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Group 2

 B) Paresthesia – persistent anesthesia beyond expected duration. A) Toxicity (overdose) – caused by single inadvertent intravascular injection or repeated injections.[traumatic ulcer (the child chewed at that area)]  Ref : Guideline on Use of Local Anesthesia for Pediatric Dental Patients .can be caused by trauma of the needle to the nerve or hemorrhage in and around the nerve.  C) Postoperative soft tissue injury – most lip and cheek biting lesion of this nature are self-limiting and heal without complications although bleeding and infection possibly may result.

.more common after exposure to topical anesthetic within 30-60 minutes Managements  If only skin reaction. unless rapid progression to other reactions 1.Dermatological Signs and symptoms  Urticaria (wheals-smooth elevated patches of skin) most common  Pruritus (intense itching)  Angioedema (localized swelling in response to allergen . not usually life threating.

increase anxiety. call EMS. depending on advice.  Medical consult .  If relapse.2.in lower airway) Respiratory distress. repeat epinephrine.transfer to hospital or release. use of accessory muscles of respiration Management  Bronchospasm.  Oxygen (5-6 liters per minute)  Epinephrine or bronchodilator every 5 minutes as needed. flushing.  Place patient in semi-erect position.  Prescribe oral histamine blocker and thorough allergy evaluation before subsequent dental therapy . wheezing. perspiration. tachycardia. Respiratory Signs and symptoms  Bronchospasm (classic response .terminate dental therapy.  Histamine blocker. dyspnea.  Observe patient for 60 minutes before discharge. cyanosis.

respiratory depression. sensory disturbances. if so. muscle twitching • Higher blood levels may result in tremors. disorientation. cardiovascular collapse 6.3. mood alteration. amides are not expected to cross-react • Metabisulfite (present with epinephrine or levonordefrin) 5. Allergy Potential allergens: • Esters • Amide allergy very rare. Toxicity • May initially present as sedation. diplopia. benzocaine . slurred speech. Methemoglobinemia • Associated primarily with prilocaine. respiratory arrest. tonic/clonic seizures • If severe. Psychogenic • Syncope (fainting) • Hyperventilation • Nausea and vomiting • Increases or decreases in heart rate • Increases or decreases in blood pressure • Appearance as allergic reaction 4. may result in coma. to a lesser extent with articaine. lightheadedness.

Fecal and urinary incontinence 7. Generalized anaphylaxis reaction 7. Possible laryngeal edema 7. Cardiac dysrhythmias. Death.1 Early phase skin reactions : Patient complains of feeling sick. Unconsciousness. Diarrhea.2 Gastrointestinal and or genitourinary reactions : Severe abdominal cramps. flushing. Cardiac arrest. Tachycardia. Cough may develope.4 Cardiovascular reactions : Pallor. Vasomotor rhinitis. Hypotension. Dyspnea. Nausea and vomiting.7.3 Respiratory reactions : Substernal tightness or pain in chest. giant hives over face and upper chest. Light-headedness. Wheezing. Conjunctivitis. Cyanosis of mucous membranes and nail beds. intense itching. ***Reaction may last minutes or days . Pilomotor erection 7. Palpitations.

Summon medical assistance. After improvement . stabilize and possibly transport to hospital if necessary  . Corticosteroids If no sign of allergy. Position patient (unconscious patient in supine position with legs elevated slightly) BLS as needed . circulation Summon medical assistance Administer epinephrine 0. BLS as indicated.not drug acute phase (wait until BP has increase and bronchospasm decreased) Histamine blocker.airway. Monitor vital signs. breathing. Oxygen. but patient loses consciouness.     Monitor vital signs.3 ml of 1:1000 IM of IV (second dose after 5 minutes if no improvement) Oxygen. Terminate treatment. Definitive management once emergency medical personnel assess. Position patent supine with legs slightly elevated.

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6 mg/kg (up to 400 mg) 6.5% with epinephrine Lidocaine 2% with epinephrine Mepivacaine 2% with levonordefrin Mepivacaine 3% plain 2 mg/kg (up to 200 mg) 7 mg/kg (up to 500 mg) 6.Drug Articaine 4% with epinephrine Maximum dose 7 mg/kg in adults (up to 500 mg) 5 mg/kg in children Bupivacaine 0.6 mg/kg (up to 400 mg) Prilocaine 4% plain or with epinephrine 8 mg/kg (up to 500 mg) .

 SCANDONEST® 2% L (WITH LEVONORDEFRIN 1:20.000) (Mepivacaine hydrochloride and Levonordefrin injection. USP)  Each cartridge contains 1. .7 mL (34 mg of 2% or 51 mg of 3%).

ad 2% 20 mg 0.s.8 with NaOH .Cartridge Each mL contains: Mepivacaine hydrochloride Levonordefrin (vasoconstrictor) Sodium chloride Potassium metabisulfite(antioxidant) Edetate disodium(chelating agent) Sodium hydroxide q.s. ad pH Hydrochloric acid (pH adjusting agent) Water for injections q.05 mg 4 mg 1.25 mg 0.5 with NaOH The pH of the 3% cartridge solution is adjusted between 4.2 mg 0.5 and 6.3 and 5.5 mg 1 mL 1 mL 3% 30 mg 6 mg The pH of the 2% cartridge solution is adjusted between 3.

8 mL. Percent solutions represent grams per 100 mL  Move the decimal place to the right and this value = mg/mL (i. lidocaine 2% = 20 mg/mL)  Most cartridges = 1. .  Therefore.8 mL x 20 mg/mL = 36 mg.e. one cartridge of 2% lidocaine contains 1.

8 mL  Therefore maximum dose = 2. therefore maximum dose = 4.4 mL / 1.4 mL  Each cartridge = 1.6 mg/kg x 20 kg = 132 mg  3% mepivacaine = 30 mg/mL  132 mg / (30 mg/mL) = 4.8 mL.4 cartridges .Mepivacaine  6.

7mg/kg x 25kg = 175mg  Lidocaine 2% = 2g/100ml = 2000mg/100ml = 20mg/ml • Maximum amount = 175mg/(20mg/ml) = 8.8ml • Maximum catridge = 8.8ml = 4. Maximum dose is 7mg/kg.75ml/1.75ml  Each catridge = 1.86 catridge . up to 500mg • For 25kg child.