The document provides information on local anesthetics used in dentistry. It begins with definitions of local anesthesia and local anesthetic agents. It then discusses the history of local anesthesia, ideal properties, mechanism of action, pharmacokinetics, commonly used local anesthetic drugs (lidocaine, bupivacaine, articaine), dosages, and complications. It also covers topics like vasoconstrictors, topical anesthetics, and recent advances in local anesthesia.
Lidocaine is a local anesthetic that has several indications and mechanisms of action. It can be used as a local anesthetic for procedures or to treat arrhythmias when given intravenously. Intravenous lidocaine may provide pain relief for postoperative, neuropathic, and chronic pain by blocking sodium channels. Studies have shown intravenous lidocaine can reduce postoperative pain and opioid use when given perioperatively, leading to benefits like shorter hospital stays. Lidocaine may be more effective than placebo for treating neuropathic pain, though epidural administration provides better pain relief than intravenous lidocaine for some surgeries. Adverse effects are typically minor when given at therapeutic doses by trained medical professionals.
This document provides information on various local anesthetic agents used by dentists, including their properties, dosages, and clinical applications. It discusses ester-type agents like procaine and propoxycaine that are no longer commonly used. It then focuses on amide-type agents still in use: lidocaine, mepivacaine, prilocaine, and articaine. For each it provides details on metabolism, onset of action, duration, maximum recommended dosages, and advantages for different clinical scenarios. The document aims to educate dentists on selecting the appropriate local anesthetic based on a patient's needs and medical history.
The document provides an overview of local anesthesia. It begins with the historical background of local anesthetics starting with cocaine in 1860. It defines local anesthesia and discusses the ideal properties, electrophysiology of nerve conduction, and theories of the mechanism of action. It classifies local anesthetics and discusses their types, biokinetics, metabolism, and armamentarium. It also outlines various local anesthesia injection techniques and potential complications. The document contains a comprehensive but concise review of the fundamentals of local anesthesia.
Intravenous lidocaine is an effective analgesic adjuvant that can reduce acute pain and opioid requirements following surgery. It works by blocking sodium channels and reducing central sensitization. While the evidence supports its use, IV lidocaine has a narrow therapeutic window and requires monitoring. The authors' hospital implemented a successful IV lidocaine protocol for postoperative patients, which showed improvements in dynamic pain scores without significant side effects. They provide guidelines for safe administration of IV lidocaine as an option for acute pain management.
Local anesthesia involves the loss of sensation, especially pain, in one part of the body through the use of local anesthetic drugs. The document discusses the historical background of local anesthesia beginning in the 1880s with cocaine. It defines local anesthesia and related terms and outlines the ideal properties of local anesthetic drugs. The document describes the composition of local anesthetic solutions, classifications of drugs, and their mechanism of action in blocking nerve conduction. It explores theories of pain and the pain pathway, which local anesthetics are able to interrupt.
Local anesthesia works by reversibly inhibiting the propagation of nerve signals in a specific body area. The first local anesthetic was cocaine, discovered in 1860. Local anesthetics are classified as esters or amides based on their chemical structure and method of metabolism. They work by blocking the influx of sodium ions through nerve cell membranes, preventing nerve depolarization. Factors like pH, lipophilicity, and vasoconstrictors affect their potency and duration of action. Common techniques for administering local anesthesia include infiltration, nerve blocks, epidurals, and spinal anesthesia. Potential side effects include both local and systemic toxicity.
This document defines local anesthetics and describes their properties and mechanisms of action. It discusses various local anesthetics including lidocaine, prilocaine, bupivacaine, ropivacaine, dibucaine, benzocaine, butamben, and oxethazaine. It covers their uses for surface anesthesia, infiltration, nerve blocks, epidurals, and other techniques. Complications are also summarized.
This document discusses the pharmacology of local anesthesia. It describes the constituents of local anesthetic cartridges which include the local anesthetic agent, vasoconstrictor, preservative, and vehicle. It discusses the properties of ideal anesthetic agents and the common properties of injectable local anesthetics. The document outlines the mode of action, pharmacokinetics including uptake, potency, duration, biotransformation, and excretion of local anesthetics. It provides details on ester and amide local anesthetic drugs as well as vasoconstrictor agents.
Lidocaine is a local anesthetic that has several indications and mechanisms of action. It can be used as a local anesthetic for procedures or to treat arrhythmias when given intravenously. Intravenous lidocaine may provide pain relief for postoperative, neuropathic, and chronic pain by blocking sodium channels. Studies have shown intravenous lidocaine can reduce postoperative pain and opioid use when given perioperatively, leading to benefits like shorter hospital stays. Lidocaine may be more effective than placebo for treating neuropathic pain, though epidural administration provides better pain relief than intravenous lidocaine for some surgeries. Adverse effects are typically minor when given at therapeutic doses by trained medical professionals.
This document provides information on various local anesthetic agents used by dentists, including their properties, dosages, and clinical applications. It discusses ester-type agents like procaine and propoxycaine that are no longer commonly used. It then focuses on amide-type agents still in use: lidocaine, mepivacaine, prilocaine, and articaine. For each it provides details on metabolism, onset of action, duration, maximum recommended dosages, and advantages for different clinical scenarios. The document aims to educate dentists on selecting the appropriate local anesthetic based on a patient's needs and medical history.
The document provides an overview of local anesthesia. It begins with the historical background of local anesthetics starting with cocaine in 1860. It defines local anesthesia and discusses the ideal properties, electrophysiology of nerve conduction, and theories of the mechanism of action. It classifies local anesthetics and discusses their types, biokinetics, metabolism, and armamentarium. It also outlines various local anesthesia injection techniques and potential complications. The document contains a comprehensive but concise review of the fundamentals of local anesthesia.
Intravenous lidocaine is an effective analgesic adjuvant that can reduce acute pain and opioid requirements following surgery. It works by blocking sodium channels and reducing central sensitization. While the evidence supports its use, IV lidocaine has a narrow therapeutic window and requires monitoring. The authors' hospital implemented a successful IV lidocaine protocol for postoperative patients, which showed improvements in dynamic pain scores without significant side effects. They provide guidelines for safe administration of IV lidocaine as an option for acute pain management.
Local anesthesia involves the loss of sensation, especially pain, in one part of the body through the use of local anesthetic drugs. The document discusses the historical background of local anesthesia beginning in the 1880s with cocaine. It defines local anesthesia and related terms and outlines the ideal properties of local anesthetic drugs. The document describes the composition of local anesthetic solutions, classifications of drugs, and their mechanism of action in blocking nerve conduction. It explores theories of pain and the pain pathway, which local anesthetics are able to interrupt.
Local anesthesia works by reversibly inhibiting the propagation of nerve signals in a specific body area. The first local anesthetic was cocaine, discovered in 1860. Local anesthetics are classified as esters or amides based on their chemical structure and method of metabolism. They work by blocking the influx of sodium ions through nerve cell membranes, preventing nerve depolarization. Factors like pH, lipophilicity, and vasoconstrictors affect their potency and duration of action. Common techniques for administering local anesthesia include infiltration, nerve blocks, epidurals, and spinal anesthesia. Potential side effects include both local and systemic toxicity.
This document defines local anesthetics and describes their properties and mechanisms of action. It discusses various local anesthetics including lidocaine, prilocaine, bupivacaine, ropivacaine, dibucaine, benzocaine, butamben, and oxethazaine. It covers their uses for surface anesthesia, infiltration, nerve blocks, epidurals, and other techniques. Complications are also summarized.
This document discusses the pharmacology of local anesthesia. It describes the constituents of local anesthetic cartridges which include the local anesthetic agent, vasoconstrictor, preservative, and vehicle. It discusses the properties of ideal anesthetic agents and the common properties of injectable local anesthetics. The document outlines the mode of action, pharmacokinetics including uptake, potency, duration, biotransformation, and excretion of local anesthetics. It provides details on ester and amide local anesthetic drugs as well as vasoconstrictor agents.
Dr. Shalini Singh's document discusses local anesthetics. It provides definitions, classifications, mechanisms of action, properties and examples of specific local anesthetics. It also covers the history of local anesthetics from early discoveries like cocaine to modern drugs like lidocaine. Complications from both local and systemic effects are discussed.
1) The document discusses local anesthetics, providing their history, uses, mechanisms of action, classifications, and factors influencing their effects.
2) It describes the pharmacokinetics of local anesthetics including absorption, distribution, metabolism and excretion of ester and amide-linked drugs.
3) Guidelines are provided for managing severe local anesthetic toxicity, including airway management, treating seizures and arrhythmias, and considering lipid emulsion therapy.
The document provides information on local anesthetics including their history, mechanism of action, properties of ideal anesthetics, constituents, and vasoconstrictors. It discusses how local anesthetics work by blocking sodium channels and preventing nerve impulse propagation. Ideal anesthetics should have rapid onset and sufficient duration while being non-toxic, stable, and sterile. Vasoconstrictors are added to local anesthetics to prolong their duration by decreasing absorption and increasing the amount that remains near the nerve.
Dr. Nermine Ramadan Mahmoud will present on the pharmacology of local anesthesia. The presentation will cover the constituents of local anesthetic cartridges, including the anesthetic drug, vasoconstrictor, preservative, vehicle, and distilled water. It will also discuss the pharmacology of local anesthetic drugs and vasoconstrictors, including their mechanisms of action, classifications, and effects. The presentation will summarize the factors that influence the uptake, potency, duration, biotransformation, and excretion of local anesthetics.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The document provides an overview of local anesthesia. It defines local anesthesia as the loss of sensation in a circumscribed area caused by depression of nerve endings or inhibition of nerve conduction. The document then reviews the history of local anesthesia, from the initial use of cocaine in the 1880s to the development of newer agents like lidocaine in the 1940s-1950s. It also covers topics like the ideal properties of local anesthetics, their classification, mechanisms of action, composition, and clinical uses. The document serves as a reference on the fundamentals of local anesthesia.
This document summarizes the pharmacokinetics and pharmacology of local anesthetics. It discusses the uptake, distribution, metabolism, and excretion of local anesthetics. It also covers the cardiovascular, neurological, and toxic effects that can occur at high blood levels, including seizures. Specifically, it describes how local anesthetics are absorbed into the bloodstream and distributed to tissues, metabolized primarily in the liver, and excreted by the kidneys. Their effects include CNS depression and potential excitation that can lead to seizures at high concentrations.
- Local anesthetics are drugs that cause reversible loss of sensation in a restricted area of the body when applied topically or injected locally. They work by blocking nerve conduction without structural nerve damage.
- Early uses of local anesthetics included chewing cocoa leaves for pain relief in Peru and spinal/epidural anesthesia developed in the late 19th century. Common types include amide drugs like lidocaine, bupivacaine, and ropivacaine as well as ester drugs like cocaine and tetracaine.
- Local anesthetics can be administered via various techniques including infiltration, nerve blocks, epidural/spinal anesthesia, intravenous regional anesthesia, and topical application. Factors like drug properties, dosage,
This document provides an overview of local anaesthesia. It discusses the history of local anaesthetics from cocaine to lidocaine. It describes the properties, theories of action, classifications, composition, and pharmacology of local anaesthetics. The key modes of action are blocking sodium channels to prevent nerve impulse conduction. Local anaesthetics reversibly bind to specific receptor sites on sodium channels to inhibit sodium influx and nerve depolarization. Complications can include both local tissue toxicity and systemic effects.
Local anesthetics work by reversibly blocking sodium channels in nerve cell membranes, preventing the propagation of action potentials and sensation. They are useful for minor procedures as they cause loss of sensation in a localized area without loss of consciousness. Common local anesthetics include lidocaine, bupivacaine, and procaine. Factors like lipid solubility and pH influence their onset and duration of action. While generally safe, local anesthetics can potentially cause adverse effects like numbness, seizures, or cardiac issues depending on the drug and dosage. Proper technique and patient health assessment are important considerations for safe use of local anesthesia.
Local anesthetics work by blocking sodium channels in nerves, preventing impulse transmission and sensation. The document traces the history of local anesthetics from ancient use of coca leaves to modern drugs like lidocaine. It discusses the development of cocaine as the first local anesthetic and its replacement by safer amide-based drugs like procaine and lidocaine due to cocaine's high toxicity and potential for addiction. The mechanisms of action, factors affecting onset and duration, and properties of common dental anesthetics are also outlined.
EVERYTHING RELATED TO LOCAL ANESTHETICS LIKE DEFINITION, HISTORY INTRODUCTION PHYSIOLOGY MECHANISM OF ACTION ANATOMY OF NERVES CLASSIFICATIONS INDIVIDUAL DRUGS AND ITS USES LOCAL ANESTHETICS TOXICITY LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST) MANAGEMENT OF LAST ETC...
Local anesthetics work by blocking sodium channels in nerves, limiting the propagation of action potentials and producing loss of sensation in a specific area. Early local anesthetics like cocaine and procaine had limitations. Lidocaine, introduced in 1940, was a major breakthrough as the first modern local anesthetic due to its quick onset of action, duration of several hours, and minimal allergenicity. The two classes of local anesthetics are esters and amides; amides are preferable due to lower risk of allergic reactions. Factors like lipid solubility, pH, vasoconstrictors, and dosage levels affect the onset and duration of local anesthetics.
Long-acting local anesthetics - present and futurescanFOAM
A presentation by Joseph Cravero at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
This document provides information on local anesthesia. It begins with definitions and history, describing how local anesthesia was developed by Koller in 1884 using procaine. It then discusses the various methods of inducing local anesthesia and the neuroanatomy and electrophysiology of nerve conduction. The remainder of the document focuses on the pharmacology of local anesthetics, including theories of action, properties, classification, pharmacokinetics, composition, and maximum permissible doses. Specific local anesthetic techniques for the maxilla and mandible are also outlined.
Local anesthetics and techniques of anesthesia Sadaqat Ali
This document provides information on local anesthetics including definitions, mechanisms of action, classifications, pharmacokinetics, clinical uses, and details on specific local anesthetics like lidocaine and dyclonine. It defines local anesthesia as loss of sensation in a body area without loss of consciousness. It discusses how local anesthetics work by inhibiting nerve membrane depolarization and action potential propagation. Common classes include esters, amides, and ketones. Clinical uses include analgesia, regional anesthesia, and treatment of arrhythmias or seizures.
This document provides an overview of local anesthesia and local anesthetic agents. It begins with definitions of local anesthesia and discusses the desirable properties of local anesthetics. It then covers the history of local anesthesia from early uses of coca leaves to the development of procaine and lidocaine. The rest of the document discusses modes of action, classifications, compositions, examples of local anesthetic agents, and considerations for their safe use.
The document discusses the pharmacology of local anesthesia, including the constituents of local anesthetic cartridges which contain a local anesthetic agent, vasoconstrictor, preservative, and vehicle. It describes the properties and mode of action of common local anesthetic drugs, which are classified as esters or amides, and how they are metabolized and excreted from the body. The document also compares the differences between ester and amide local anesthetics and lists some commonly used local anesthetic agents.
Local anesthetics work by binding to and inhibiting sodium channels, blocking the generation and conduction of nerve impulses. Early local anesthetics included cocaine and procaine. Lidocaine, discovered in 1943, was a major advancement as it had a quick onset and was less allergenic than earlier agents. Local anesthetics are classified as esters or amides; esters are metabolized faster. Later agents have longer durations of action but also higher risks of toxicity. The pharmacology of local anesthetics focuses on factors like potency, speed of onset, duration, and cardiac toxicity risks. Proper dosing and administration are important to avoid local anesthetic systemic toxicity.
Local anesthesia Mechanism Of Action as well as typesSuman Bhattarai
This document summarizes key information about local anesthesia. It discusses the mechanism of action, desirable properties, and classification of local anesthetics. It also provides details about specific local anesthetics like procaine, lidocaine, and pramocaine. Local anesthetics work by reversibly blocking sodium channels in nerve cell membranes, preventing the generation and conduction of nerve impulses and thereby inducing local anesthesia with no permanent nerve damage. The document outlines the pharmacological effects, pharmacokinetics, clinical uses and dosages of different local anesthetic drugs.
local anesthesia: Uses, Types, Side effects and SafetyPrachiRathi40
This document provides an overview of local anesthesia. It begins with definitions and an introduction. It then covers the historical background, classifications, components, mechanisms of action, techniques, and complications of local anesthesia. The classifications section divides local anesthetics based on their pharmacology, route of administration, biologic site and mode of action, and duration of action. Key local anesthetic agents like lidocaine, mepivacaine, articaine, bupivacaine, and topical anesthetics are also summarized. Maximum recommended doses and specific nerve block techniques for the maxillary nerve are outlined. In conclusion, the document reviews local anesthesia in detail.
Local anesthetics work by reversibly blocking sodium channels in nerve cell membranes, preventing the propagation of nerve impulses and inducing localized numbness. The document discusses the mechanisms of action, factors affecting activity, termination of effects, use of vasoconstrictors, classification, adverse effects, and techniques of local anesthesia. It also covers the introduction, objectives, mechanisms, activity, termination, classification, effects, and choice of local anesthetic agents.
Dr. Shalini Singh's document discusses local anesthetics. It provides definitions, classifications, mechanisms of action, properties and examples of specific local anesthetics. It also covers the history of local anesthetics from early discoveries like cocaine to modern drugs like lidocaine. Complications from both local and systemic effects are discussed.
1) The document discusses local anesthetics, providing their history, uses, mechanisms of action, classifications, and factors influencing their effects.
2) It describes the pharmacokinetics of local anesthetics including absorption, distribution, metabolism and excretion of ester and amide-linked drugs.
3) Guidelines are provided for managing severe local anesthetic toxicity, including airway management, treating seizures and arrhythmias, and considering lipid emulsion therapy.
The document provides information on local anesthetics including their history, mechanism of action, properties of ideal anesthetics, constituents, and vasoconstrictors. It discusses how local anesthetics work by blocking sodium channels and preventing nerve impulse propagation. Ideal anesthetics should have rapid onset and sufficient duration while being non-toxic, stable, and sterile. Vasoconstrictors are added to local anesthetics to prolong their duration by decreasing absorption and increasing the amount that remains near the nerve.
Dr. Nermine Ramadan Mahmoud will present on the pharmacology of local anesthesia. The presentation will cover the constituents of local anesthetic cartridges, including the anesthetic drug, vasoconstrictor, preservative, vehicle, and distilled water. It will also discuss the pharmacology of local anesthetic drugs and vasoconstrictors, including their mechanisms of action, classifications, and effects. The presentation will summarize the factors that influence the uptake, potency, duration, biotransformation, and excretion of local anesthetics.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The document provides an overview of local anesthesia. It defines local anesthesia as the loss of sensation in a circumscribed area caused by depression of nerve endings or inhibition of nerve conduction. The document then reviews the history of local anesthesia, from the initial use of cocaine in the 1880s to the development of newer agents like lidocaine in the 1940s-1950s. It also covers topics like the ideal properties of local anesthetics, their classification, mechanisms of action, composition, and clinical uses. The document serves as a reference on the fundamentals of local anesthesia.
This document summarizes the pharmacokinetics and pharmacology of local anesthetics. It discusses the uptake, distribution, metabolism, and excretion of local anesthetics. It also covers the cardiovascular, neurological, and toxic effects that can occur at high blood levels, including seizures. Specifically, it describes how local anesthetics are absorbed into the bloodstream and distributed to tissues, metabolized primarily in the liver, and excreted by the kidneys. Their effects include CNS depression and potential excitation that can lead to seizures at high concentrations.
- Local anesthetics are drugs that cause reversible loss of sensation in a restricted area of the body when applied topically or injected locally. They work by blocking nerve conduction without structural nerve damage.
- Early uses of local anesthetics included chewing cocoa leaves for pain relief in Peru and spinal/epidural anesthesia developed in the late 19th century. Common types include amide drugs like lidocaine, bupivacaine, and ropivacaine as well as ester drugs like cocaine and tetracaine.
- Local anesthetics can be administered via various techniques including infiltration, nerve blocks, epidural/spinal anesthesia, intravenous regional anesthesia, and topical application. Factors like drug properties, dosage,
This document provides an overview of local anaesthesia. It discusses the history of local anaesthetics from cocaine to lidocaine. It describes the properties, theories of action, classifications, composition, and pharmacology of local anaesthetics. The key modes of action are blocking sodium channels to prevent nerve impulse conduction. Local anaesthetics reversibly bind to specific receptor sites on sodium channels to inhibit sodium influx and nerve depolarization. Complications can include both local tissue toxicity and systemic effects.
Local anesthetics work by reversibly blocking sodium channels in nerve cell membranes, preventing the propagation of action potentials and sensation. They are useful for minor procedures as they cause loss of sensation in a localized area without loss of consciousness. Common local anesthetics include lidocaine, bupivacaine, and procaine. Factors like lipid solubility and pH influence their onset and duration of action. While generally safe, local anesthetics can potentially cause adverse effects like numbness, seizures, or cardiac issues depending on the drug and dosage. Proper technique and patient health assessment are important considerations for safe use of local anesthesia.
Local anesthetics work by blocking sodium channels in nerves, preventing impulse transmission and sensation. The document traces the history of local anesthetics from ancient use of coca leaves to modern drugs like lidocaine. It discusses the development of cocaine as the first local anesthetic and its replacement by safer amide-based drugs like procaine and lidocaine due to cocaine's high toxicity and potential for addiction. The mechanisms of action, factors affecting onset and duration, and properties of common dental anesthetics are also outlined.
EVERYTHING RELATED TO LOCAL ANESTHETICS LIKE DEFINITION, HISTORY INTRODUCTION PHYSIOLOGY MECHANISM OF ACTION ANATOMY OF NERVES CLASSIFICATIONS INDIVIDUAL DRUGS AND ITS USES LOCAL ANESTHETICS TOXICITY LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST) MANAGEMENT OF LAST ETC...
Local anesthetics work by blocking sodium channels in nerves, limiting the propagation of action potentials and producing loss of sensation in a specific area. Early local anesthetics like cocaine and procaine had limitations. Lidocaine, introduced in 1940, was a major breakthrough as the first modern local anesthetic due to its quick onset of action, duration of several hours, and minimal allergenicity. The two classes of local anesthetics are esters and amides; amides are preferable due to lower risk of allergic reactions. Factors like lipid solubility, pH, vasoconstrictors, and dosage levels affect the onset and duration of local anesthetics.
Long-acting local anesthetics - present and futurescanFOAM
A presentation by Joseph Cravero at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
This document provides information on local anesthesia. It begins with definitions and history, describing how local anesthesia was developed by Koller in 1884 using procaine. It then discusses the various methods of inducing local anesthesia and the neuroanatomy and electrophysiology of nerve conduction. The remainder of the document focuses on the pharmacology of local anesthetics, including theories of action, properties, classification, pharmacokinetics, composition, and maximum permissible doses. Specific local anesthetic techniques for the maxilla and mandible are also outlined.
Local anesthetics and techniques of anesthesia Sadaqat Ali
This document provides information on local anesthetics including definitions, mechanisms of action, classifications, pharmacokinetics, clinical uses, and details on specific local anesthetics like lidocaine and dyclonine. It defines local anesthesia as loss of sensation in a body area without loss of consciousness. It discusses how local anesthetics work by inhibiting nerve membrane depolarization and action potential propagation. Common classes include esters, amides, and ketones. Clinical uses include analgesia, regional anesthesia, and treatment of arrhythmias or seizures.
This document provides an overview of local anesthesia and local anesthetic agents. It begins with definitions of local anesthesia and discusses the desirable properties of local anesthetics. It then covers the history of local anesthesia from early uses of coca leaves to the development of procaine and lidocaine. The rest of the document discusses modes of action, classifications, compositions, examples of local anesthetic agents, and considerations for their safe use.
The document discusses the pharmacology of local anesthesia, including the constituents of local anesthetic cartridges which contain a local anesthetic agent, vasoconstrictor, preservative, and vehicle. It describes the properties and mode of action of common local anesthetic drugs, which are classified as esters or amides, and how they are metabolized and excreted from the body. The document also compares the differences between ester and amide local anesthetics and lists some commonly used local anesthetic agents.
Local anesthetics work by binding to and inhibiting sodium channels, blocking the generation and conduction of nerve impulses. Early local anesthetics included cocaine and procaine. Lidocaine, discovered in 1943, was a major advancement as it had a quick onset and was less allergenic than earlier agents. Local anesthetics are classified as esters or amides; esters are metabolized faster. Later agents have longer durations of action but also higher risks of toxicity. The pharmacology of local anesthetics focuses on factors like potency, speed of onset, duration, and cardiac toxicity risks. Proper dosing and administration are important to avoid local anesthetic systemic toxicity.
Local anesthesia Mechanism Of Action as well as typesSuman Bhattarai
This document summarizes key information about local anesthesia. It discusses the mechanism of action, desirable properties, and classification of local anesthetics. It also provides details about specific local anesthetics like procaine, lidocaine, and pramocaine. Local anesthetics work by reversibly blocking sodium channels in nerve cell membranes, preventing the generation and conduction of nerve impulses and thereby inducing local anesthesia with no permanent nerve damage. The document outlines the pharmacological effects, pharmacokinetics, clinical uses and dosages of different local anesthetic drugs.
local anesthesia: Uses, Types, Side effects and SafetyPrachiRathi40
This document provides an overview of local anesthesia. It begins with definitions and an introduction. It then covers the historical background, classifications, components, mechanisms of action, techniques, and complications of local anesthesia. The classifications section divides local anesthetics based on their pharmacology, route of administration, biologic site and mode of action, and duration of action. Key local anesthetic agents like lidocaine, mepivacaine, articaine, bupivacaine, and topical anesthetics are also summarized. Maximum recommended doses and specific nerve block techniques for the maxillary nerve are outlined. In conclusion, the document reviews local anesthesia in detail.
Local anesthetics work by reversibly blocking sodium channels in nerve cell membranes, preventing the propagation of nerve impulses and inducing localized numbness. The document discusses the mechanisms of action, factors affecting activity, termination of effects, use of vasoconstrictors, classification, adverse effects, and techniques of local anesthesia. It also covers the introduction, objectives, mechanisms, activity, termination, classification, effects, and choice of local anesthetic agents.
Local anesthetics produce localized, reversible nerve block by inhibiting sodium channels. They are commonly used for surface anesthesia, infiltration, nerve blocks, intravenous regional anesthesia, epidural anesthesia, and spinal anesthesia. Common local anesthetics include lidocaine, bupivacaine, procaine, and tetracaine which vary in duration of action from short to long. Adverse effects include allergic reactions and systemic toxicity.
Local anesthetics work by reversibly blocking sodium channels, preventing nerve impulse conduction. This summary will discuss the key points about local anesthetics:
1. Local anesthetics come in different classes based on their chemical structure and duration of action. They are used to numb specific body regions without loss of consciousness.
2. The effectiveness of local anesthetics depends on factors like pH, lipophilicity, and concentration. Adding epinephrine prolongs the numbing effect and reduces systemic absorption.
3. Overdose of local anesthetics can cause seizures, cardiac issues, and other toxic effects. The dose must be carefully controlled to safely numb nerves without systemic side effects.
Local anesthetics work by reversibly blocking sodium channels in neural membranes, preventing action potentials. The first local anesthetic was cocaine in the 1860s. Local anesthetics are now classified as esters or amides and commonly used in infiltration, nerve blocks, and regional techniques. Factors like lipid solubility, dose, and pH influence their duration and potency. Toxicity can affect the central nervous system, heart, and lungs. Severe toxicity requires securing the airway, oxygen, benzodiazepines or propofol for seizures, and IV lipid emulsion along with standard cardiac life support protocols.
Local anesthetics work by reversibly blocking sodium channels in neural membranes, preventing action potentials. The first local anesthetic was cocaine in the 1860s. Local anesthetics are now classified as esters or amides and commonly used in infiltration, nerve blocks, and regional techniques. Factors like lipid solubility, dose, and site of injection influence onset and duration of their effects. Toxicity can involve the central nervous system, heart, or lungs. Treatment of severe toxicity includes securing the airway, oxygen, benzodiazepines or propofol for seizures, lipid emulsion therapy, and CPR if needed.
The document provides an overview of regional anesthesia techniques including the mechanism of local anesthesia, types of anesthetic drugs, types of local nerve blocks, and complications. It focuses on femoral, ankle, and wrist nerve blocks, describing the relevant anatomy, techniques, and complications of each block. Key details on the pharmacology of local anesthetics like lidocaine, bupivacaine, and epinephrine are also summarized.
This document provides an overview of local anaesthesia including:
- A definition and historical background of local anaesthetics such as cocaine and procaine.
- Desirable properties and classifications of local anaesthetics.
- Details on common local anaesthetics like lidocaine including mechanism of action, dosage, and comparisons to other agents.
- Factors to consider in selecting a local anaesthetic for a patient and important information to obtain from the patient.
- Techniques for administering local anaesthesia and managing complications.
Local analgesia in animals_ Dr. Awad RizkAwad Rizk
The document discusses local analgesia, including definitions, mechanisms of action, commonly used agents, and considerations for safe use. It describes how local anesthetics work by blocking sodium channels and nerve impulse conduction. The most commonly used agents are lidocaine, bupivacaine, and mepivacaine. Proper administration and avoiding excess doses are important to prevent local tissue toxicity and systemic effects.
The document discusses local anesthesia techniques used in dentistry. It begins with the history of local anesthesia, describing how early indigenous populations discovered numbing effects of coca leaves and how cocaine was later used as the first local anesthetic. It then defines local anesthesia and describes the ideal properties, classification, composition, mechanisms of action, and pharmacokinetics of local anesthetic drugs. The remainder of the document details the equipment used to administer local anesthesia such as syringes, needles, and cartridges, as well as various anesthesia techniques including infiltration, conduction block, and nerve block anesthesia.
Local anesthesia is defined as a transient reversible loss of sensation caused by blocking nerve conduction in a localized area. There are two types of local anesthetics: amides and esters. Amides such as lidocaine are preferred due to their longer duration of action and lower risk of allergic reactions. Local anesthetic solutions also contain vasoconstrictors to prolong the effects and buffering agents. The document discusses the mechanisms, uses, contraindications and toxicity of local anesthesia in detail. It provides classifications based on duration and vasoconstrictor types used. Potential adverse effects on the central nervous system, cardiovascular system and risks of methemoglobinemia are outlined.
Local anesthesia in dentistry /certified fixed orthodontic courses by Indian...Indian dental academy
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Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
This document discusses local anesthetics, including their classification, mechanism of action, pharmacokinetics, uses, and properties of an ideal local anesthetic. Specifically, it classifies local anesthetics based on their chemical structure as either esters or amides and describes the differences between the two. It explains how local anesthetics work by blocking sodium channels and nerve impulse conduction. The document also lists the desired learning objectives and properties students should understand about local anesthetics.
This document provides an overview of regional anaesthetics. It begins by defining regional anaesthesia as anaesthesia of a segment of the body through peripheral or neuraxial interruption of nerve transmission without loss of consciousness. The document then discusses the history of local anaesthetics from cocaine in the 1860s to modern agents like lidocaine and bupivacaine. It also covers the classification, mechanisms of action, pharmacological properties and therapeutic uses of various local anaesthetic agents.
General anesthesia has evolved significantly since the 19th century. Key developments include Crawford Long using ether in 1842, Morton demonstrating ether's anesthetic properties in 1846, and the discovery of intravenous agents like thiopental and propofol. Common inhalational agents today include sevoflurane, desflurane, and isoflurane. They work primarily by enhancing GABA receptor activity in the brain and spinal cord to produce unconsciousness, amnesia, and muscle relaxation. Nitrous oxide is also commonly used for its analgesic properties. Selection of agents considers their cardiovascular, respiratory and renal effects as well as factors like cost and emergence time.
This document provides an overview of local anaesthesia. It begins with definitions and a brief history of local anaesthesia from ancient times to the development of modern agents like lidocaine. It describes the desirable properties of local anaesthetics and discusses their electrophysiology, mechanism of action, classification, pharmacokinetics and systemic effects. Specific details are provided about lidocaine, one of the most commonly used local anaesthetics. Theories on the mechanism of action and uses of local anaesthetics are also summarized.
This document provides an overview of local anesthesia, including its types, history, classification, mechanism of action, pharmacological actions, uses and techniques, adverse effects, and differences from general anesthesia. It discusses how local anesthetics work by reversibly blocking sodium channels in nerve fibers to inhibit nerve impulse conduction. Common local anesthetics and their properties, uses for surface, infiltration, nerve block, spinal and epidural anesthesia are summarized. Potential adverse effects including CNS, cardiovascular and local tissue toxicity are also outlined.
This document discusses acidulated phosphate fluoride (APF), a topical fluoride treatment used to prevent tooth decay. It is presented in two forms - a 1.23% fluoride solution with a pH of 3.0 or a gel with 1.23% fluoride and a pH between 4-5. APF is indicated for caries-active individuals and is applied using trays or cotton rolls, keeping the teeth wet for 4 minutes. It works by increasing fluoride uptake into enamel and providing topical fluoride to teeth. While effective, it has drawbacks like an acidic taste and potential to irritate tissues.
This document provides information about the Visual Analog Scale (VAS) which is used to measure pain, especially in children. It discusses that VAS is a straight line with descriptions of "no pain" on one end and "worst imaginable pain" on the other. Patients indicate their pain level by marking on the line. The distance from the left end is measured to determine the intensity of pain. VAS has benefits such as being sensitive to changes in pain levels, taking little time to complete, and not requiring training. However, it is subjective and cannot be used verbally or over the phone.
This document discusses various theories of tooth eruption and the phases of tooth eruption. It summarizes six main theories of tooth eruption: root elongation theory, bone remodeling theory, periodontal ligament contraction theory, hydrostatic pressure theory, pulp constriction theory, and dental follicle theory. It states that the periodontal ligament contraction theory, whereby fibroblasts in the periodontal ligament contract to apply an axial force, is the most widely accepted. It also outlines the three phases of tooth eruption: pre-eruptive, eruptive, and post-eruptive phases.
This document discusses glass ionomer cement, including its classification, composition, setting reaction, manipulation, advantages, disadvantages, and limitations. Glass ionomer cement was introduced in 1972 by Drs. Wilson and Kent as a tooth-colored material based on the reaction between silicate glass powder and polyacrylic acid. It bonds chemically to tooth structure and releases fluoride for a relatively long period. The document describes the different types of glass ionomer cements and provides details on their composition, setting reaction when mixed, and how they are manipulated for use in dental procedures. Advantages include adhesion, esthetics, and fluoride release, while disadvantages include susceptibility to erosion, brittleness, and moisture sensitivity. Limitations include weakness against fracture
This document discusses the use of mineral trioxide aggregate (MTA) in dentistry. It provides information on:
1) The composition and types of MTA, including that it is a powder made of Portland cement, bismuth oxide, and gypsum that is available in grey and white varieties.
2) The properties of MTA, including its compressive strength, pH, radiopacity, solubility, and biocompatibility.
3) The clinical applications of MTA, such as pulp capping, non-vital pulpotomy, root-end fillings, repair of root fractures and perforations.
4) MTA is described as having excellent tissue compatibility and ability to aid
The document discusses various classification systems for cavity preparation in dentistry. It describes G.V. Black's original classification system of Classes I-V which categorize cavities based on their location. It also discusses modifications to Black's system proposed by Charbeneu, Sturdevant, Finn, and others. Finally, it introduces the Mount and Hume classification system which defines the extent and complexity of cavities based on the site of carious lesions and their size.
Pedodontics involves the dental care of children. It aims to promote good oral and overall health in children and adolescents. The scope of pedodontics has expanded over time due to factors like increased fluoride use, advances in technology and materials, and greater recognition of the importance of dental health. Current trends in pediatric dentistry include an emphasis on prevention, child psychology, advanced restorative techniques, preventive orthodontics, endodontics, forensics, and genetics.
This document summarizes the standardization and classification of endodontic files. It discusses how endodontic hand files were first standardized by Ingle and LeVine to have a constant taper and diameter increments of 5 or 10. Files are now numbered from 10-140 based on tip diameter in hundredths of a millimeter. The shaft extends 16mm from the tip and tapers 0.32mm. Common file types discussed include K-files, K-flex, Flex-R, Hedstroem, Safety H, Hyflex, Unifiles, and S-files. Each file type has a unique cross-section or design that provides specific advantages for root canal shaping and cleaning.
This document provides an overview of the physiology of pain. It begins with a brief history of pain theories, then defines pain and discusses its classification. The document outlines the mechanism of pain perception, including the roles of sensory receptors, neurons, and ascending and descending pain pathways in the spinal cord and brain. It also addresses factors that affect pain perception as well as electrophysiology concepts like action potentials. The document concludes by discussing pain in unborn children and referencing additional resources.
The document provides an overview of oral mucosa, including its definition, functions, development, classification, components, organization, differences from skin, regional differences, junctions, temperature, turnover time, and age changes. It discusses the epithelium, lamina propria, and their features in different oral regions like hard palate, gingiva, lips, cheek, soft palate, alveolar mucosa, floor of mouth, and tongue. The document concludes with references for further reading.
The document provides an overview of the lymphatic system, describing its key components and functions. It discusses lymph capillaries, lymph vessels, lymph nodes, and how lymph is formed and circulates. The summary highlights that:
1) The lymphatic system helps fight infection and removes cellular waste and debris.
2) It contains lymph capillaries that form lymph fluid from tissue fluids, as well as lymph vessels and lymph nodes that filter and drain lymph back to the bloodstream.
3) Lymph nodes act as filters to trap pathogens and produce immune cells, helping the body fight infection.
The document provides an overview of oral microbiology from birth through adolescence, with a focus on dental caries and periodontal diseases. It discusses the complex microbial communities that inhabit the mouth, including both beneficial and pathogenic bacteria. Key points include:
- The mouth harbors over 600 bacterial species and 100 billion bacteria per mouth.
- Dental plaque is a microbial biofilm that forms on teeth and is the primary etiological factor for dental caries and periodontal diseases.
- Cariogenic bacteria like Streptococcus mutans and lactobacilli are the primary pathogens involved in dental caries. Periodontal diseases involve a shift to anaerobic gram-negative bacteria like Porphyromonas ging
This document provides an overview of Acquired Immunodeficiency Syndrome (AIDS) and the human immunodeficiency virus (HIV) that causes it. It discusses the global prevalence of HIV/AIDS, how the virus works and the stages of HIV infection. Modes of HIV transmission include unprotected sex, contaminated blood or needles and mother-to-child transmission. The document also outlines testing and counseling procedures, treatment options including antiretroviral drugs, prevention methods, and ethical and legal considerations surrounding HIV/AIDS.
This document discusses the pediatric treatment triangle model in dentistry. The pediatric treatment triangle describes the relationship between the child patient, parents, and dentist. It was originally proposed by Dr. GZ Wright in 1975 and later modified by McDonald in 2004 to include societal influences. The success of pediatric dental treatment depends on effective communication and cooperation between all three parties in the triangle relationship. Parental attitudes and anxiety levels can significantly impact a child's behavior and response to dental procedures.
This document discusses the scope of pedodontics. It begins by defining pedodontics as the branch of dentistry concerned with providing comprehensive dental care to children. It then discusses the stages of childhood and aims/objectives of pedodontics, which include a focus on overall health, prevention over treatment, and comprehensive oral healthcare. The document outlines the various areas and specialties within the scope of pedodontics, including restorative dentistry, oral surgery, preventive dentistry, and others. It also discusses behavior management techniques, treating special patients, diagnosis/treatment planning, preventive dentistry procedures, operative procedures, traumatic dental injuries, and the father of pediatric dentistry in India.
This document discusses biomaterials used in dentistry. It defines biomaterials as materials used for structural applications in medicine and dentistry. Biomaterials must be biocompatible, bond to tissues, match tissue appearance, and promote tissue repair. Biomaterials are classified as metals, ceramics, polymers, and composites. Common dental biomaterials discussed include varnishes, bases, amalgam, stainless steel crowns, cements, composites, glass ionomer cement, zinc oxide eugenol, and compomer.
The document summarizes the International Caries Detection and Assessment System (ICDAS). ICDAS provides a standardized system for detecting and coding dental caries, accounting for both enamel and dentine lesions. It has applications in dental education, clinical practice, research, and epidemiology/public health. ICDAS involves visual inspection of clean, dried teeth and codes lesions from 0 to 6 based on their severity. It also provides codes for caries detection associated with restorations and sealants, as well as root surface caries detection.
This document provides an overview of immunology and the oral immunology of dental caries and periodontal diseases. It defines immunity and its types, including innate and acquired immunity. It describes the development and processing of lymphocytes, including T cells in the thymus and B cells in the liver and bone marrow. It explains the development of cell-mediated immunity, involving antigen presentation by macrophages, dendritic cells and B cells to helper T cells. It also briefly mentions the major histocompatibility complex and its role in antigen presentation. In summary, the document covers the key concepts of immunology as they relate to oral health conditions like dental caries and periodontal disease.
This document summarizes glass ionomer cement (GIC). It discusses the composition of GIC powder and liquid, the setting reaction, clinical manipulation, advantages like adhesion and anticariogenic properties, disadvantages like sensitivity to moisture, and indications like luting and ART. It also describes types and modifications of GIC, including resin-modified and giomer versions.
This document provides information about sterilization methods and guidelines. It defines sterilization as a process that destroys all microorganisms. It discusses factors that influence sterilization efficacy like organism load and resistance. Physical sterilization methods covered are heat, radiation, filtration and ultrasonic sterilization. Chemical methods discussed are aldehydes, oxidizing agents, gas sterilization and plasma sterilization. It also covers Spaulding's classification of medical devices and recommended sterilization methods for critical, semi-critical and non-critical devices.
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2. CAN U IMAGINE A DENTAL
EXTRACTION WITHOUT ANY
ANESTHESIA?????
2
3. INTRODUCTION
3
5500 B.C -Isn’t it comforting to know that the dental drill dates back 9,000
years ago and the first local anesthetic only appeared in 1846…………
Does it mean that anesthetics wouldn’t emerge until 1846?
4. “IT NUMBS THE
TONGUE AND TAKES
AWAY BOTH FEELING
AND TASTE”
The History of Local Anesthesia, Malvin e.
RING 4
6. CONTENTS
Definition
Ideal Properties Of LA
History
Structure and activity
Mechanism Of Action
Pharmacokinetics-
Uptake,distribution,
Metabolism,excretion
Factors Affecting LA
Role of vasoconstrictors
Common used drugs (local
anesthetics)
Topical anesthesia
Complications, adverse
effects
Clinical considerations
Recent advances.
Anesthesia and law
Conclusion
References
6
7. DEFINITION
Local anesthesia has been defined as a loss
of sensation in a circumscribed area of the
body caused by depression of excitation in
nerve endings and inhibition of the
conduction process in peripheral nerves.
LA produces loss of sensation without
inducing a loss of consciousness. LA differs
from GA. Malamed.
Malamed SF. Handbook of local anesthesia. 4th ed. St. Louis: Mosby; 1997.
7
8. A local anesthetic is an agent that
interrupts pain impulses in a specific
region of the body without a loss of
patient consciousness. Normally, the
process is completely reversible--the
agent does not produce any residual effect
on the nerve fiber.
8
Robert L. Copeland
11. 11
Nonirritating to the tissues.
Not cause any permanent alteration of
nerve .
Low systemic toxicity.
It must be effective.
Time of onset should be short.
The duration of action must be enough.
12. Desirable properties by Bennett
12
.
Sufficient potency to give complete anesthesia
without the conc. solutions.
No allergic reactions.
Stable in solution & undergo
biotransformation in the body.
Sterile or capable of being sterilized by heat
without deterioration.
14. • COCAINE was the first local anesthetic
isolated from coca leaves by Albert Niemann
in 1860s.
• Newer agents Lidocaine in 1943,
Bupivicaine in 1957 and Prilocaine in 1959.
14
17. CLASSIFICATION
17
ESTER
• Hydrolyzed in
plasma by pseudo-
cholinesterase.
• By-product of
metabolism is
PABA
• cause of allergic
reactions
• include cocaine,
procaine,
tetracaine, and
chloroprocaine
AMIDE
• Metabolized in
the liver to
inactive agents.
• True allergic
reactions are rare.
• lidocaine,
mepivicaine,
prilocaine,
bupivacaine, and
etidocaine
23. METABOLISM
1. Ester-type Local Anesthetics
a. Hydrolyzed in plasma by pseudocholinesterases.
b. Metabolites as PABA imp as may produce allergic
reactions.
2. Amide-type Local Anesthetics: In the liver by CYP P450
EXCRETION:
Kidney is the major excretory route for excretion of
unchanged drug and metabolites
23
24. HENDERSON HASSELBALCH EQUATION
Determines how much of a local anesthetic will be in a
non-ionized vs ionized form Based on tissue pH and
anesthetic Pka.
Injectable local anesthetics are acidic salts of weak bases
(pka=7.5-9.5).
The non-ionized base is what diffuses into the nerve.
Hence If the tissue is infected, the pH more acidic,- less of
the non-ionized drug to cross into the nerve (rendering the
LA less effective)
24
25. FACTORS AFFECTING LA
1. Effect of pH :-
PH ~ ONSET OF ACTION
Acidic pH – slow onset of action
25
2 EFFECT OF LIPOPHILICITY ON ANESTHETIC POTENCY
lipophilic agents are more potent as local
anesthetics
MORE LIPOPHILIC~MORE PENETRATION INTO
THE NERVE
26. Effect of protein binding –
Increased binding increases duration of action
Effect of diffusibility –
Increased diffusibility - decreased time of
onset
Effect of vasodilator activity –
Greater vasodilator activity - decreased
potency and duration of action.
26
27. FACTORS AFFECTING SENSITIVITY OF
NERVE FIBERS
FIBER SIZE
27
TYPE FUNCTION DIAMETER(μ
m)
Conduction
velocity (m/sec)
α Proprioception, somatic
motor
12-20 70-120
β Touch, pressure 5-12 30-70
γ Motor to muscle spindles 3-6 15-30
δ Pain, temperature 2-5 12-30
B Preganglionic autonomic <3 3-15
C-DORSAL
ROOT
Pain 0.4-1.2 0.5-2
SYPMATHETIC Postganglionic
sympathetics
0.3-1.3 0.7-2
28. SUSCEPTIBILITY TO BLOCK - TYPES OF
NERVE FIBERS
In general, small nerve fibers are more
susceptible than large fibers; however,
the type of fiber
degree of myelination
fiber length and
frequency- dependence are also important.
28
29. ORDER OF SENSORY FUNCTION BLOCK
1. PAIN
2. COLD
3. WARMTH
4. TOUCH
5. DEEP PRESSURE
6. MOTOR
Recovery in reverse order
29
31. IMPROTANCE OF VASOCONSTRICTORS
Malamed SF. Handbook of local anesthesia. 4th ed. St. Louis: Mosby; 1997. 31
It slows absorption of
LA into blood stream
and thus reduces
toxicity
Increases duration of
action
Provides clean
bloodless field
32. SYMPATHOMIMETIC AMINES ACT BY
Attaching directly to stimulating adrenergic
receptors.
Acting indirectly by provoking release of
endogenous catecholamine from their
intraneuronal storage sites;
A combination of direct and indirect actions.
32
33. DRUG INTERACTIONS WITH EPINEPHRINE AND
LEVONORDEFRIN
Nonselective ß-blockers-
Tricyclic antidepressants-
General anesthetic (halothane ,
Fluothane] serious cardiac
dysrhythmia
Cocaine
So, FELYPRESSIN SAFER. 33
34. Examples of calculations of doses of vasoconstrictors
• Ratio concentrations represent grams per millilitre
• 1:100,000 = 0.01 mg/mL or 10 μg/mL
• 1:200,000 = 0.005 mg/mL or 5 μg/mL
• 1:50,000 = 0.02 mg/mL or 20 μg/mL
• 1 cartridge of epinephrine 1:200,000 = 9 μg
• 1 cartridge of epinephrine 1:100,000 = 18 μg
• 1 cartridge of epinephrine 1:50,000 = 36 μg
• 1 cartridge of levonordefrin 1:20,000 = 90 μg
34
The most common agent is epinephrine, which is available in
formulations of 1:50,000, 1:100,000 in USA and 1:200,000 in
other countries.
36. AAPD Recommendations:
1. Selection of local anesthetic agents should be
based upon:
a. The patient’s medical history and
mental/developmental status;
b. The anticipated duration of the dental procedure;
c. the need for hemorrhage control;
d. The planned administration of other agents (eg,
nitrous oxide, sedative agents, general anesthesia)
e. The practitioner’s knowledge agent.
36
37. 2. Use of vasoconstrictors in local anesthetics is
recommended to decrease the risk of toxicity of
the anesthetic agent.
3. In cases of bisulfate allergy, use of a local
anesthetic without a vasoconstrictor is indicated.
4. The established maximum dosage for any
anesthetic should not be exceeded.
AAPD GUIDELINES 37
38. procaine
• Ester type local anesthetic
• Slower onset of action than lidocaine
• Duration of action is approx one hr.
• Metabolized in the plasma.
• Infiltration: 0.25%, 0.5%
• Nerve block: 1.0%, 2.0%
• Maximum dose 11 mg/kg or 13 mg/kg
with Epinephrine
• Toxic IV dose: 450 mg
38
39. Chloroprocaine
• It is a benzoic acid ester and short-acting local
anesthetic.
• Onset of action is rapid (6-12 min.)
• Duration of anesthesia is up to 60 min.
• Ineffective for topical anesthesia.
39
40. DOSES AND ROUTE
• Local infiltration: 2.0%, 3.0% for motor
block
• Peripheral nerve block: 1.0%, 2.0%
• Maximum dose 11 mg/kg or 13 mg/kg with
Epinephrine
• Toxic IV dose: 450 mg
40
41. LIGNOCAINE
In 1943, the first modern LA agent trade
name Xylocaine® By Lofgren.
Derivative of xylidine
Belongs to the amide class, it’s
hypoallergenic
Sets on quickly and produces a desired
anesthesia effect for several hours 41
42. Onset for infiltration is 0.5 to 1 minute.
Duration- 30 minutes to 1 hour.
42
This drug is also a class1B antidysrhythmic
agent that suppresses automaticity and
shortens the effective refractory period and
action potential duration of the His/Purkinje
system
43. DOSE AND ROUTES LIDOCAINE
Regional infiltration: 0.5%
Peripheral nerve: 1.0%, 1.5%,
2.0%
Max dose 4 mg/kg or 7 mg/kg with
epinephrine
Toxic IV dose: 250 mg
Repeated doses cause significant increases in blood
level because of slow accumulation
43
44. ADVERSE REACTIONS, PRECAUTIONS, AND
INTERACTIONS
Contraindicated in patients with a known
sensitivity to amide anesthetics
All LA can produce CNS stimulation,
depression, or both
Use with caution in patients with hypovolemia,
severe congestive heart failure, shock, and all
forms of heart block.
44
45. BUPIVICAINE
Amide-type local anesthetic
Onset of action is slower than lidocaine and
anesthesia is long acting
Metabolized in the liver and excreted by the
kidneys.
Normally provides 2-4 hours of anesthesia
Can be extended in some cases by using
solution with epinephrine to 7 hours
45
46. DOSES :-
Local infiltration: 0.25%
Peripheral nerve block: 0.25%, 0.5%
Maximum dose 3 mg/kg or 4 mg/kg with
Epinephrine
Toxic IV dose 80 mg
Not recommended for the child or the
physically or mentally disabled.
46
47. ARTICAINE
Amide type
Synthesized in 1969 in Germany,
In April 2000, the U.S. FDA approved
4 percent articaine with 1:100,000
epinephrine, as septocaine
(septodont
47
48. The primary metabolite, articainic acid, is
inactive. Eliminated via the kidneys.
The use of 2% articaine in pediatric dentistry
is particularly advantageous because of the
lower C max and the shorter half-life.
Serum Levels of Articaine 2% and 4% in
Children.
W. Jakobs,, B. Ladwig, P. Cichon, R. Ortel, Kirch, Anesth Prog 42:113-115 1995. 48
49. Expected duration of action of local
anesthetics Duration of action (min
49
Maxillary infiltration Inferior alveolar block
Formulation Pulp Soft tissue Pulp Soft
Articaine 4% with epinephrine 1:100,000 or 1:200,000 60 190 90 230
Bupivacaine 0.5% with epinephrine 1:200,000 40 340 240 440
Lidocaine 2% with epinephrine 1:50,000 or 1:100,000 60 170 85 190
Mepivacaine 2% with levonordefrin 1:20,000 50 130 75 185
Mepivacaine 3% plain 25 90 40 165
Prilocaine 4% with epinephrine 1:200,000 40 140 60 220
Prilocaine 4% plain 20 105 55 190
50. RECOMMENDED MAXIMUM DOSES OF
LOCAL ANESTHETICS WITH VASOCONSTRICTOR
3% solution without vasoconstrictor
50
DRUG MAXIMUM DOSE MAX NO. OF
CARTRGES
Articaine 7 mg/kg (up to 500 mg)
5 mg/kg in children
7
Bupivacaine 2 mg/kg (up to 200 mg 10
Lidocaine 7 mg/kg (up to 500 mg 13
Mepivacaine 6.6 mg/kg (up to 400 mg) 11 , 7 if plain
Prilocaine 8 mg/kg (up to 500 mg 8
An Update on Local Anesthetics in Dentistry, Daniel A. Haas, J Can Dent Assoc 2002; 68(9):546-51
52. • Topical anesthetic is effective on
surface tissues (2-3 mm in depth) to
reduce painful needle penetration of
the oral mucosa.
• A variety of agents are available in
Gel,
Liquid,
Ointment,
Patch,
Aerosol forms.
52
53. Benzocaine conc. up to 20%;
Benzocaine has a rapid onset. Not toxic.
• lidocaine is available as a solution or
ointment up to 5% and as a spray up to
a 10% conc.
• Topical lidocaine has low incidence of
allergic reactions, but increase the risk
of overdose
53
54. • Compounded topical anesthetics have
been used in:-
• Orthodontic procedures for placement of
mini-screw implants to aid tooth
movement,
• In pediatric dentistry to anesthetize
palatal tissues prior to injection and for
extraction of loose primary teeth without
the need for an injection.
54
55. • Recommendations:
• 1. Topical anesthetic to reduce discomfort associated
with needle penetration.
• 2. The pharmacological properties of the topical
agent should be understood.
• 3. A metered spray is suggested if an aerosol
preparation is selected.
• 4. Systemic absorption of the drugs in topical
anesthetics must be considered when calculating the
total amount of anesthetic administered.
• The AAPD recommends further investigation
regarding the safety and efficacy of compounded
topical anesthetics and their applications for pediatric
dental patients
55
56. ADVERSE REACTIONS OF LOCAL ANESTHETICS
Psychogenic
Syncope
Hyperventilation
Nausea, vomiting
Alterations in heart rate or blood pressure
Mimicking of an allergic reaction
ALLERGIC (POTENTIAL ALLERGENS)
Esters (true amide allergy is very rare)
Metabisulfite (present with epinephrine and with
levonordefrin)
Methylparaben (no longer added to dental
cartridges)
56
58. METHEMOGLOBINEMIA
Prilocaine, articaine, benzocaine. It is
induced by an excess of the metabolites of
these drugs and manifests as a cyanotic
appearance that does not respond to the
administration of 100% oxygen.
Prilocaine C/I in methemoglobinemia, sickle
cell anemia, hypoxia or
Acetaminophen or Phenacetin, both elevate
methemoglobin levels.
58
60. SOFT TISSUE INJURY
Most lip- and cheek-biting lesions are self-
limiting and heal easily,
bleeding and infection may result.
To avoid use:-
use pheytolamine mesylate injections to
reduce the duration of action.
Placing a cotton roll - mucobuccal fold may
help prevent injury, lubricating the lips with
petroleum jelly helps prevent drying.
60
62. Pregnant and Lactating Women
• Lidocaine and prilocaine have
the best FDA ranking.
• Although high-dose
vasoconstrictors used to manage
hypotension may be a concern
for pregnant patients,
• the doses of epinephrine used in
formulations are so low that they
are unlikely to affect uterine
blood flow.
62
63. Children
• Determine the child’s
weight and age , to avoid
overdosage.
• Thus, 2% lidocaine with
epinephrine 1:100,000
may be the ideal local
anesthetic for a child.
63
64. ELDERLY
There are no significant differences in the
response to local anesthetics between
younger and older adults.
64
65. CARDIOVASCULAR DISEASES
For such patients dental treatment may
be routine fashion,but amount of
vasoconstrictor- containing anesthetics
need to be limited
Patient carefully monitored.
Dose- .04 mg per appointment.
2ml of 1:50,000 (1 cartridge)
65
66. HYPERTENSION
If a patient has uncontrolled hypertension,
dental treatment -delayed until BP under
control.
But if emergency treatment is needed, the
clinician may elect to sedate the patient
with valium and use one to two cartridges
of local anesthetics with a
vasoconstrictors.
66
67. ANGINA PECTORIS AND POST-MYOCARDIAL
INFARCTION
The use vasoconstrictor should be
limited.
Only emergency treatment is done stress-
reduction protocols with antianxiety
agents.
67
68. CEREBROVASCULAR ACCIDENT
No dental treatment performed Six months
after stroke .
After six months, dental procedures may be
provide with the use of vasoconstrictors-
containing local anesthetics where required
for adequate pain control.
68
69. DIABETES
No special precaution required if control of
their disease is well-managed.
69
70. LOCAL ANESTHESIA WITH SEDATION, GENERAL ANESTHESIA,
AND/OR NITROUS OXIDE/OXYGEN ANALGESIA/ANXIOLYSIS
Particular attention on LA doses used in
children.
The dosage of local anesthetic should not be
altered if nitrous oxide/oxygen
analgesia/anxiolysis is administered.
When general anesthesia is employed, LA may
be used to reduce the maintenance dosage of
the anesthetic drugs. The anesthesiologist
should be informed of the type and dosage of
the local anesthetic used.
Recovery room personnel also should be
informed
70
72. ELMA
EUTECTIC MIXTURE OF LA.
Clark in 1986.
Cream with mixture of lignocaine and
prilocaine.
Used as anesthesia on intact skin before
venipuncture.
c/I in children below 6yrs
Rashes and erythema seen.
72
73. CENTBURIDINE- Quinoline derivative
no side effects
ROPIVACAINE – Long acting amide, has
greater safety margin , less toxicity than
bupivicaine.
pH ALTERATION- sodium bicarbonate is
being added immediate to injection , which
makes solution alkaline and thus increases
its absorption into nerve.
73
74. CARBONDIOXIDE – Enhances diffusion
of LA, so more rapid onset of action
INTRAORAL LIGNOCAINE PATCH
10-20% Lignocaine can be used on buccal
mucosa for 15 mins.
ELECTRONIC DENTAL ANESTHESIA –
Use principle of transcutaneous electric nerve
stimulation which relives pain. Pain control
in case of needle phobia.
74
75. JET INJECTIONS
75
Solution is propelled out into mucosa as a jet
without any needle.
Effective for palatal anesthesia.
76. "when it comes to the actual fear of needles..well
one thing i have found that helps the most with that
is a numbing machine called 'THE WAND'
76
77. THE MAGIC WAND COMPUDENT OR
STA SYSTEM
The Wand is essentially a computer-controlled
dental injection.
ADVANTAGES
non-threatening . Researchers have found
that the Wand induces less anxiety (Kudo et
al, 2001)
DISAVANTAGES
Costly, takes more time and space in clinic.
77
79. INFORMED CONSENT – THE VERDICT IS IN
Anesthesia specific consent form should
be implemented, all risk factors should
be highlighted….as a defense for various
medical issues.
79
80. DOCUMENTATION OF LOCAL ANESTHESIA
AAPD Recommendations:
1. Documentation must include the type and
dosage of LA. Dosage of vasoconstrictors
must be noted.
2. Documentation may include the type of
injection(s) given (eg, infiltration, block,
intraosseous), needle selection and patient’s
reaction to the injection.
80
81. If the LA was administered in conjunction
with sedative drugs, the doses of all agents
must be noted on a time-based record.
4. For whom maximum dosage of LA may
be a concern, the weight should be
documented pre-op.
5. Documentation should include that post-
injection instructions were reviewed with the
patient and parent.
81
83. REFERENCES
Malamed SF. Handbook of local anesthesia. 4th
ed. St. Louis: Mosby; 1997.
Monheims local anesthesia and pain control in
dental practice.
Textbook of Pedodontics- Shobha Tondon
An Update on Local Anesthetics in Dentistry,
Daniel A. Haas, J Can Dent Assoc 2002;
68(9):546-51
Guide lines for local anesthesia in pediatric
patients.(AAPD) pediatric dentistry 2009.
Local Anesthetics in Dentistry, Bach Van Pham
,Southern Methodist University; November 30, 83
84. Local Anesthetics; Robert L. Copeland
Lidocaine Toxicity - Pushkar Mehra, Alfons Caiazzo,
and Philip Maloney.
Essentials of Local Anesthetic Pharmacology.
Daniel E. Becker, DDS, and Kenneth L. Reed,
Anesth Prog 53:98–109 2006
The History of Local Anesthesia, Malvin e. RING.
www.wikipedia.com
Effectiveness of 20% Benzocaine as a Topical
anesthetic for Intraoral Injections. John M. Nusstein,
and Mike Beck, Anesth Prog 50:159-163 2003.
84
Though many people still cringe at the mere idea of a dentist’s chair, the sounds of drills and saliva-vacuums are music to my ears, when I think about some of the tools and methods dentists have used through time.
Here is a brief history of dentistry and how it has evolved through the ages
He tried chewing some and reported that “it numbs the tongue and takes away both feeling and taste.” Unfortunately, he did not consider its value as an anesthetic in surgery,,, he began experimenting with cocaine. In 884, he published a famous paper “Über Cocaine.”
“sit in cold water until it be deadened; then draw him up. Then cut four scarifications around the pocks and let drip as long as he will.”
A dramatic use of refrigeration anesthesia occurred during Napoleon’s retreat from Moscow. When his surgeon general, Baron Larrey, needed to amputate mangled legs of some soldiers, he found that those who were almost frozen stiff felt no pain
Prevention of pain during dental procedures can nurture the relationship of the patient and dentist, building trust, allaying fear and anxiety, and promoting a positive dental attitude. The technique of local anesthetic administration is an important consideration in the behavior guidance of a pediatric patient. Age-appropriate “nonthreatening” terminology, distraction, topical anesthetics, proper injection technique, and nitrous oxide/oxygen analgesia/anxiolysis can help the patient have a positive experience during administration of local anesthesia. In pediatric dentistry, the dental professional should be aware of proper dosage (based on weight) to minimize the chance of toxicity and the prolonged duration of anesthesia, which can lead to accidental lip or tongue trauma
It must be effective regardless of whether it is injected into the tissue or applied locally to mucous membranes
The duration of action must be enough to permit completion of procedure yet not so long as to require an extended recovery
Aromatic portion– Responsible for lipophilicity of compounds, i.e., lipid/water distribution and protein binding characteristics.
2. Amine portion– usually a secondary or tertiary amine and is associated with water solubility of the compounds, but is not necessary for anesthetic activity. Compounds lacking the amine portion are insoluble in water and useful only topically.
3. Intermediate linkage– connected to aromatic residue via an ester or amide linkage. Type of linkage important in determining the route of metabolism and the allergic potential of the compounds.
4. Other classes of compounds– not usually classified as local anesthetics, but share this same general structure and thus exhibit local anesthetic properties: beta-blocking agents , antihistamines (e.g. diphenhydramine
Local anesthetic action. An injected local anesthetic exists in equilibrium as a quaternary salt (BH) and tertiary base (B). The proportion of each is determined by the pKa of the anesthetic and the pH of the tissue. The lipid-soluble species
(B) is essential for penetration of both the epineurium and neuronal membrane. Once the molecule reaches the axoplasm of the neuron, the amine gains a hydrogen ion, and this ionized, quaternary form (BH) is responsible for the actual blockade of the sodium channel. Presumably, it binds within the sodium channel near the inner surface of the neuronal membrane
Vasoconstrictors are invaluable to local anesthesia in dentistry. It improves the depth and duration of anesthesia. Without them, local anesthetics have a very short duration of action intraorally.
Interaction may result in increased blood pressure, Reduced use of vasconstrictor is warranted.
Levonordefrin is contraindicated
Anesthetist should be advised as to whether epinephrine is needed in local anesthetic; epinephrine should be limited to 1 μg/kg if thiopental is used and 2 μg/kg otherwise
Reduced dose of epinephrine is warranted
The recommendation to keep doses below 0.04 mg is arbitrary but can act as a guide.
Systemic epinephrine has a brief duration of action (approximately 10 minutes), so if more is required, injections can be repeated. If multiple quadrants are being treated, the timing of the injections should be spread out.
Minimizing the likelihood of systemic effects of vasoconstrictors is another reason why aspiration before every injection is so important
The duration of bupivicaine is significantly longer than with any other commonly used local anesthetic
A long-acting local anesthetic, patient due to its prolonged effect, which increases the risk of soft tissue injury
Fear of the needle has been reported as one of the
major causes of apprehension in dental patients.1-3
Patients have reported that the feeling of the needle being
inserted into the tissue is a chief source of anxiety. Topical anesthesia has been advocated for the
reduction of a patient's anxiety and pain.
Compounded topical anesthetics also are available.14,15 Two of the more common formulations contain 20% lidocaine, 4% tetracaine, and 2% phenylephrine or 10% lidocaine, 10% prilocaine, 4% tetracaine, and 2% phenylephrine
A patient may be allergic to other compounds in the anesthetic cartridge. For example, methylparabens are preservatives necessary for multidose vials and were present in dental cartridges in the past. They are no longer included as dental cartridges are single-use items. Allergy to para-aminobenzoic acid would rule out use of esters and methylparabens. It may be best to avoid a vasoconstrictor if there is a true documented allergy to sulfites, as metabisulfite is added as an antioxidant whenever vasoconstrictor is present. Vasoconstrictor can be used in patients with an allergy to the sulfonamide antibacterials, commonly called sulfa, as there is no cross-allergenicity with sulfites
patients with congenital methemoglobinemia
Use of phentolamine mesylate injections in patients over age 6 years or at least 15 kg has been shown to reduce the duration of effects of local anesthetic by about 47% in the maxilla and 67% in the mandible
This dose will have minimal physiologic effect and will provide prolonged anesthesia
The majority of local anesthesia procedures in pediatric dentistry involve traditional methods of infiltration or nerve block techniques with a dental syringe, disposable cartridges, and needles as described so far
The precise control of flow rate and pressure reliably produces a comfortable injection even in potentially more "difficult" areas like the palate, where the tissue is less elastic.
Many dentists enjoy the light weight and easy handling. The penlike grasp allows the operator to rotate the handpiece, which can make it easier to glide the needle into the tissue.
Two "fancy" injection techniques (the AMSA and P-ASA, for the nerds among you) are much more comfortable and effective when the Wand is used.
The patient record is an essential component of the delivery of competent and quality oral health care.
Following each appointment, an entry is made.
For ex, 34 mg lido with 0.017 mg epi or 34 mg lido with 1:100,000 epi.