In: Anesthesia7 Dec 2009
This study was approved by the institutional review board of Columbus Children’s Hospital. Eligible subjects were selected from children scheduled for operative dentistry under general anesthesia at the Children’s Hospital Outpatient Surgery Center. These children had exhibited disruptive behaviors during routine dental appointments, thus requiring general anesthesia for comprehensive dental care. Eligible patients were those children who were healthy (ASA I), weighed over 12 kg, and were 2-7 years old. The sample studied consisted of 11 children with a mean age of 56.3 months and a range of 25-85 months. The mean weight was 18.5 kg with a range of 12.6-26.3 kg. All subjects were healthy, not taking any medications, and had no history of drug-related allergies. After the study was explained to the parents, written consent was obtained.
After mask induction, an intravenous line was placed for delivery of drugs associated solely with the general anesthetic. After nasotracheal intubation, an additional venous access was obtained using a catheter placed in the back of the hand, in the forearm, or in the antecubital fossa. This second line was used solely as a blood sampling port. Dental treatment was then provided as necessary.
A lidocaine patch was placed according to the manufacturer’s instructions. The mucosa overlying the maxillary incisors was first dried with a gauze, and then the patch was held firmly on the tissue for 30 seconds. The patch was then allowed to remain adhered to the area for a period of 5 minutes (as shown in Figure 1). No supplemental lidocaine or other local anesthetics were given at any point during the study period. After the patch was removed, the underlying tissue was examined for signs of irritation.
Figure 1. DentiPatch application on maxillary buccal mucosa.
For baseline measures, 2.0 mL of venous blood was drawn immediately before placing the patch. After the lidocaine patch was removed, blood samples (2.0 mL) were drawn at 1-, 5-, 10-, 15-, and 45-minute intervals. canadian cialis
During the blood draw, 1 mL was discarded before each 2-mL sample was taken. Lactated Ringer’s and 5% Dextrose solution was used to flush the cannula after each sample was taken and to maintain the patency of the catheter. Each sample was placed in a lithium heparin vacutainer tube in an ice bath. Lidocaine and its metabolite, MEGX, were quantified by fluorescence polarization immunoassay using the Abbott TDX/FLX (Abbott Diagnostics, Chicago, 111).
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