LOCAL ANESTHESIA

• Yash raj saud

• 21
• 4th course
Introduction
• The practice of various psychological, physical, and chemical
approaches to the prevention and treatment of preoperative,
operative, and postoperative anxiety and pain.
• Methods of pain control
• Anesthetic agents
• Inhalation sedation
• Antianxiety agents
• Intravenous sedation
• General anesthesia
 Anesthetic Agents
• The numbing of a specific site or area.
• Topical Anesthesia provides a temporary numbing effect on
nerve endings that are located on the surface of the oral
mucosa.
• Supplied as:
• Ointments
• Liquids
• Sprays
 Local Anesthesia
• Agents most frequently used for pain control in dentistry.
• Criteria for use:
• Be nonirritating to the tissues in the area of the injection.
• Produce minimal toxicity.
• Be of rapid onset.
• Provide profound anesthesia.
• Be of sufficient duration.
• Be completely reversible.
• Be sterile.
 Method of Action
• Local anesthesia temporarily blocks the normal generation
and conduction action of the nerve impulses.
• Local anesthesia is obtained by injecting the anesthetic
agent near the nerve in the area intended for dental
treatment.
• Induction time is the length of time from the injection of
the anesthetic solution to complete and effective conduction
blockage.
 Duration
• Length of time from induction until the reversal process is
complete.
• Short-acting:
• Local anesthetic agent lasts less than 30 minutes.
• Intermediate-acting:
• Local anesthetic agent lasts about 60 minutes.
• Long-acting:
• Local anesthetic agent lasts longer than 90 minutes.
 Vasoconstrictor
• Criteria for use:
• Prolongs the duration of an anesthetic agent by decreasing the blood
flow in the immediate area of the injection.
• Decreases bleeding in the area during surgical procedures.
• Types:
• Epinephrine
• Levonordefrin
• Norepinephrine
 Vasoconstrictor- cont’d
• Ratio of vasoconstrictor to anesthetic solution:
• 1:20,000
• 1:50,000
• 1:100,000
• 1:200,000
 Vasoconstrictor- cont’d
• Contraindications for the use of vasoconstrictors
• Unstable angina.
• Recent myocardial infarction.
• Recent coronary artery bypass surgery.
• Untreated or uncontrolled severe hypertension.
• Untreated or uncontrolled congestive heart failure.
 Types of Local Anesthesia Injections
• Infiltration is achieved by injecting the solution directly into
the tissue at the site of the dental procedure.
• Most frequently used to anesthetize the maxillary teeth.
• Used as a secondary injection to block gingival tissues surrounding the
mandibular teeth.
 Types of Local Anesthesia Injections- co
• Block anesthesia
• The solution is injected near a major nerve, and the
entire area served by that nerve is numbed.
• Type of injection required for most mandibular
teeth.
• Inferior alveolar nerve block
• Obtained by injecting the anesthetic solution near the
branch of the inferior alveolar nerve close to the
mandibular foramen.
• Type of injection for half of the lower jaw, including
the teeth, tongue, and lip.
 Types of Local Anesthesia Injections- co
• Incisive nerve block
• Injection given at the site of the mental foramen.
• Used when the mandibular anterior teeth or premolars require anesthesia.

• Periodontal ligament
• Alternative infiltration anesthesia method by which the anesthetic
solution is injected directly into the periodontal ligament and
surrounding tissues.
Table 37-2 Local Anesthesia Setup: Anesthetic Syringe
 Local Anesthesia Setup
• Anesthetic carpule: Care and caution of use
• Cartridges should be stored at room temperature and
protected from direct sunlight.
• Never use a cartridge that has been frozen.
• Do not use a cartridge if it is cracked, chipped, or
damaged in any way.
• Never use a solution that is discolored or cloudy or has
passed the expiration date.
• Do not leave the syringe preloaded with the needle
attached for an extended period of time.
• Never save a cartridge for reuse.
Table 37-3 Disposable Needle
Local Anesthetic Cautions
• Injection into a blood vessel
• Infected area
• Localized toxic reaction
• Systemic toxic reaction
• Temporary numbness
• Paresthesia
Electronic Anesthesia
• A noninvasive method to block pain electronically by using
a low current of electricity through contact pads that target
a specific electronic waveform directly to the nerve bundle
at the root of the tooth.
• Benefits to the patient:
• No needles.
• No post-operative numbness or swelling.
• Chemical-free method of anesthesia.
• No risk of cross-contamination.
• Reduces fear and anxiety.
• Patients have control over their own comfort level.
Inhalation Sedation
• Nitrous oxide/oxygen (N²O/O²) is a combination of these
gases that the patient inhales to help eliminate fear and to
help the patient relax.
• History
• Dates back to 1844.
• Dr. Horace Wells first used it on his patients.
• Effects
• Non addictive.
• Easy onset, minimal side effects, and rapid recovery.
• Produces stage I anesthesia.
• Dulls the perception of pain.
Contraindication of Using N O/O
• Pregnancy: First trimester ² ²
• Nasal obstruction: Problems inhaling through the nose
• Emphysema: Increased O²
• Multiple sclerosis: Breathing difficulties
• Emotional stability: Altered perception of reality
Inhalation Sedation Equipment
• Cylinders: Gases are dispensed in steel cylinders, which
are colored green for O² and blue for N²O.

• N²O machines: Portable or part of the dental unit.

• Control valves: Control the flow of each gas.
• Flowmeter: Indicates the rate of flow of the gases.
• Reservoir bag: The two gases are combined in this
bag and the patient draws on it for breathing.
Inhalation Sedation Equipment- cont’d
• Gas hose
• Carries the gases from the reservoir bag to the mask or nosepiece.
• Masks: Supplied in sizes for adults and children
• The nosepiece through which the patient breathes the gases.
• Scavenger system
• Protection from the occupational risks of N²O.
Exposure to Nitrous Oxide
• Used only for patient treatment.
• Never administered for recreational purposes.
• How to reduce N²O hazards to dental personnel
• Use a scavenger system.
• Use a patient mask that fits well.
• Discourage patients from talking.
• Vent gas outside the building.
• Routinely inspect equipment and hoses for leaks.
• Use an N²O monitoring badge system.
Patient Preparation for Inhalation Sedation
• Review health history.
• Obtain base-line vital signs.
• Describe the procedure of administering the gases.
• Describe the use of the mask and the importance of nasal
breathing.
• Describe the sensations that the patient will experience.
• Reassure the patient.
Assisting in the Administration of
Inhalation Sedation
• Start with pure oxygen while establishing the patient’s tidal
volume.
• Slowly titrate the nitrous oxide until the desired results are
achieved.
• Patients should refrain from talking or mouth breathing.
• The N²O/O² analgesia should end with the administration of
100% O² for 3 to 5 minutes.

• Obtain postoperative vital signs and compare them to the

preoperative recordings.
Antianxiety Agents
• For the relief of anxiety.
• Sedatives
• Criteria for use:
• Patients are very nervous about a procedure.
• Procedures are long or difficult.
• Mentally challenged patients.
• Very young children requiring extensive treatment.
Sedatives
• Commonly prescribed:
• Secobarbital sodium (Seconal)
• Chlordiazepoxide HCl (Librium)
• Diazepam (Valium)
• Chloral hydrate (Noctec): For children
Intravenous Sedation
• Antianxiety drugs that are administered intravenously
continuously throughout a procedure at a slower pace,
providing a deeper stage I analgesia.
Intravenous Sedation- cont’d
• Patient assessment
• A health history, physical examination, and signed consent are
performed.
• Baseline vital signs are taken and recorded.
• Oximetry and electrocardiogram are completed and recorded.
• Weight taken and recorded for dose determination.
Intravenous Sedation- cont’d
• Patient monitoring
• Physiologic measurements taken and recorded every 15
minutes.
• Level of consciousness
• Respiratory function
• Oximetry
• Blood pressure
• Heart rate
• Cardiac rhythm
General Anesthesia
• A controlled state of unconsciousness in which there is a loss
of protective reflexes, including the ability to maintain an
airway independently and to respond appropriately to physical
stimulation or verbal command. This controlled state in loss of
consciousness, produces stage III general anesthesia.
General Anesthesia- cont’d
• Pharmacologic make-up
• Combination of gases
• N²O/O²
• Halothane or enflurane mixtures
• Intravenous agents such as thiopental sodium and methohexital
sodium
Four Stages of Anesthesia
• Stage I: Analgesia is the stage at which a patient is relaxed
and fully conscious. The patient is able to keep his or her
mouth open without assistance and is capable of following
directions. The patient will have a sense of euphoria and a
reduction in pain. Vital signs are normal. Depending on the
agent, the patient can move into different levels of
analgesia.
Four Stages of Anesthesia- cont’d
• Stage II: Excitement is the stage at which a patient is less
aware of his or her immediate surroundings and can start to
become unconscious. The patient can become excited and
unmanageable. Nausea and vomiting can occur. This is an
undesirable stage.
Four Stages of Anesthesia- cont’d
• Stage III: General anesthesia is the stage of anesthesia that
begins when the patient becomes calm after stage II. The
patient feels no pain or sensation. The patient will become
unconscious. This stage of anesthesia can be met only under
the guidance of an anesthesiologist in a controlled
environment such as a hospital.
Four Stages of Anesthesia- cont’d
• Stage IV: Respiratory failure or cardiac arrest is the stage
at which the lungs and heart slow down or stop functioning.
If this stage is not reversed quickly, the patient will die.
General Anesthesia- cont’d
• Patient preparation
• Preoperative physical examination.
• Laboratory tests.
• Patient or legal guardian must sign a consent form.
• Preoperative instructions
• Dentist will review the procedure, as well as the risks.
• Must not have anything to drink or eat 8 to 12 hours before receiving
general anesthesia.
Record Keeping for Sedation Methods
• Always document the following measures and observations:
• Review of patient’s medical history.
• Preoperative and postoperative vital signs.
• Patient’s tidal volume if using inhalation sedation.
• Time anesthesia began and ended.
• Peak concentration administered.
• Amount of postoperative time (in minutes) for patient recovery.
• Adverse events or patient complaints.