Local Anesthetic Formulations
You will receive 4 credit(s) of continuing education credit upon successful completion of this course. The purchase price of this course is $164.00

Description:
This course discusses local anesthetics (with and without vasopressors), precautions and potential drug interactions.

Author:
Dr. Daniel Becker, DDS Show Full Bio

Learning Objectives:
Upon completion of this course, participants should be able to do the following:
  1. Explain the mechanism of action for local anesthetics and correlate chemical and physical properties with their clinical characteristics.
  2. Calculate the dose of local anesthetic and vasopressor included in anesthetic cartridges.
  3. Explain principal variables that influence systemic concentration following submucosal injections and describe systemic complications associated with local anesthetics, including their metabolites.
  4. Discuss issues regarding allergic reactions to local anesthetics and appropriate management of patients presenting a history of hypersensitivity.
  5. Explain the advantages of including vasopressors in local anesthetic solutions and state the effects mediated by each of the three principal adrenergic receptors.
  6. Distinguish the hemodynamic influences of epinephrine and levonordefrin and describe the appropriate use of these agents for patients with cardiovascular disorders.
  7. Explain the basis for putative interactions of vasopressors with antidepressants and nonselective beta-blockers, including appropriate management of patients receiving these medications.
     

Abstract:
This course is an update on the pharmacology and rational use of local anesthetics, those with and without vasopressors. Which anesthetics do you use and why? Do you really know the difference or do you select by habit? This course will review and update your knowledge on the appropriate use of local anesthetics and vasopressors and address the necessary precautions and potential drug interactions.
Outline:
  1. General Properties of Local Anesthetics

  2. Clinical

  3. Molecular

  4. System Toxicity

  5. Dosage

    1. Systemic Serum Concentration

    2. Metabolites

    3. Allergy

  6. Agent Comparisons

    1. Maximum Dosages

  7. Vasopressors

    1. Cardiovascular Disease

      1. Epinephrine

      2. Levonordefrin


References:
    1. Abdulwahab M, Boynes S, Moore P et al. The efficacy of six local anesthetic formulations used for posterior mandibular buccal infiltration anesthesia. J Am Dent Assoc 2009; 140(8):1018-24.
    2. Adkinson Jr. NF. Drug Allergy. In: Adkinson Jr. NF, Yunginger JW, Busse WW, et al. (Editors): Middleton's Allergy: Principles and Practice, 6th ed., Philadelphia: Mosby, Inc; 2003.
    3. Becker DE. Clinical implications of autonomic pharmacology. J Oral Maxillofac Surg 1992; 50: 734- 740.
    4. Berde CB, Strichartz GR. Local anesthetics. In: Miller RD, Eriksson LI, Fleisher LA, et al. Editors. Miller's Anesthesia. 7th edition. Philadelphia: Elsevier, Churchhill Livingstone, 2009.
    5. Berkun Y, Ben-Zvi A, Levy Y, Galili D, Shalit M. Evaluation of adverse reactions to local anesthetics: experience with 236 patients. Ann Allergy Asthma Immunol 2003; 91(4):342-5.
    6. Dagher FB, Yared GM, Machtou P. An evaluation of 2% lidocaine with different concentrations of epinephrine for inferior alveolar nerve block. J Endod. 1997;23(3):178-80.
    7. Dionne RA, Goldstein DS, Wirdzek PR. Effects of diazepam premedication and epinephrine-containing local anesthetic on cardiovascular and catecholamine responses to oral surgery. Anesth Analg 1984;63:640-646
    8. Foster CA., Aston SJ. Propranolol-epinephrine interaction: A potential disaster. Plast Reconstr Surg 1983;72(1):74–78.
    9. Gandy W. Severe epinephrine-propranolol interaction. Ann Emerg Med 1989;18(1):98-9
    10. Garisto GA, Gaffen AS, Lawrence HP, Tenenbaum HC, Haas DA. Occurrence of paresthesia after dental local anesthetic administration in the United States. J Am Dent Assoc 2010; 141(7):836-44.
    11. Haas DA, Lennon D. A 21 year retrospective study of reports of paresthesia following local anesthetic administration. J Can Dent Assoc. 1995;61(4):319-30.
    12. Mikesell P, Nusstein J, Reader A, Beck M, Weaver J. A comparison of articaine and lidocaine for inferior alveolar nerve blocks. J Endod 2005; 31(4):265-70
    13. Mito RS., Yagiela JA. Hypertensive response to levonordefrin in a patient receiving propranolol: report of a case. JADA 1988;116(1):55–57.
    14. Moore PA, Doll B, Delie RA et al. Hemostatic and anesthetic efficacy of 4% articaine HCl with 1:200,000 epinephrine and 4% articaine HCl with 1:100,000 epinephrine when administered intraorally for periodontal surgery. J Periodontol 2007; 78(2):247-53.
    15. Moore PA, Hersh EV, Papas AS et al. Pharmacokinetics of lidocaine with epinephrine following local anesthesia reversal with phentolamine mesylate. Anesth Prog 2008; 55(2):40-8.
    16. Prchal JT, Gregg X. Hemoglobinopathies: Methemoblobinemias, polycythemias and unstable hemoglobins. In: Goldman L, Ausiello D Editors. Cecil Textbook of Medicine. 22nd edition. Philadelphia: W.B. Saunders Co., 2004.
    17. Robertson D, Nusstein J, Reader A, Beck M, McCartney M. The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth. J Am Dent Assoc 2007; 138(8):1104-12.
    18. Santos CF, Modena KC, Giglio FP et al. Epinephrine concentration (1:100,000 or 1:200,000) does not affect the clinical efficacy of 4% articaine for lower third molar removal: a double-blind, randomized, crossover study. J Oral Maxillofac Surg 2007; 65(12):2445-52.
    19. Scott DB, Jebson PJR, Braid DP, et al. Factors affecting plasma levels of lignocaine and prilocaine. Brit J Anaesth 1972; 44: 1040-9.
    20. Tofoli GR, Ramacciato JC, de Oliveira PC, et al. Comparison of effectiveness of 4% articaine associated with 1: 100,000 or 1: 200,000 epinephrine in inferior alveolar nerve block. Anesth Prog. 2003;50(4):164-8.
    21. Westfall TC, Westfall DP. Adrenergic agonists and antagonists. In: Brunton LL, Lazo JS, Parker KL. Eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th edition. New York: McGraw-Hill, 2006.
    22. Yagiela JA. Local anesthetics. In: Dionne RA, Phero JP, Becker DE. Management of Pain & Anxiety in the Dental Office. W.B. Saunders / Elsevier Science Pub, St. Louis, 2002.
    23. Yagiela JA, Duffin SR, Hunt LM. Drug interactions and vasoconstrictors used in local anesthetic solutions. Oral Surg Oral Med Oral Pathol 1985; 59(6):565-71.







American Dental Association is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.