This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rehman, K.-U. Articles by Tong, J. L. Search for Related Content PubMed PubMed Citation Articles by Rehman, K.-U. Articles by Tong, J. L.

---

LETTER TO THE EDITOR

Editor's note: Due to a publisher's error, the following response by Amar et al. to the Letter to the Editor by Lohser and Brodsky published in the July 2008 issue (Anesth Analg 2008;107:342) was left out of the July issue. The publisher apologizes for the error.

Air Penetration into the Tissues During Oral Surgery

Department of Oral and Maxillofacial Surgery; University Hospital Birmingham, UK (Rehman, Monaghan) Department of Military Anaesthesia and Critical Care; Royal Centre for Defence Medicine Birmingham, UK j.l.tong{at}bham.ac.uk (Tong)

To the Editor:

We would like to comment on the report by Magni et al.1 Surgical emphysema after a dental procedure was first reported in 19002 and, after the introduction of high speed air turbine drills, its incidence has increased. It has been recommended that air turbine drills exhausting air into the surgical field or those using pressurized air or water as a coolant should no longer be used in oral surgery.3 Drills with an electric motor driven handpiece or air turbine drills with a gravity fed water source, significantly reduce the risk of surgical emphysema. Although our ability to influence the choice of surgical instrument is limited, it is appropriate to recognize the type of drill and cooling mechanism the oral surgeon is using.

Once pressurized air has penetrated the tissues, the onset of adverse signs is usually rapid4 and, interestingly, in this case, adverse signs did not occur until 45 min after emergence from anesthesia and complete cognitive recovery.

Finally, the interlink system, a safety feature of modern anesthetic machines used when administering nitrous oxide designed to prevent the delivery of a hypoxic gas mixture, makes it unlikely that the authors could have administered an air-nitrous oxide mixture to their patient.

REFERENCES

1. Magni G, Imperiale C, Rosa G, Favaro R. Nonfatal cerebral air embolism after dental surgery. Anesth Analg 2008;106: 249–51[Abstract/Free Full Text]
2. Turnbull A. A remarkable coincidence in dental surgery. BMJ 1900;1:1131[Free Full Text]
3. Chen SC, Lin FY, Chang KJ. Subcutaneous emphysema and pneumomediastinum after dental extraction. Am J Emerg Med 1999;17:678–80[Web of Science][Medline]
4. Ali A, Cunliffe DR, Watt-Smith SR. Surgical emphysema and pneumomediastinum complicating dental extraction. Br Dent J 2000;188:589–90[Web of Science][Medline]

This article has been cited by other articles:

				G. Magni, C. Imperiale, G. Rosa, and R. Favaro Air Penetration into the Tissues During Oral Surgery Anesth. Analg., September 1, 2008; 107(3): 1085 - 1085. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rehman, K.-U. Articles by Tong, J. L. Search for Related Content PubMed PubMed Citation Articles by Rehman, K.-U. Articles by Tong, J. L.