具体描述
James Ferraro, current President of the American Society of Maxillofacial Surgeons, presents this comprehensive volume on maxillofacial surgery, based on the Society's annual courses. This book will serve as an ideal introduction for residents into the field of maxillofacial surgery as well as serving as a "refresher course" for the more experienced.
The Atlas of Dental Anesthesiology: Precision Techniques in Oral and Maxillofacial Pain Management A Comprehensive Visual and Textual Guide to Modern Anesthetic Protocols for Dental and Oral Surgery This meticulously compiled volume serves as the definitive resource for practitioners navigating the complexities of pain control and anesthesia within the scope of modern dentistry and maxillofacial practice. Far transcending basic procedural instructions, The Atlas of Dental Anesthesiology offers an in-depth, evidence-based exploration of the physiological principles, pharmacological agents, advanced delivery systems, and risk management strategies essential for safe and effective patient care. It is designed not merely as a reference but as a practical, clinical companion, rich with high-resolution anatomical illustrations, detailed procedural radiographs, and algorithmic decision-making trees. I. Foundational Sciences and Pharmacological Deep Dive (Sections 1-3) Section 1: Neurophysiology of Pain and Local Anesthetic Mechanisms This section establishes the bedrock understanding necessary for rational anesthetic application. It provides a state-of-the-art review of nociception, pain transmission pathways from peripheral afferent neurons to the central nervous system, and the neurobiology of chronic orofacial pain. Crucially, the text dissects the molecular pharmacology of commonly used local anesthetics (LAs)—lidocaine, articaine, prilocaine, bupivacaine, and mepivacaine. Detailed comparative tables outline pKa values, lipid solubility, protein binding affinity, intrinsic activity, and metabolic pathways, correlating these physicochemical properties directly to clinical onset, duration of action, and potential systemic toxicity. Furthermore, the role and mechanism of action of various anesthetic adjuvants, including vasoconstrictors (epinephrine, levonordefrin, fentanyl) and buffering agents (sodium bicarbonate), are analyzed through the lens of contemporary pharmacokinetic modeling. Section 2: Pharmacokinetics and Dynamics of Sedation Agents Moving beyond local anesthesia, this segment provides exhaustive coverage of conscious sedation and deeper levels of monitored anesthesia care (MAC). It meticulously details the pharmacokinetics of intravenous agents such as midazolam, diazepam, propofol, and ketamine, emphasizing titration techniques tailored for the ambulatory patient undergoing oral surgical procedures. Non-pharmacological adjuncts, including cognitive behavioral techniques and controlled breathing exercises, are integrated as essential components of a multi-modal anxiolysis protocol. Special emphasis is placed on recognizing and managing the continuum of sedation depth, utilizing standardized monitoring tools, and establishing clear escalation protocols for unexpected patient responses. Section 3: Advanced Drug Delivery Systems and Regional Blocks This section focuses on innovative techniques that minimize systemic exposure while maximizing operative field anesthesia. It features detailed, step-by-step video stills and diagrams illustrating the precise anatomical landmarks for a comprehensive repertoire of regional nerve blocks—including the V3 mandibular block (Halstead approach, Gow-Gates, Akinosi-Vazirani closed-mouth), infraorbital block, posterior superior alveolar block, and palatal infiltrative blocks. The text critically evaluates the utility of advanced delivery devices, such as computer-controlled local anesthetic delivery (CCLAD) systems, assessing their impact on patient comfort, successful block achievement, and management of post-injection pain flares. The inclusion of ultrasound guidance in select, complex infraorbital or mandibular blocks is discussed, integrating imaging technology into standard dental anesthesia practice. II. Clinical Applications and Patient-Specific Management (Sections 4-6) Section 4: Anesthesia in Medically Compromised Patients This is perhaps the most critical section for safe practice, moving beyond the healthy ASA I patient. It systematically addresses the anesthetic management of patients with significant comorbidities, organized by organ system failure: cardiovascular disease (ischemic heart disease, arrhythmias, uncontrolled hypertension), respiratory compromise (COPD, asthma), endocrine disorders (Type 1 and 2 diabetes mellitus, adrenal insufficiency), hematologic disorders (anticoagulation therapy, sickle cell trait), and neurological conditions (epilepsy, history of stroke). For each condition, the text provides clear contraindications, necessary pre-operative laboratory assessments, recommended drug modifications (dosing adjustments for renal or hepatic impairment), and specific emergency management pathways tailored to the oral surgery environment. The application of minimum local anesthetic dose (MLAD) principles in high-risk patients is thoroughly explored. Section 5: Pediatric and Geriatric Anesthesia Considerations Managing anesthetic requirements across the lifespan presents unique challenges. The pediatric chapter details appropriate drug selection, volume considerations (based on weight and body surface area), behavioral management techniques (tell-show-do), and strategies for minimizing psychological trauma associated with needle administration in children. Conversely, the geriatric chapter focuses on age-related physiological changes—decreased renal clearance, altered volume of distribution, increased sensitivity to CNS depressants, and polypharmacy interaction profiles—and how these necessitate modified dosing strategies and extended recovery monitoring for elderly patients undergoing lengthy oral surgical procedures. Section 6: Managing Anesthetic Complications and Emergencies This section functions as an acute care protocol repository. It provides algorithmic guidance for the immediate recognition, differential diagnosis, and aggressive management of five core emergencies: (1) Local Anesthetic Systemic Toxicity (LAST), focusing on lipid emulsion administration protocols; (2) Airway compromise and laryngospasm; (3) Syncope and vasovagal reactions; (4) Anaphylaxis; and (5) Acute cardiovascular events (myocardial infarction, malignant hypertension). The required contents of an emergency drug kit and the necessary training prerequisites for all personnel administering sedation are detailed according to contemporary consensus guidelines. III. Specialized Techniques and Pain Control Modalities (Sections 7-8) Section 7: Anesthesia for Advanced Oral and Maxillofacial Procedures This chapter bridges the gap between routine operative dentistry and complex maxillofacial surgery. It covers the unique anesthetic demands associated with orthognathic surgery, facial trauma management (e.g., open reduction and internal fixation cases), complex implantology requiring extensive bone grafting, and major pathology resection. Focus is placed on prolonged operative times, the need for controlled hypotension, intra-operative fluid dynamics, and meticulous post-operative pain regimens utilizing multimodal analgesia (opioid-sparing protocols). The interaction between the operating surgeon and the dedicated anesthesia provider (if utilized) is examined within the context of the operating room environment. Section 8: Non-Invasive Pain Management and Alternative Modalities Recognizing the contemporary drive towards reduced reliance on systemic opioids, this concluding section reviews validated non-pharmacological and adjunct modalities for acute and chronic orofacial pain management. This includes a critical review of the efficacy of acupuncture, transcutaneous electrical nerve stimulation (TENS) application in the maxillofacial region, topical anesthetic preparations beyond standard formulations, and the role of preemptive analgesia using non-steroidal anti-inflammatory drugs (NSAIDs) and targeted nerve blocks prior to incision. The text ensures that practitioners can integrate these evidence-based alternatives seamlessly into their existing anesthesia plans. The Atlas of Dental Anesthesiology is distinguished by its integration of fundamental science with practical, operative theatre relevance. It prioritizes safety, precision, and a deep respect for the physiological variance inherent in the patient population, setting a new standard for anesthetic education in oral healthcare.
