N2O showed a significant increase in frequency of sleeping, talking less than normal after arriving home, and an increased need for postoperative pain medication. CONCLUSIONS: Different oral sedation regimens produce different adverse sedation-related events. The provider of pediatric oral sedation should select a sedative regimen with an adverse sedation-related profile that he/she believes is optimal for the patient being treated. Parents should be counseled as to possible postsedation effects anticipated based on the sedative regimen administered.

Methemoglobin levels in generally anesthetized pediatric dental patients receiving prilocaine versus lidocaine.

The purpose of this study was to measure and compare peak methemoglobin levels and times to peak methemoglobin levels following the use of prilocaine and lidocaine in precooperative children undergoing comprehensive dental rehabilitation under general anesthesia. Ninety children, 3-6 years of age, undergoing dental rehabilitation under general anesthesia were enrolled and randomly assigned into 3 equal groups: group 1, 4% prilocaine plain, 5 mg/kg; group 2, 2% lidocaine with 1:100,000 epinephrine, 2.5 mg/kg; and group 3, no local anesthetic. Subjects in groups 1 and 2 were administered local anesthetic prior to restorative dental treatment. Methemoglobin levels (SpMET) were measured and recorded throughout the procedure using a Masimo Radical-7 Pulse Co-Oximeter (Masimo Corporation, Irvine, Calif, RDS-1 with SET software with methemoglobin interface). Data were analyzed using chi-square, one-way analysis of variance (ANOVA), and Pearson correlation (significance of P < .05). Group 1 had a significantly higher mean peak SpMET level at 3.55% than groups 2 and 3 at 1.63 and 1.60%, respectively. The mean time to peak SpMET was significantly shorter for group 3 at 29.50 minutes than that of group 1 at 62.73 and group 2 at 57.50 minutes. Prilocaine, at 5 mg/kg in pediatric dental patients, resulted in significantly higher peak SpMET levels than lidocaine and no local anesthetic. In comparison to no local anesthetic, the administration of prilocaine and lidocaine caused peak SpMET levels to occur significantly later in the procedure.

Acquired methemoglobinemia revisited.

Dentistry has two medications in its pain management armamentarium that may cause the potentially life-threatening disorder methemoglobinemia. The first medications are the topical local anesthetics benzocaine and prilocaine. The second medication is the injectable local anesthetic prilocaine. Acquired methemoglobinemia remains a source of morbidity and mortality in dental and medical patients despite the fact that it is better understood now than it was even a decade ago. It is in the interest of all dental patients that their treating dentists review this disorder. The safety of dental patients mandates professional awareness.

Mechanisms of acute pain: an update.

Dentists are faced with human suffering generated by dental diseases and treatments on a daily basis. This exposure to suffering has resulted in the dental practitioner's constant pursuit of more efficacious ways to decrease their patient's acute pain experience. Expertise in the administration of local anesthetics and the use of nitrous oxide/oxygen inhalation sedation were born from this pursuit. Advances in the management of acute pain will follow an improved understanding of the physiology of acute pain, the physiology of the immune system and their interaction. Indeed, their interaction has become a productive area of investigation. This article reports on promising new developments in acute pain research. Our current understanding offers a few new recommendations and a vision of a less painful experience associated with dental diseases and their treatments.

The use of general anesthesia to facilitate dental treatment.

General anesthesia can help the dental professional provide treatment to individuals who otherwise would be unable to receive dental care. State-mandated training, current anesthesia techniques, and adequate planning by the dentist make general anesthesia safe and effective in the private dental office. This article discusses the multiple benefits general anesthesia offers both the dentist and the patient. Suggestions are presented to facilitate the accessibility and utilization of general anesthesia for routine office dental care.