Drug reference
Infiltration anaesthesia in dentistry ▶BY REGIONAL ADMINISTRATION ▶Adult: Consult expert dental sources DOSES AT EXTREMES OF BODY-WEIGHT ▶To avoid excessive dosage in obese patients, dose should be calculated on the basis of ideal body-weight.
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Injection into infected tissues. injection into inflamed tissues. preparations containing preservatives should not be used for caudal, epidural, or spinal block CONTRA-INDICATIONS, FURTHER INFORMATION ▶Injection site Manufacturer advises the local anaesthetic effect may be reduced when injected into an inflamed or infected area, due to altered local pH. Increased absorption into the blood also increases the possibility of systemic side-effects.
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Arrhythmias. arteriosclerosis. cardiovascular disease. cerebrovascular disease. cor pulmonale. debilitated patients (consider dose reduction). diabetes mellitus. elderly (consider dose reduction). epilepsy. hypercalcaemia. hyperreflexia. hypertension. hyperthyroidism. hypokalaemia. hypovolaemia. impaired cardiac conduction. impaired respiratory function. ischaemic heart disease. myasthenia gravis. obstructive cardiomyopathy. occlusive vascular disease. organic brain damage. phaeochromocytoma. prostate disorders. psychoneurosis. severe angina. shock. susceptibility to angle-closure glaucoma CAUTIONS, FURTHER INFORMATION ▶Use of vasoconstrictors In patients with severe hypertension or unstable cardiac rhythm, the use of adrenaline with a local anaesthetic may be hazardous. For these patients an anaesthetic without adrenaline should be used.
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▶Hypersensitivity and cross-sensitivity Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as tetracaine; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be avoided by using the alternative chemical type.
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Should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and should not be administered parenterally unless adequate resuscitation equipment is available.
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→Appendix 1: articaine. sympathomimetics, vasoconstrictor
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Face oedema. gingivitis. headache. nausea . sensation abnormal SIDE-EFFECTS, FURTHER INFORMATION Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection. The toxicity mainly involves the central nervous and cardiovascular systems. The onset of toxicity can be unpredictable and delayed. Monitor as per local protocol for at least 30 minutes after administration.
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Use only if potential benefit outweighs risk— no information available.
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Avoid breast-feeding for 48 hours after administration.
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Manufacturer advises caution (increased risk of toxicity in severe impairment).
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Manufacturers advise use with caution in severe impairment.
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Consider monitoring blood pressure and ECG (advised with systemic adrenaline/epinephrine).
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection EXCIPIENTS: May contain Sulfites ▶Septanest (Septodont Ltd) Adrenaline (as Adrenaline acid tartrate) 10 microgram per 1 ml, Articaine hydrochloride 40 mg per 1 ml Septanest 1 in 100,000 Anaesthesia solution for injection cartridges | 50 cartridge P £24.95 Adrenaline (as Adrenaline acid tartrate) 5 microgram per 1 ml, Articaine hydrochloride 40 mg per 1 ml Septanest 1 in 200,000 solution for injection cartridges | 50 cartridge P £24.95
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Consult expert dental sources
First-line fragment. Read the complete Indications and Dose section above.
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