la in children

8/2/2019 La in Children

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Group 2



A) Toxicity (overdose)–

caused by single inadvertentintravascular injection or repeated injections.

B) Paresthesia – persistent anesthesia beyond expectedduration.can be caused by trauma of the needle to thenerve or hemorrhage in and around the nerve.

C) Postoperative soft tissue injury – most lip and cheekbiting lesion of this nature are self-limiting and heal without complications although bleeding andinfection possibly may result.[traumatic ulcer (the

child chewed at that area)]

Ref : Guideline on Use of Local Anesthesia for Pediatric Dental Patients



1. DermatologicalSigns and symptoms

Urticaria (wheals-smooth elevated patches of skin) -most common

Pruritus (intense itching)

Angioedema (localized swelling in response to allergen- more common after exposure to topical anesthetic within 30-60 minutes

Managements

If only skin reaction, not usually life threating, unlessrapid progression to other reactions



2. Respiratory Signs and symptoms

Bronchospasm (classic response - in lower airway) Respiratory distress, dyspnea, wheezing, flushing, cyanosis, perspiration,tachycardia, increase anxiety, use of accessory muscles of respiration

Management

Bronchospasm- terminate dental therapy. Place patient in semi-erect position. Oxygen (5-6 liters per minute) Epinephrine or bronchodilator every 5 minutes as needed. Observe patient for 60 minutes before discharge. If relapse, repeat epinephrine, call EMS. Histamine blocker. Medical consult - transfer to hospital or release, depending on

advice. Prescribe oral histamine blocker and thorough allergy evaluation

before subsequent dental therapy



3. Psychogenic

• Syncope (fainting)

• Hyperventilation

• Nausea and vomiting

• Increases or decreases in heart rate• Increases or decreases in blood pressure

• Appearance as allergic reaction

4. Allergy

Potential allergens:

• Esters• Amide allergy very rare; if so, amides are not expected to cross-react

• Metabisulfite (present with epinephrine or levonordefrin)

5. Toxicity

• May initially present as sedation, lightheadedness, slurred speech, mood alteration,

diplopia, sensory disturbances, disorientation, muscle twitching• Higher blood levels may result in tremors, respiratory depression, tonic/clonic seizures

• If severe, may result in coma, respiratory arrest, cardiovascular collapse

6. Methemoglobinemia

• Associated primarily with prilocaine; to a lesser extent with articaine, benzocaine



7.1 Early phase skin reactions :

Patient complains of feeling sick,intense itching, flushing, giant hivesover face and upper chest.Conjunctivitis. Vasomotor rhinitis.Pilomotor erection

7.2 Gastrointestinal and orgenitourinary reactions :

Severe abdominal cramps. Nausea and vomiting. Diarrhea. Fecal and urinary incontinence

7.3 Respiratory reactions :

Substernal tightness or pain in chest.Cough may develope. Wheezing,Dyspnea. Cyanosis of mucousmembranes and nail beds. Possiblelaryngeal edema

7.4 Cardiovascular reactions :

Pallor. Light-headedness. Palpitations.Tachycardia. Hypotension. Cardiacdysrhythmias. Unconsciousness.Cardiac arrest. Death.

***Reaction may last minutes or days

7. Generalizedanaphylaxis reaction



Position patient (unconscious patient in supine position with legs elevated slightly)BLS as needed - airway, breathing, circulation

Summon medical assistance

Administer epinephrine 0.3 ml of 1:1000 IM of IV (second dose after 5 minutes if noimprovement) Oxygen.

Monitor vital signs.

After improvement - not drug acute phase (wait until BP has increase andbronchospasm decreased) Histamine blocker. Corticosteroids

If no sign of allergy, but patient loses consciouness. Terminate treatment. Positionpatent supine with legs slightly elevated. BLS as indicated. Summon medicalassistance. Oxygen. Monitor vital signs. Definitive management once emergencymedical personnel assess, stabilize and possibly transport to hospital if necessary



Drug Maximum dose

Articaine 4% with epinephrine 7 mg/kg in adults (up to 500 mg) 5mg/kg in children

Bupivacaine 0.5% withepinephrine

2 mg/kg (up to 200 mg)

Lidocaine 2% with epinephrine 7 mg/kg (up to 500 mg)

Mepivacaine 2% with

levonordefrin

6.6 mg/kg (up to 400 mg)

Mepivacaine 3% plain 6.6 mg/kg (up to 400 mg)

Prilocaine 4% plain or withepinephrine

8 mg/kg (up to 500 mg)



SCANDONEST® 2% L(WITH LEVONORDEFRIN 1:20,000)(Mepivacaine hydrochloride and Levonordefrininjection, USP)

Each cartridge contains 1.7 mL (34 mg of 2% or 51 mgof 3%).



Cartridge

Each mL contains: 2% 3%

Mepivacaine hydrochloride 20 mg 30 mg

Levonordefrin (vasoconstrictor) 0.05 mg -

Sodium chloride 4 mg 6 mg

Potassium metabisulfite(antioxidant) 1.2 mg

Edetate disodium(chelating agent) 0.25 mg

Sodium hydroxide q.s. ad pH

Hydrochloric acid (pH adjusting agent) 0.5 mg

Water for injections q.s. ad 1 mL 1 mL

The pH of the 2% cartridge solution is adjusted between 3.3 and 5.5 with NaOH

The pH of the 3% cartridge solution is adjusted between 4.5 and 6.8 with NaOH



Percent solutions represent grams per 100 mL

Move the decimal place to the right and this value= mg/mL (i.e. lidocaine 2% = 20 mg/mL)

Most cartridges = 1.8 mL.

Therefore, one cartridge of 2% lidocaine contains1.8 mL x 20 mg/mL = 36 mg.



Mepivacaine

6.6 mg/kg x 20 kg = 132 mg 3% mepivacaine = 30 mg/mL 132 mg / (30 mg/mL) = 4.4 mL Each cartridge = 1.8 mL, therefore maximum

dose = 4.4 mL / 1.8 mL Therefore maximum dose = 2.4 cartridges



Maximum dose is 7mg/kg, up to 500mg• For 25kg child,

7mg/kg x 25kg = 175mg

Lidocaine 2% = 2g/100ml

= 2000mg/100ml

= 20mg/ml

• Maximum amount = 175mg/(20mg/ml)

= 8.75mlEach catridge = 1.8ml

• Maximum catridge = 8.75ml/1.8ml

= 4.86 catridge

la in children

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