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Case 3.7
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
She proceeds with a MACS lift under local anaesthetic. On post-operative review the next morning, you notice she has a facial weakness. What now?I will consider that the local anaesthesia might still have an effect. If it persists beyond the timeline for this, then I will have to assume this is a neurapraxia or a neurotmesis.I will be open and honest with the patient and inform her of both possibilities, however the likelihood is that this is a neuropraxia as the MACS lift involves a limited dissection that is not sub-SMAS.My options are to either re-explore or manage conservatively – which may be considered a controversial area. If the patient agrees, then I will re-explore for two reasons:if the nerve branch has indeed been cut, then this will give me the opportunity to repair it in the acute stage with a better outcome, andit also affords the opportunity to give a more certain prognosis if the nerve is visualized directly and found to be intact.
Paediatric Orthopaedic Surgery
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Jonathan Wright, Russell Hawkins, Aresh Hashemi-Nejad, Peter Calder
Both Hoke and DAMP procedures are used to treat combined gastrocnemius-soleus tightness. The advantages are improved healing and the option of local anaesthesia. However, these techniques are associated with an increased incidence of over-lengthening and inadvertent complete tenotomy.
Effects of Stress on Physiological Conditions in the Oral Cavity
Published in Eli Ilana, Oral Psychophysiology, 2020
A different approach has been adopted by Kaufman et al.115 The study surveyed 93 general dental practitioners, as to their experience with patients who failed to feel numb after being administered local anesthesia. The majority of dentists (90%) reported some anesthetic failure during restorative visits 5 years prior to the survey. Unlike the authors’ original hypothesis, no association was found between years of experience and percentage of failure reported. Furthermore, a similar percentage of at least one anesthetic failure was also found among dental students in a continuing study.118 The dentists indicated that a high percentage (47%) of patients who did not experience numbness were fearful or anxious.115
Chronotherapy in dentistry: A scoping review
Published in Chronobiology International, 2023
Mohammad Abusamak, Mohammad Al-Tamimi, Haider Al-Waeli, Kawkab Tahboub, Wenji Cai, Martin Morris, Faleh Tamimi, Belinda Nicolau
This review included two studies that investigating local anesthesia injected at different times of the day in humans. Lemmer and Wiemers (1989) used an electronic pulp tester to measure the stimulus threshold of anterior teeth. They quantified the total local anesthesia effect by time to reach peak effect, duration at peak effect and time to return to baseline threshold. On the other hand, Pöllmann (1982) measured numbness duration and pain onset after oral surgery. In addition to reporting circadian behavior of local anesthesia (Lemmer and Wiemers 1989; Pöllmann 1982), both studies showed that maximal drug effect was achieved when local anesthesia was injected at 14:00 h and 17:00 h (Lemmer and Wiemers 1989). Moreover, the longest duration of local anesthesia was achieved when injected at 15:00 h, while the shortest duration was at night and early morning (Pöllmann 1982).
A hypnotic turbo-induction technique for wisdom tooth extraction
Published in American Journal of Clinical Hypnosis, 2023
Albrecht Schmierer, Leonardo De Col, Thomas Stöcker, Thomas G. Wolf
Additionally, the patient from Gheorghiu and Orleanu (1982) described his state after the induction like he was separated from his body. He knew that the treatment was going to be painful, but he did not feel that he could or would have intervened; in a treatment without hypnosis, he feels that he would have resisted the intervention. So, with these rapid induction techniques the patients seem to be disconnected from their bodies and because of this they don’t really feel the pain, but most of the time they are totally aware of what is happening around them. Vaguely like the feeling experienced, when a treatment is performed with local anesthesia, where as well, the pain in the respective area is turned off, but everything else can be noticed, especially the pressure from the instruments used by the dentist. However, with local anesthesia just the feeling of pain is eliminated and not the whole body is disconnected.
The bleeding risk and safety of multiple treatments by bronchoscopy in patients with central airway stenosis
Published in Expert Review of Respiratory Medicine, 2023
Congcong Li, Yanyan Li, Faguang Jin, Liyan Bo
The bronchoscopy procedures were performed by interventional pulmonologists with flexible or rigid bronchoscopes or a combination of both methods, depending on the location and type of the airway stenosis. The rigid bronchoscope was used to place silicone stents, for debulking extensive tumor and granulation tissues, and for removing large foreign bodies that were essential. Otherwise, a flexible bronchoscope was used. The anesthesia methods included local anesthesia and general anesthesia. Local anesthesia was achieved with topical tetracaine and lidocaine. General anesthesia was achieved with intravenous propofol and remifentanil, and high frequency ventilation was used during the procedure. The operation techniques and devices that were used were chosen depending on the patients’ conditions and the interventional pulmonologists’ discretions. A combination of different techniques was used when needed.