Cardiac arrhythmias during outpatient dental anaesthesia: comparison of halothane with enflurane

Minimal morbidity in outpatients undergoing oral surgical procedures under general anaesthesia in the dental surgery

Economic pressures have resulted in an increased demand for surgical treatment under general anaesthesia on an outpatient basis. Previous studies have reported a high incidence of severe morbidity associated with general anaesthesia in both general dentistry and oral surgery. This is particularly marked with dento-alveolar procedures. The ready availability of relatively inexpensive monitoring equipment together with upgraded standards recently announced by various authorities necessitates that all practitioners review their current practices in the areas of sedation and general anaesthesia. In addition to the ultimate importance of patient care and safety, the increased incidence of litigation leaves no latitude for complacency. This paper details a relatively simple, cost-effective general anaesthetic technique suitable for outpatient oral surgical procedures in the dental surgery in which all relevant recommendations at the time of writing were observed or exceeded. Associated morbidity was considerably less than previously reported, with a high degree of patient satisfaction.

Bradycardia during elevation of a zygomatic arch fracture

A case of bradycardia occurring during elevation of a zygomatic arch fracture is reported and possible mechanisms for the phenomenon are discussed. This case report serves to alert oral and maxillofacial surgeons and anesthesiologists to a possible hazard during surgical elevation of a fractured zygomatic arch.

A comparison of the incidence and nature of cardiac dysrhythmias occurring during enflurane and isoflurane anaesthesia for dental surgery

The incidence and nature of dysrhythmias with equipotent concentrations of enflurane and isoflurane during dental surgery were compared. Seventy-six Chinese patients between 17-30 years, of ASA Grade I, randomly received either enflurane or isoflurane with N2O and O2 for spontaneous ventilation during third molar extractions. The cardiac rhythm and the blood pressure were continuously monitored during the procedure. The incidence of dysrhythmias with both enflurane and isoflurane was low and the difference not statistically significant. During surgery one patient exhibited unifocal ventricular ectopics with isoflurane. Sinus tachycardia was common with both agents. No life-threatening dysrhythmias were seen with either agent and no clinically significant lowering of blood pressure occurred in association with the exhibited dysrhythmias. In this Chinese population, as in other studies, the incidence of dysrhythmias with both agents was low thus showing no difference between the races.

Prevention of complications associated with intravenous sedation and general anesthesia

An analysis of three time phases--induction, maintenance, and recovery from anesthesia--is presented to clarify specific risk situations and the treatment necessary to decrease morbidity and mortality in the dental office.

[Comparative effect of halothane and isoflurane on peroperative cardiac arrhythmias]

Cardiac arrhythmias were studied in twenty ASA class 1 patients under general anesthesia using halothane or isoflurane to supplement nitrous oxide in oxygen. The study began during the maintenance period, once the expiratory MAC value had reached a stable level of 1, and stopped one hour later. Both intubation and recovery periods were excluded. The end-tidal gas concentration was measured for carbon monoxide and vapours. The ECG was recorded on a magnetic tape. The incidence of arrhythmias was higher in the halothane group when compared to the isoflurane group (p less than 0.05). The main types of arrhythmias observed were supraventricular and ventricular ectopic beats. None of the arrhythmias observed were serious; in particular the ventricular beats were all unifocal and occasional. Heart rate measured at 10 min intervals tended to be more rapid in the isoflurane group.