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Anesthesia in Dentistry

Anesthesia in Dentistry

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Published by: Sophorn Sok on Aug 17, 2011
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Anesthesia In Dentistry

Anesthesia In Dentistry
Dentistry was often a painful and even a barbarous affair . Relieving pain is one of the important subject in dentistry . Many procedures could not be done properly unless pain is well controlled ; ex. Fillings , extraction , periodontal procedures , root canal treatment , minor or major surgeries , etc ..

Anesthesia In Dentistry (contd«) 

Some important definitions
‡Anesthesia : The loss or abolition of all modalities of sensations which includes : Pain , touch , temperature , and pressure . ‡General anesthesia : becomes unconscious . Achieved when the patient

‡Local anesthesia : The patient remain conscious but the anesthesia is localized to one part only .

Anesthesia In Dentistry (contd«) ‡Infiltration anesthesia : Deposit of solution in the region to be anesthetized and permeates through the tissue to affect fine nerve endings . . ‡Topical or surface anesthesia : Local anesthetic applied on an intact mucous membrane to anesthetize the nerve endings . ‡Block anesthesia : To anesthetize a region by blocking the conduction in the nerve trunk supplying the area .

Local anesthetic action starting to work or wearing off .g.A damaged sensory nerve is regenerating . ‡Sedatives : Produce sedation and relieve anxiety by acting on the CNS ( e.A. . L.Anesthesia In Dentistry (contd«) ‡Paresthesia : Altered sensation occurred when : . and air . Valium (Diazepam) ) . ‡Relative analgesic : A sedation technique in which the patient remains conscious but mental relaxation is induced by inhalation of a mixture of nitrous oxide . is used as adjacent when necessary . .Described as tingling sensation or pins and needles . oxygen .

Neurophysiology A ± Desirable properties of local anesthetics.      . How local anesthetics work. ‡ B ± Fundamentals of impulse generation and ‡ transmission: Nerve anatomy. Basic concepts of pain. Electrophysiology of nerve conduction. Physiology of the peripheral nerves.

There are many methods of inducing local anesthesia . . * Anoxia. * Low temperature. * Neurolytic agents such as alcohol and phenol. * Chemical irritants. some of which follow: * Mechanical trauma. * Chemical agents such as local anesthetics.A ± Desirable properties of local anesthetics . 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 or an inhibition of the conduction process in peripheral nerves.

local anesthetics act by preventing this entry of sodium ions and stopping propagation of electrical transmission by inhibiting nerve cell depolarization.Electrophysiology of nerve conduction (contd«) # In simple terms. .

 Types of local anesthesia a) Topical b) Infiltration c) Regional .Local anesthesia is defined as a loss of sensation in circumscribed area of the body caused by a depression of excitation in nerve endings or an inhibition of the conduction process in peripheral nerves.Pharmacology Of Local Anesthetics .

A.Pharmacology Of Local Anesthetics (contd«) Methods Of Inducing L.L.A.A. should prevent the conduction and generation of nerve impulse. a) Mechanical trauma b) Low temperature c) Chemical irritants d) Neurolytic agents such as alcohol or phenol e) Chemical agents as in L. . .

constitute the major categories of local anesthetics. it is derived from benzoic acid or aniline. Aromatic in structure.  The Lipophilic part is the largest portion of the molecule. Esters. .Local anesthetic I ± Classification of anesthetic agents :  Amides.  The Hydrophilic part is an amino derivative of ethyl alcohol or acetic acid .  The Ketone-linkage class of anesthesia has relatively little clinical importance and currently consists of a single topical agents.

Sodium bisulfite is commonly used. in a concentration between 0.   .1 %. is acidified to 4. a  Local anesthetic solutions that contain a vasopressor (e.g. thereby prolonging the period of the drug effectiveness.5 and 7. with a pH of 6.II ± Clinical Implications of pH and Local Anesthetic Activity (contd«)  Most solutions of local anesthetics without vasoconstrictor have a pH between 5. A 2 % solution of Lidocaine..2 by the addition of Sodium bisulfite.05 % and 0. Epinephrine) are acidified by the manufacturer to retard oxidation of the vasoconstrictor.8.

 Solution Of Local Anesthetic L.A. drug Vasopressor drug ------------preservative for vasopressor Sodium chloride Distilled water .

Pharmacology Of Vasoconstrictors After injection of local anesthetic ( L.A. blood vessels in the area dilate resulting in increased blood flow to the site . ) ‡ into the tissue . .

S. with its turn remove it from the injection site .A. administration to increased perfusion . . . with increased risk of c) Decreased duration of action and decreased depth of anesthesia . d) Increased bleeding at the site of L. b) Higher plasma level of the L.Pharmacology Of Vasoconstrictors (contd«) - This increase perfusion leads to the following reactions : a) Increased rate of absorption of the L.A. into the C.V. toxicity .A.

S.Vasoconstrictors are highly important additions to a local anesthetic solution .A.Pharmacology Of Vasoconstrictors (contd«) . therefore increase the duration of action of L. e) Decrease bleeding at the site of administration and surgical site . resulting in lower anesthetic blood level . agent remains around the nerve for longer periods . b) Absorption of the L. the vasoconstrictors ( V.A. .A. ) . d) Higher volume of the L.A. into C. toxicity . is slowed .V. for the following reasons : a) By constricting blood vessels ( B.V. ) decrease blood flow to the site of injection . c) Lower anesthetic blood level decreases the risk of L.C.

Types Of Vasoconstrictors ( Sympathomimetic or Adrenergic ) drugs 1) Catecholamines : .Amphetamine .Epinephrine .Nor-Epinephrine .Ephedrine 3) Felypressin ---Synthetic analogue hormone ) ( anti-diuretic .Dopamine 2) Non-catecholamines .

Ahlquist in 1948 recognized two types of adrenergic receptors .Adrenergic Receptors Adrenergic receptors are found in most tissues of the body . termed alpha and beta based on the inhibitory or excitatory actions of catecholamines on smooth muscle .

Adrenergic Receptors (contd«) 1) Alpha [ ] receptors : Activation of [ ] receptors by a sympathomimetic drug usually produces a response that includes the contraction of smooth muscle in blood vessels ( vasoconstriction ) . * * Alpha 1 : Excitatory Alpha 2 : Inhibitory .

1 : Found in the heart and small intestines and responsible for cardiac stimulation and lipolysis 2 : Found in the bronchi . vasodilatation . vascular beds . bronchodilatation and cardiac stimulation .Adrenergic Receptors (contd«) 2) Beta [ ] receptors : Smooth muscle relaxation . and uterus and produces bronchodilation & vasodilation . .

000 1 : 200.Dilutions of Vasoconstrictors Concentration solution .0125 mg / ml 0.000 1 : 80.000 1 : 100.005 mg / ml = 1 mg / ml = 5 micrograms / .000 ml 1 : 1000 means 1 gm / 1000 ml 1000 mg / 1000 ml 0. This means 1 : 10.01 mg / ml 0.1 mg / ml 0.

Nor-Epinephrine is not recommended . because it produces intense peripheral vasoconstriction with possible elevation of blood pressure .Adrenergic Receptors (contd«) - Epinephrine remains the most effective and most used vasoconstrictor in medicine and dentistry . - . with nine times higher side effects than epinephrine .

. .  Epinephrine is available as a synthetic and is also obtained from the adrenal medulla of animals ( approximately 80% of adrenal medullary secretions being epinephrine ) .  Slightly acid solutions are relatively stable if they are protected from air .and -adrenergic receptors .  Sodium bisulfite is usually added to epinephrine solutions to delay its deterioration ( through oxidation ) .  Epinephrine acts directly on both effect predominate .Epinephrine { Adrenalin }  Epinephrine as the acid salt is highly soluble in water .

) Adrenalin has a number of systemic actions .  Rise in systolic and diastolic blood pressures ( standard dose has little effect ) .  Increase in pulse rate .  Increased myocardial oxygen consumption ..Epinephrine { Adrenalin } (contd. These actions lead to an overall decrease in cardiac efficiency . adrenaline affects : 1 ) The heart  Increases the rate and force of contraction of the heart raising cardiac output .

Vessels supplying the skin .) 2 ) Effect on blood vessels . 2 adrenoreceptor stimulation produces vasodilatation by activation of Adenylate cyclase resulting in fall in diastolic pressure . with 2 predominating . Blood vessels supplying the skeletal muscles contain both 2 and receptors . mucous membranes ..Epinephrine { Adrenalin } (contd. and kidneys contain primarily receptors ( epinephrine produces constriction in these vessels ) . .

.Epinephrine { Adrenalin } (contd. as 2 actions predominate . for some bleeding to be noted at about 6 hours following surgery . a predominant -receptor stimulation . As epinephrine tissue levels decrease with time the primary action on blood vessels will revert to vasodilation . and hemostasis . therefore . . It is not uncommon .) The injection of epinephrine directly into surgical sites leads to high tissue concentrations .

. It is important lifethreatening in case of bronchoconstriction (acute asthma ). the adrenalineinduced hyperpolarization ( activation of a membrane-bound Na / K pump ) .) 3 ) Effect on the lungs  B2 adrenoreceptor stimulation in the lungs leads to bronchiolar muscle relaxation .Epinephrine { Adrenalin } (contd. . has been shown to induce analgesia . 4 ) Effect on biological membranes  In animal models .

Epinephrine { Adrenalin } (contd.) 5 ) Effect on metabolism  Glucose concentration is increased due to an Alpha adrenergic inhibition of Insulin release .  .The catecholamine reduces local tissue oxygen tension .. Sodium bisulfite is usually added to epinephrine solution to delay its deterioration.Produces fibrinolysis . . 6 ) Effect on wound healing  Interferes with wound healing : .

 Management of bronchospasm ..Epinephrine { Adrenalin } (contd. . for hemostasis .  As a vasoconstrictor in local anesthetics .  Treatment of cardiac arrest . to increase duration of action .) Clinical applications ± Epinephrine  Management of acute allergic reactions . to decrease absorption into the cardiovascular system .  As a vasoconstrictor in local anesthetics .  To produce mydriasis .  As a vasoconstrictor .

No effect on adrenergic nerve transmission . .Felypressin - ( Octapressin ) Non-sympathomimetic amine . Pronounced on venous than arteriolar microcirculation . so safely given to : . .Hyperthyroid patient . .MAO inhibitor .Tricyclic antidepressants .

‡ Patient receiving MAO inhibitors .) .03 IU / ml + 3 % Prilocaine # : Few contraindications of Epinephrine . instead we use Felypressin ‡ Patient with significant cardio-vascular disease .Contra-indicated for pregnant women .( oxytocic actions on the uterus ) . sulfite sensitivity .. diabetes . Available in 0. tricyclic antidepressant . ‡ Patient with thyroid dysfunction .Felypressin ( Octapressin ) (contd. .

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