{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T12:01:52Z","timestamp":1770292912229,"version":"3.49.0"},"reference-count":29,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,1]]},"abstract":"<jats:p>Myotonic dystrophy (dystrophia myotonica; DM) is an uncommon progressive hereditary muscle disorder that can present with variable severity at birth, in early childhood, or most commonly as an adult. Patients with DM, especially type 1 (DM1), are extremely sensitive to the respiratory depressant effects of sedative-hypnotics, anxiolytics, and opioid agonists. This case report describes a 37-year-old male patient with previously undiagnosed DM1 who received dental care under minimal sedation using intravenous midazolam. During the case, the patient experienced 2 brief episodes of hypoxemia, the second of which required emergency intubation after propofol and succinylcholine and resulted in extended hospital admission. A lipid emulsion (Liposyn II 20%) infusion was given approximately 2 hours after the last local anesthetic injection due to slight ST elevation and suspicion of local anesthetic toxicity (LAST). Months after treatment, the patient suffered a fall resulting in a fatal traumatic brain injury. Complications noted in this case report were primarily attributed to the unknown diagnosis of DM1, although additional precipitating factors were likely present. This report also provides a basic review of the literature and clinical guidelines for managing myotonic dystrophy patients for dental care with local anesthesia, sedation, or general anesthesia.<\/jats:p>","DOI":"10.2344\/anpr-69-02-09","type":"journal-article","created":{"date-parts":[[2022,12,19]],"date-time":"2022-12-19T18:38:34Z","timestamp":1671475114000},"page":"26-31","source":"Crossref","is-referenced-by-count":3,"title":["Complications After Dental Sedation: A Myotonic Mystery Case Report"],"prefix":"10.2344","volume":"69","author":[{"given":"Milad","family":"Karamlou","sequence":"first","affiliation":[{"name":"*Former Resident, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iman","family":"Asaria","sequence":"additional","affiliation":[{"name":"\u2020Resident, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaime","family":"Barron","sequence":"additional","affiliation":[{"name":"\u2020Resident, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petra","family":"Boutros","sequence":"additional","affiliation":[{"name":"\u2020Resident, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Fisher","sequence":"additional","affiliation":[{"name":"\u2020Resident, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Grandinetti","sequence":"additional","affiliation":[{"name":"\u2020Resident, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Johnson","sequence":"additional","affiliation":[{"name":"\u2020Resident, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Richard","sequence":"additional","affiliation":[{"name":"\u2020Resident, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Susko","sequence":"additional","affiliation":[{"name":"\u2020Resident, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristobal","family":"Urrutia","sequence":"additional","affiliation":[{"name":"\u2020Resident, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryce","family":"Woolsey","sequence":"additional","affiliation":[{"name":"\u2021Chief Resident, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald","family":"Baumann","sequence":"additional","affiliation":[{"name":"\u00a7Former Assistant Professor and Attending, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Cottle","sequence":"additional","affiliation":[{"name":"||Assistant Professor and Attending, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Sweaney","sequence":"additional","affiliation":[{"name":"||Assistant Professor and Attending, The Ohio State University College of Dentistry General Practice Residency Program, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Wenzel","sequence":"additional","affiliation":[{"name":"#Program Director and Hospital Attending, The Ohio State University College of Dentistry General Practice Residency Program and Wexner Medical Center, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Nusstein","sequence":"additional","affiliation":[{"name":"**Professor and Chair Division of Endodontics, The Ohio State University College of Dentistry, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Hall","sequence":"additional","affiliation":[{"name":"\u2020\u2020Associate Professor and Hospital Attending, The Ohio State University College of Dentistry General Practice Residency Program and Wexner Medical Center, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1191","published-online":{"date-parts":[[2022,12,19]]},"reference":[{"key":"2023021718361632600_","unstructured":"National Institutes of Health. 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Benzodiazepines protect mice from local anesthetic convulsions and deaths. Anesth Analg. 1981; 60: 385\u2013 389."},{"key":"2023021718361632600_","doi-asserted-by":"crossref","unstructured":"El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth. 2018; 11: 35\u2013 44.","DOI":"10.2147\/LRA.S154512"},{"key":"2023021718361632600_","doi-asserted-by":"crossref","unstructured":"Sekimoto K, Tobe M, Saito S. Local anesthetic toxicity: acute and chronic management. Acute Med Surg. 2017; 4: 152\u2013 160.","DOI":"10.1002\/ams2.265"},{"key":"2023021718361632600_","doi-asserted-by":"crossref","unstructured":"Bruguerolle B, Emperaire N. Local anesthetic-induced toxicity may be modified by low doses of flumazenil. Life Sci. 1992; 51: 1\u2013 4.","DOI":"10.1016\/0024-3205(92)90121-5"},{"key":"2023021718361632600_","doi-asserted-by":"crossref","unstructured":"Kar NC, Pearson CM. 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