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Clinical pharmacology: local anesthetics
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
Jonathan McGhie, Michael G Serpell
A vasoconstrictor, usually epinephrine (adrenaline), is often added to LAs in clinical practice. The vasoconstriction reduces the rate of systemic absorption by up to one third,34 which will increase the duration of block and will reduce the risk of toxicity. Vasoconstrictors should not be used for intravenous regional anesthesia or in regions that are poorly vascularized or supplied by endarteries such as digits, as they may cause ischemia and tissue necrosis. Epinephrine is often used in a concentration of 1:200 000 (5 μg/mL); if intravascular, it may exhibit its own systemic effects and so should be used with caution in patients with cardiac disease.35 Felypressin is often used in dentistry as an alternative as it has less systemic effect, but it is still a coronary vasoconstrictor.
Anaesthetic efficacy of 2% lidocaine with different concentrations of epinephrine (1:80,000 and 1:200,000) in intraligamentary injection after a failed primary inferior alveolar nerve block: a randomized double-blind study
Published in Acta Odontologica Scandinavica, 2020
Vivek Aggarwal, Mamta Singla, Masoud Saatchi, Mukesh Hasija
According to Meechan [2], the efficacy and the duration of anaesthesia of intraligamentary injection are dependent upon the type of the anaesthetic solution, type of the operative procedure and the type of tooth. Various studies have evaluated the different type of anaesthetic solutions for intraligamentary injections. Berlin et al. [16] compared the anaesthetic success of 1.4 mL intraligamentary injections of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine in asymptomatic mandibular posterior teeth. Using a pulp tester, the articaine gave 86% successful anaesthesia and lidocaine gave 74% successful anaesthesia with no significant difference between both the solutions. Grey et al. [28] evaluated 3% plain mepivacaine and 3% prilocaine with felypressin with 2% lidocaine with and without 1:80,000 epinephrine and reported that both mepivacaine and prilocaine were not as effective as lidocaine with epinephrine. However, the success rates of these three solutions were not statistically different. Grey et al. [29] reported that lidocaine with adrenaline, given as intraligamentary injection, was effective in 91.6% of cases vs. 42% when given without adrenaline.
Liposomal-based lidocaine formulation for the improvement of infiltrative buccal anaesthesia
Published in Journal of Liposome Research, 2019
Ana Cláudia Pedreira de Almeida, Luciana Matos Alves Pinto, Giuliana Piovesan Alves, Lígia Nunes de Morais Ribeiro, Maria Helena Andrade Santana, Cíntia Maria Saia Cereda, Leonardo Fernandes Fraceto, Eneida de Paula
Lidocaine (LDC) is a gold standard LA with moderate action that is used in a wide range of dentistry procedures, mainly in association with vasoconstrictors, in order to increase the duration of nerve blockade. Nevertheless, the use of vasoconstrictors is either not recommended or contraindicated in many clinical conditions (Perusse et al.1992a, 1992b, Eidelman et al.2005). In this context, we have previously reported that liposomal formulation with prilocaine is able to prolong the duration of anaesthesia when compared to plain prilocaine (without vasoconstrictor). Also this formulation showed similar effects of felypressin-containing prilocaine suggesting that liposomal encapsulation is able to replace the vasoconstrictor in LA formulations to dentistry uses (Cereda et al.2004), especially when the vasoactive compound is contraindicated.
Cochlear implantation in children with congenital long QT syndrome: Introduction of an evidence-based pathway of care
Published in Cochlear Implants International, 2018
Victoria Scott-Warren, Anju Bendon, Iain A. Bruce, Lise Henderson, Jacques Diacono
Propofol in contrast, is known to reduce the QT interval (Paventi et al., 2001). As previously mentioned, sympathetic stimulation is a known trigger for arrhythmia in children with cLQTS, particularly in the subtype seen in our cohort, LQT1. For this reason, it is imperative that the anaesthetic technique obtunds the sympathetic response to laryngoscopy and surgical stimulation. This makes remifentanil valuable as part of the anaesthetic technique, although bradycardia as a result of the combination of beta-blockade and remifentanil could potentially be significant. Non-pharmacological means of increasing the heart rate must therefore be immediately available. All sympathomimetics are potentially dangerous in cLQTS and must be avoided. This includes ketamine and adrenaline containing local anaesthetics used by the surgical team. Should vasoconstriction be required to provide an adequate surgical field then local anaesthetic with Felypressin (commercially available as Citanest 3% with Octapressin®) can be used.