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Local Anesthetic (Vasoconstrictors (Dosage (epi (1:50,000, 1:100,000, 1…

- - - - stress hormone
        
        sympathetic nervous system (fight/flight)
  - - - freely soluble in dilute acidic soln
    - - need more of it (1:20,000)
        
        mepivacaine with levo = similar depth and duration as lido with epi
  - - - decreases risk of adverse rxn
  - - - can result in angina
    - - dilation of bronchiole smooth muscles
    - - low pH of solution
        
        caused by preservatives FOR vasoconstrictors
  - - - 1:20,000
    - - 1:50,000
      - 1:100,000
      - 1:200,000
    - - LESS vasoconstrictor present
    - - DEPENDS ON PATIENT HEALTH
        
        Healthy: 0.2mg epi / appointment and 1mg of levo / appointment
        
        Cardio Problems: 0.04mg epi / appointment and 0.2mg levo / appointment
- - - - drug becomes inactive
    - - 6 half-lives to almost completely eliminate drug (98%)
  - - - PABA (para-aminobenzoic acid ) is produced as a result of hydrolysis
        
        this can cause allergic reaction
      - if a patient has atypical pseudocholinesterase they are at higher risk for toxicity
  - - - articaine is an exception. 90-95% in the blood and 5-10% liver
      - can be a problem when patients have poor liver function
      - cardio problems slow blood circulation reducing the amount of drug reaching the liver. Relative contraindication
  - - - drugs and metabolites leave the body
        
        via kidneys
        
        small % leave unchanged (in urine)
        
        renal diseases slow down elimination
        
        pregnancy can disturb kidney function
- - - - the barrier maintains homeostasis and protects from certain substances
    - - excitation
        
        agitation
        
        numbness
        
        dizziness
        
        tinnitus
        
        metallic taste
        
        paraesthesia
        
        disorientation
        
        confusion
        
        twitching
        
        talkativeness
        
        anxiety
        
        seizure
        
        shivering
      - depression
        
        drowsiness
        
        profound hypotension
        
        unconsciousness
        
        arrhythmia
        
        cardio vascular collapse
        
        seizure
        
        respiratory arrest
      - if either is observed in 5-10min of admin. suspect serious toxicity
  - - - affects patient in expected time-frame and manner (70%)
        
        example: 60min pulpal anesthesia with Lido
    - - affects patient longer than expected (15%)
    - - affects patients less than expected
        
        at more risk of overdose because we need to give more carps
- - - - no-longer used
  - - - creates 1-2mm bubble
- - - - procaine
        
        Novacaine and is no longer available
      - propoxycaine
      - cocaine
      - Benzocaine
  - - - Lidocaine
        
        Xylocaine
        
        Pregnancy B
        
        MRD: 500mg or 3.2mg/lb
        
        2% drug with 60min pulpal and 3-5hr soft tissue
        
        1/2 life: 1.9hrs
        
        Gold Standard
      - prilocaine
        
        Citanest (Citanest Forte if epi)
        
        Pregnancy B
        
        MRD: 600mg or 4.9 mg/lb
        
        4% with epi (1:200,000): 60-90min pulpal and 3-5hrs soft tissue
        
        4% plain
        
        block: 40-60min pulpal, 2-4hrs soft tissue
        
        infil: 10-15min pulpal, 1.5-2hrs soft tissue
        
        1/2 life: 1.6hrs
        
        Methemoglobinemia
        
        cyanosis
        
        respiratory distress
        
        NOT USED FOR IA BLOCK
      - articaine
        
        Septocaine
        
        liver AND PLASMA
        
        pregnancy C
        
        MRD: 500mg or 3.2mg/lb
        
        4% 1:100k: 60-75min pulpal, 3-6hrs soft tissue
        
        4% 1:200k: 45-60min pulpal, 2-5hr soft tissue
        
        1/2 life: 0.5hrs
        
        due to dual metabolism and mostly in plasma
        
        diffuses soft and hard tissues more reliably
        
        could have higher paresthesia risk
      - mepivacaine
        
        Carbocaine
        
        least vasodilation
        
        Pregnancy C
        
        MRD: 400mg or 3.0mg/lb
        
        2% (1:20,000 levo) 60min pulpal, 3-5hr soft tissue
        
        3% (plain): 20min infil or 40min block pulpal, 2-3 hrs soft tissue
        
        best used when vasoconstrictors are contraindicated or quick dental procedure
        
        1/2 life: 1.9hrs
      - bupivacaine
        
        Marcaine
        
        Pregnancy C
        
        MRD: 90mg or 0.9mg/lb (canada)
        
        0.5% 1:200k: 90-180min pulpal, 4-9hrs soft tissue
        
        4x more potent/toxic than lido and mepivacaine
        
        used for longer procedures
        
        management of post op pain
  - - - muliply by carp mls (1.8)
    - - under 18
        
        if under 150#: patient weight x mg/# number
        
        Lido and Mepivacaine: 300mg or 2mg/lb
        
        Articaine: 500mg or 3.2mg/lb
        
        Prilocaine: 400mg or 2.7mg/lb
        
        Bupivacaine: 90mg or 0.6mg/lb