Local Anesthesia Affects Physiological Parameters and Reduces Anesthesiologist Intervention in Children Undergoing General Anesthesia for Dental Rehab

Resident: Adam J. Bottrill
Date: 26JAN11
Region: Providence
Article title: Local Anesthesia Affects Physiological Parameters and Reduces Anesthesiologist Intervention in Children Undergoing General Anesthesia for Dental Rehabilitation
Author(s): Watts, Amy K. DDS, MS
Journal: Pediatric Dentistry
Page #s: 414-419
Vol:No Date: 31:5, SEP/OCT 2009
Major topic: Local Anesthesia, General Anesthesia, Children
Minor topic(s): NA
Type of Article: Randomized, parallel-design study
Main Purpose: The purpose of this article was to evaluate the use of intraoperative local anesthetics in pediatric outpatient dental surgery. It assessed physiological stability, as defined by fluctuations in end-tidal CO2, HR, RR and subsequent anesthesiologist intervention.

Key points in the article discussion:

I. General:
A. Pain is both a real emotional and physiological respoonse
B. Research suggests that the use of regional anesthesia can reduce the amount of required inhaled general anesthesia.
C. LA, in conjunction with GA can produce a more hemodynamically stable patient AND control pain in the immediate post-operative period.
D. IDEAL ANESTHETIC AGENT: immobility, amnesia, , sedation, analgesia/nociception, arousal blockade with a pharmacological profile that possesses a wide margin of safety.
E. Currently, no guidelines by either the ASA or the ADA for use of local anesthesia during GA dental rehab. AAPD states that LA "may be used" to reduce pain in post-op period.


II. Methods:
A. Pilot study was conducted for feasability purposes
B. 48 children (mean age of 3.87) undergoing GA
C. Inclusion Criteria
1. 12-84 mo
2. at least one maxillary extraction.
3. rubber dam clamp in maxilla
4. at least one primary tooth needing pulp/crown
5. ASA I or ASA II
D. One dental anesthesiologist used for all GA's
E. Two groups: LA and NON-LA
F. LA administered prior to procedures (for LA group)
G. 2% xylocaine was given in the LA group
H. No patient exceeded 4.4mL of LA
I. Vital sign changes recorded 30 seconds after each procedure.
J. Anesthesiologist intervention was with 10 mg boluses of propofol
K. Intervention if: movement, breath holding, 20% increase in vital signs, ETCO2 <40mm Hg
B. Two groups: LA and NON-LA
C. LA administered prior to procedures (for LA group)
D. Vital sign changes recorded 30 seconds after each procedure.

III. Results/Discussion: (pooled data)
A. NON-LA group: changes in vital signs were statistically significant for two parameters.
1. Post extraction ETCO2
2. Post extraction HR
B. Interference: Different patients have different tolerability for changes in vital signs from baseline.
C. Weaknesses:
1. The exact amount of anesthesia received by each tooth was not able to be controlled.
2. Order of procedures was decided by the dentist.

IV. Conclusions:
A. Patients who were not given intraoperative local anesthesia were more likely to experience vital sign fluctuation requiring anesthesiologist intervention.

Assessment of article: I thought it was an efffective, thorough study. I wish there was more statistical significance to some of the other parameters and procedures. The conclusions seemed to only follow what is already known anecdotally. Despite this fact, it is nice to have an actual article backing up existing practice.

: Juvenile Xanthogranuloma of the Oral Cavity in Children: A Clinico-pathologic study.

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 7/17/2009
Article title: Juvenile Xanthogranuloma of the Oral Cavity in Children: A Clinico-pathologic study.
Author(s): Flaitz C., Allen C., Neville B., et al
Journal: Oral Surg Oral Med Oral pathol Oral Radiol Endod
Volume (number): 345-52
Date: Sept 2002
Major topic: Clinical and Histochemical evaluation of JXG
Type of Article: Case Reports
Main Purpose: This article reviews 5 cases of oral JXG in children
Review of Cases: JXG is a benign reactive self-healing disorder of children which is classified as a normolipenic, non Langerhans cell disease caused by the proliferation of phagocytoid monocytes. It most commonly affects infants less than 1 year of age with a male predilection. The cutaneous type is most commonly associated with the head and neck region of the skin and occurs as single or multiple lesions in a cluster. The lesion is papulonodular with a color varying from yellow to red to red brown to normal skin color. The lesions are usually asymptomatic and the lesions undergo spontaneous regression after several months leaving a permanent scar.
Systemic JXG can affect several different organ systems, and skin lesions are associated with it in 40-50% of cases. Treatment includes surgical excision. If left untreated, this disorder may be life threatening
Five cases of Oral JXG were studied ranging in age from 5 months to 10 years with a mean age of 6.3 years. Most lesions were solitary affecting the gingival, dorsum of tongue, and buccal mucosa and none were associated with cutaneous lesions. Histopathological examination indicated an increase in histiocytes and dendritic cells in the lesions. Extensive histological evaluation was discussed in the article.
Differential diagnosis with Langherhan cell disease (LCD0 is necessary. Other diseases linked to JXG are neurofibromatosis type I, juvenile chronic myeloid leukemia, ALL, LCD, Diabetes Mellitus, etc.
Key points/Summary : Oral JXG tends to occur in an older age group than the other types of JXG. Cellular analysis of a biopsy is necessary to differentiate it from LCD
Assessment of article: Good article. Too much information about the ultrastuctural and immunocytochemical studies of the lesions.