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Remimazolam, a novel, ultra-short-acting intravenous anesthetics, belongs to the benzodiazepine class of drugs and was approved for as a general anesthetic. Its pharmacological action is similar to that of midazolam. However, the differences in the metabolic pathway and pharmacokinetic profiles of its metabolites contribute to the faster offset of the action of remimazolam than midazolam. The context-sensitive half time (CSHT) is as short as 6.8 ± 2.4 min. An advantage of remimazolam over other intravenous anesthetics, such as propofol, is the presence of antagonists. Remimazolam-induced sedation is reversed by flumazenil, a benzodiazepine antagonist. Moreover, lower prevalence of injection site pain and less reduction in blood pressure in the are the advantages of remimazolam over propofol. Although our knowledge is limited at present, remimazolam may be useful for general anesthesia. We look forward to the future possibilities of this new anesthetic agent. [ABSTRACT FROM AUTHOR]

Erector spinae plane block (ESPB) was first reported as a technique, blocking the posterior ramus of the spinal nerves to obtain analgesia in the back. After the original report, many reports have suggested that ESPB could obtain a broader analgesic effect than initially thought and be effective in thoracic or abdominal surgery. By the ESPB, the local anesthetic spreads laterally and blocks the lateral cutaneous branch of the intercostal nerve. Another possibility is the local anesthetic infiltrates ventrally and migrates to the paravertebral space or epidural space. However, the results of the cadaver examination, whether the local anesthetics can reach the paravertebral space were inconsistent. Recently, the clinical effectiveness of ESPB has been reported in thoracic surgery and abdominal surgery. However, the clinical effect of ESPB might be only due to an increase in the blood concentration of local anesthetics. The ideal target might be a deeper site than that currently used in ESPB to reach the paravertebral space. Further studies will investigate more effective and reliable sites for pain relief by injecting local anesthetics around the erector spinae muscle. [ABSTRACT FROM AUTHOR]

COVID-19 has engulfed the continents into a pandemic, filling the hospitals with this viral disease, heavily taxing the healthcare facilities and claiming thousands of lives in almost every country. In the absence of a known evidence-based remedy, many treatment options have been tried with variable results. Multiple vaccines have been developed by the drug industry, but none can be claimed to be 100% effective in prevention of the disease. There has been some evidence about the beneficial effects of ivermectin - an anthelmintic drug. This editorial discusses the various aspects of the use of ivermectin for the treatment of active COVID-19. [ABSTRACT FROM AUTHOR]

The left subclavian vein appeared normal; therefore, we successfully inserted the catheter via the left subclavian vein on the other day. Figure 1: X-ray fluoroscopy view during the procedure Figure 2: Contrast-enhanced computed tomography to diagnose the subclavian vein anatomy. © 2021 Saudi Journal of Anesthesia | Published by Wolters Kluwer - Medknow Access this article online Website: www.saudija.org Quick Response Code DOI: 10.4103/sja.sja 11 21 Difficult central venous catheter insertion via the right subclavian vein Sir, Ultrasound-guided central venous catheter insertion has improved the success rates and safety associated with the procedure. [Extracted from the article]

Postoperative cognitive dysfunction (POCD) remains a serious complication with increasing importance. Cerebral dysfunction after surgery presents as stroke, delirium, or POCD. POCD is the post-operative disturbance of memory, and speed of information processing. The incidence of POCD is dependent on the type of procedure. The highest incidence of POCD occurs in patients undergoing cardiac surgery. CABG performed without CPB could reduce the incidence of postoperative neurological disturbance. However, there were no distinct differences in the incidence of POCD between off-pump and on-pump CABG. Many risk factors including aging and poor cognitive status about POCD have been reported. The recent reports suggest that low cerebral oxygenation, as evaluated by near-infrared spectroscopy, during the surgery is a good predictor of POCD. The careful monitoring of the central nervous system during cardiac surgery might predict POCD, and help in avoiding its occurrence. [ABSTRACT FROM AUTHOR]

Transversus abdominis plane (TAP) block is now a commonly used regional anesthesia technique. It can provide unilateral analgesia to the skin and muscles of lower abdominal wall. Original TAP block was introduced as regional abdominal field infiltration technique using landmarks. Use of ultrasound for TAP blocks enabled to perform safe and reliable block procedure. The indication for this block has been extended especially for lower abdominal surgeries. There are two concepts for TAP blocks. By subcostal to lateral TAP blocks, spread of local anesthetic is on the transvers abdominis plane. By, posterior TAP blocks including quadratus lumborum block, the target of local anesthetic is paravertebral space. The efficiency of these two techniques should be evaluated by prospective studies. [ABSTRACT FROM AUTHOR]

Regional anesthesia has an important role in the anesthetic management of thoracic surgeries. Regional anesthesia provides better pain control than systemic opioid analgesia, controls stress response, and prevents respiratory complications. These factors should improve patient outcomes. The first choice of regional anesthesia for thoracic surgery is epidural analgesia or thoracic paravertebral block (TPVB). In general, analgesic efficiency of epidural analgesia and TPVB is equivalent. However, TPVB has some advantage over epidural analgesia including fewer complications. When these two blocks are contraindicated, application of intercostal nerve block or inter-pleural block can be considered. [ABSTRACT FROM AUTHOR]

Corona virus disease has engulfed the globe for well over one year now. Multiple strategies to control the pandemic have been in practice in different countries, ranging from strict curfew like lock down to selective lock down (also called smart lock down) to no lock down at all. Proponents of no lock down favored the hypothesis of 'herd immunity'. In Japan and some other developed countries, the main emphasis has been on identification of positive case through mass testing. Although, if it made any difference in the morbidity or mortality, is anyone's guess. However, the use of mask by all and identification and separation of the infective (not all infected) persons has led Japan to control the spread better than many other countries. The author emphasizes that we shall need to continue our all-out efforts to defeat the virus for many more months if not years. [ABSTRACT FROM AUTHOR]

Objectives The purpose of the present study was to elucidate the significance of cone bean computed tomography (CBCT) for patients hoping to undergo implant-supported restorations of the maxilla. Therefore, two studies were planned. One was to compare the prevalence of anatomic variations and lesions in the maxillary sinus on CBCT of patients hoping to undergo implant-supported restorations of the maxilla with that in patients with other chief complaints in a private dental office in Japan. The other study was to elucidate the limitations of panoramic radiographs in the detection of anatomic variations and lesions in the maxillary sinus. Study design Sixty-one pairs of panoramic radiographs and CBCT were retrospectively analyzed in two groups of patients, those who hoped to undergo implant-supported restorations in the maxilla (Implant group) and those who did not (Non-implant group). The presence of anatomic variations and lesions in the maxillary sinus were analyzed. Results The detection rate of mucosal thickening was significantly higher in the Implant group than in the Non-implant group. The detection rates for the features analyzed were significantly lower on panoramic radiographs. In particular, the detection rates of internal and anterior locations of some features were noticeably lower on panoramic radiographs. A significant relationship was found between the change in the detection rate on panoramic radiographs and the widths of mucosal thickening or the lengths of the major axis of SOLs in the maxillary sinus. If the width of mucosal thickening or the length of the major axis of SOLs was <3 mm or <4 mm, respectively, the detection rate on panoramic radiographs was significantly decreased. Conclusion CBCT is important for patients hoping to undergo implant-supported restorations of the maxilla because of the mucosal thickening in the maxillary sinus in such patients and their lower detection rates on panoramic radiographs. [ABSTRACT FROM AUTHOR]

Mineral trioxide aggregate (MTA) is amaterial that has been used worldwide in several clinical applications, such as apical barriers in teeth with immature apices, repair of root perforations, root-end filling, pulp capping, and pulpotomy. The purpose of this case report was to describe successful revascularization treatment of an immature mandibular right second premolar with apical periodontitis in a 9-year-old female patient. After preparing an access cavity without anesthesia, the tooth was isolated using a rubber dam and accessed. The canal was gently debrided using 5% sodium hypochlorite (NaOCl) and 3% hydrogen peroxide irrigant. And then MTA was packed into the canal. X-ray photographic examination showed the dentin bridge 5 months after the revascularization procedure. Thickening of the canal wall and complete apical closure were confirmed 10 months after the treatment. In this case, MTA showed clinical and radiographic success at revascularization treatment in immature permanent tooth. The successful outcome of this case suggests that MTA is reliable and effective for endodontic treatment in the pediatric dentistry. [ABSTRACT FROM AUTHOR]