What anesthesia is in dentistry. Types of modern anesthesia methods in dentistry, drugs for anesthesia. Features of local anesthesia

In dentistry, pain is the main problem of attendance of dental offices around the world. It is because of the fear of painful sensations, many patients avoid visits to the doctor - a dentist, mistakenly assuming that the treatment will be extremely and unbearable painfully.

Anesthesia, anesthetics, anesthesia, premedication in dentistry

Package methods:

1. injection anesthesia,
2. application anesthesia,
3. general anesthesia.

In the clinic "Imperial" in St. Petersburg, in the preparation of our patients to dental procedures, we try to conduct a psychological attitude and, if necessary, use premedication.

Features of local anesthesia.

For the so-called "risk group (gr)", some components of local anesthesia may be particularly dangerous.

• experiencing increased fear (fear) before treatment, doctors;
• with intolerance to drugs;
• with some hereditary diseases;
• women during pregnancy (in extreme cases, anesthesia applies, only in the second trimester);
• women during lactation.

When applying local anesthesia, there are several tasks in front of the doctor:

First, the selection of local anesthesis should be such that to completely eliminate the sensitivity to pain in the intervention and get the maximum efficiency during the operation and after it.

Secondly, choose such a drug that will minimize the effects of individual substances in the preparation.

Please note that if, after anesthesia, you still feel pain, then most likely there was an insufficient dose of anesthetic or anesthesia was carried out wrong!

An experienced dentist should be well focused not only in the anesthetic drugs of various companies, but also in their chemical composition.

The doctor is obliged to know:

• the duration of the topics of the topics,
• time of its removal from the body,
• toxicological properties,
• the use of anesthetic with other dental preparations in different combinations and various concentrations.

Contrary to the expectations of people, modern medicine stepped out so far ahead, which makes any treatment very easy and comfortable even for the most raw patients.

The "Imperial" clinic invites you to feel the newest developments in anesthesiology and feel comfort instead of fear and pain.

Components of the components of modern local anesthesia

Component components of local anesthetic (or local anesthetic) are substances such as:

1. Local anesthetic (Artictic, Bupivacaine, Lidocaine, MEPIVACAIN, Novocaine, Plokokain, Trimkain, Etidocaine);
2. Paragidroxybenzoates (nutritional supplements);
3. Substance for narrowing blood vessels - Vasoconstrictor (adrenaline or epinephrine, Meston, norepressure or norepinephrine, Felipressin or octapressin);
4. Stabilizers (sodium sulfite, potassium sulfite).

Preparations that are used for local anesthesia do not always contain all the above components.

To carry out the blockade of pulses by nervous endings, only one, only local anesthetic, but for a longer action and enhancing the effect of anesthesia are used - vasoconstritors.

Almost all new, local, anesthetic drugs, allest and in different degrees, but are a vasodilator, so vasoconstrictors are a vasoconstrictor agent, help concentrate anesthetic, just in the area of \u200b\u200bdental intervention.

If you have contraindications to such substances as Adrenaline, Meston, Noradrenaline or Felipressin, then local anesthetic, can be used without a vasoconstrictor, but at the same time the useful time of the effect of anesthesia is reduced.

The presence of stabilizers and preservatives in modern preparations says that these anesthetics have a long shelf life.

Indications for the use of local anesthesia

The anesthesia of the surface of the mucosa site at the injection site, to remove constant movable and dairy teeth and a dental stone, with simple operations on the gum (eg abscess), as well as in the treatment of diseases of the mucous membrane of the mouth (eg gingivostomatite).

Contraindications for the use of local anesthesia

All contraindications to the use of local painkillers can be combined in 3 points:

1. Hypersensitivity of the body's immune system on local anesthetic:
   - At the same time, the attending physician picks up the painkiller, which is most likely for the planned dental intervention (depth, duration, character).
2. Insufficiency of the patient's metabolic regulation system (cleaning and removal):
   - The features of the patient's patient's pathology are taken into account, its general-combat condition, as well as the presence of contraindications.
3. Age limit:
   - At this point, the dosages of local painkillers are taken into account, given the age of the patient (child or an elderly person) criteria for choosing a local anesthetic drug (anesthetic).

Types of preparations for appliquational anesthesia

Application anesthesia is used by the doctors of the "Imperial" clinic for the complete comfort of patients in the form of ointments, solutions and aerosols. The use of this tool allows you to make the penetration of the needle completely irrevocable.

Local anesthetics used in the Dentistry "Imperial"

The anesthesia of the desired site, when using appliquational anesthesia, comes one or two minutes, to a depth of 1-3 mm and last from 10 to 20 minutes.

Premedication - Preparation for anesthesia

Premedication is the use of one or more drugs directly before the operation to facilitate anesthesia and reducing the risk of possible complications.

The most common premedication is sedative.

Sedable preparations used for premedication:

• Vegetable preparations (Maltubor Tincture, Valerian, Valokordin, Corvalol, Voserdin, etc.)
• Tranquilizers benzodiazepine (phenazepam, diazepam, muscolam, etc.)
• Chemical preparations (eg trioxazine).

Indications for the use of sedative anesthesia for premedication

• Fear, horror, before dental treatment,
• violation of the blood supply of myocardium (ischemic heart disease),
• heated blood pressure (hypertension),
• the attacks of suffocation in the consequence of bronchial spasms and the eath of the mucous membrane (bronchial asthma),
• endocrine diseases (eg diabetes),
• incication by thyroid hormones,
• parkinson's disease,
• chronic neurological stereotypical seizures (epilepsy),
• finally, just the desire of the patient himself.

Conducting general anesthesia (general anesthesia) in dentistry

Anesthesia is one of the methods of anesthesia based on the blocking of consciousness in a patient due to deep braking of sensitivity, the synapses of the cerebral cortex, using various drugs.

In connection with new developments in anesthesiology, our dental clinic has stopped using anesthesia with inhalation of specialized gas and began to use a new licensed method called SEDATION (Introduction to the body of drugs that are injected into a short-term controlled medicine sleep). The cost of the new sedative method Drugs for 20 minutes - 3700 rubles.

From how the drugs are introduced into the body, you can allocate several types of sedation:

1. Inhalation sedation
2. Oral sedation
3. Intravenous sedation

In dentistry, an intravenous surface sedation is used. So, with a shallow sedation, all the functions of the body continue their normal activity, and a person is as it were in a dream.

Sedation is a modern approach to the treatment of teeth in a dream, rest. Video

Indications for the use of sedation in outpatient dentistry

• allergies to topless drugs,
• strong fear of any pain and dental manipulations of dentists (in particular).

Given innovation in practical dentistry, it is also possible to add a huge desire for many patients to be treated precisely under general anesthesia.

When taking a weighted solution to the use of anesthesia, in our clinic, each patient is necessarily informed, about all possible hazards and complications of any anesthesia.

In the Dental Clinic "Imperial" SPB, carrying out operations on the treatment, removal, prosthetics and implantation of teeth under general anesthesia, holds a licensed anesthesiologist-resuscitation doctor with experience more than 10 years in various clinics of St. Petersburg!

Our doctor anesthesiologist-resuscitation is necessarily present at all dental procedures that happen to you.

Prices for the use of general anesthesia can be viewed.

Treatment of teeth resembling medieval torture, rushed into the fly. Modern equipment, effective and diverse anesthesia in dentistry is a completely new principle of work that helps minimize all discomfort. Of course, many people remember the experience of recent years and do not trust booklets and advertising prospectuses of dentists. But, having risked, they are still convinced that there is really nothing to be afraid. Especially if you ask for help in a timely manner. Simple treatment of caries or cosmetic procedures do not require using strong anesthesia. In dentistry they are distinguished by several types, let's figure it out, what differences, advantages and in what case it is necessary to use this or other painkillers.

What is anesthesia?

The word "anesthesia" has a Greek origin and literally means "without feelings." The pharmacological effect of anesthetics can spread to certain parts of the body (local anesthesia), they, as it were, turn off the transmission of pain in the nerve receptors into the brain or the entire body as a whole (general anesthesia). All kinds are successfully used, the truth for there are reservations and special readings of the doctor.

New generation anesthetics

In the history of dental services, anesthesia as such is a big breakthrough. But at the same time, the first anesthetics had a number of contraindications, the consequences and had serious side effects. This applies to even such familiar anesthesia as "novocaine" and "lidocaine", which are still universally applied by doctors. Undoubtedly, they have good qualities, have an affordable price, which sometimes becomes a decisive factor when choosing a drug. But relatively low efficiency, high level of toxicity, side effects forced to look for new drugs to perform anesthesia in dentistry. Types of anesthesia of the new generation are much safer, the effect is more quickly, the effect of them is longer, and the concentration occurs in the right place. It is worth noting that complications from the input of an anesthetic happen if you choose an irregular preparation. The doctor is obliged to find out the patient, as he used to transfer anesthesia, whether there were complications, what was the effect.

Classification of drugs for anesthesia that are used in the treatment of teeth

Types of anesthesia in dentistry can be divided into two types: local drugs and general anesthesia. As mentioned above, local drugs have a concentrated action in a certain place, while the general anesthesia completely disables the patient's consciousness, and it does not feel any sensations during manipulations. But, except for drug anesthesia, other methods have their niche. What can be non-drug anesthesia in dentistry? Views are below:

• hypnosis;
• analgesic of electrical impulses;
• anesthesia through the perception of sounds.

These methods are used extremely rare, competent specialists who can really apply such practice, not enough. In addition, not every patient will be susceptible to such an influence, for this it is necessary for special equipment. All this does not give to develop a non-drug anesthesia wide enough.

Types of local anesthesia in dentistry

Each patient requires a personal approach not only in treatment, but also during the selection of an anesthetic drug. The use of standard procedures is also excluded because the doctor's intervention may be required for various reasons. So, the anesthesia area should be different. Depending on this distinguish such types of anesthesia in dentistry:

• application;
• infiltration;
• conductive.

At the same time, the last two types of anesthesia can be consecrated into one group. Their use occurs in the form of injection, while appliquancy anesthesia can be in the form of a spray or ointment. The medicine is applied directly to the gum near the affected tooth. Its action is very short-term, so it is impossible to treat under this drug. Its use is necessary to reduce the painful effect during an injection, to break the dairy teeth, if they are movable, to fit the implants, crowns, during the removal of the dental stone.

Anesthesia in the treatment of pulpitis, the removal of nerves, deep caries

In such cases, as well as many others, they use a deeper "freezing". All types of dentistry fall into this group for such anesthesia. It is customary to use "Lidocaine", "Novocaine", "Ultrakain", "Plilokain". To achieve a better effect, together with anesthetic, the doctor uses vasoconstrictors, stabilizers and preservatives. However, not all patients such a "rattling" mixture affects without complications, so there are drugs that can be applied in pure form. The effect of infiltration anesthetics is not very long (up to one hour), but it is enough to assist the patient.

Preparations for surgical interventions

Types of conductor anesthesia in dentistry apply in cases where it is necessary to achieve the most extensive pain relief zone, or long-term anesthesia is required. Their action lasts up to several hours and is achieved by anesthesia of all nerve. The injection is made at some distance from the place of operational intervention. Such anesthesia allows you to treat multicrete teeth, to make operations on the gums without re-anesthesia. The preparations of this species include Bupivacaine, Etidocaine.

It will help to systematize the types of anesthesia in dentistry Schematic Table:

General anesthesia as a separate anesthesia type

In the scheme, it is not for nothing that the anesthesia is highlighted separate item. Such anesthesia is a serious medical intervention. Not every clinic or private office have the right to carry out for this it is necessary to have qualifications, special equipment, the ability to help the patient in the event of side effects. Most often, such anesthesia is used in very difficult cases, or when the patient is panicing any physician manipulation. The drug can be introduced into the human body through a mask when the patient inhales a pair of anesthesia and falls asleep at the right time. But from this technique, the dentistry moves away from the fact that the constant inhalation of narcotic vapors by the doctor himself is fraught with adverse effects for his health. Another option is to enter anesthesia intravenously.

Use anesthesia in atypical cases

Anesthesia in dentistry, species and methods of use directly depend on the patient. As statistics show, more than half of all visitors to Dentist's office are people who fall into a risk group for one reason or another. This includes patients with heart diseases, neurological problems, people suffering from elevated blood pressure, pregnant and nursing women. None of these categories of the population should have a refusal of timely and qualified assistance. Especially since the pharmacological market provides good, high-quality drugs that can be used with minimal risk.

The lack of anesthesia during the treatment of dental problems is fraught with even greater worsening of health, so the competent doctor is obliged to choose the most successful drug.

Anesthesia in dentistry for children

Children may also need the help of a dentist, fortunately, most often the solution to their problems does not force the use of potent drugs. Often, this is an additional advantage, because the child does not need to even tolerate pain from the injection.

It is worth considering that not all aerosols and ointments apply to children. There are age limitations. "Dicaine" falls under them, children under 10 he is contraindicated. It is also worth paying attention to whether the doctor uses adrenaline to enhance the effect of anesthetic. It is not used at all until 5 years, but at an older age - small doses and with great care.

Anesthesia in dentistry is required in 99% of cases, since most dental manipulations are accompanied by pronounced pain syndrome. The facial and pots are equipped with a large number of nerves and blood vessels, so their irritation causes a system response from the body.

Preparations for anesthesia are selected depending on the individual characteristics of the patient and the duration of the procedure.

Anesthesia in dentistry, preparations for which are listed below, is classified as follows:

1. By chemical composition of the active component:

• esters (novocaine, previously used anesthesine and dikaine);
• substituted amides acids (lidocaine, ultrakain, kilifesin, bupivacaine and others).

2. Duration of action:

The principle of operation of local anesthetics in dentistry is to temporarily suppress the excitability of nerve endings and loss of regional sensitivity. Unlike painkillers of systemic effects, they do not lead to loss of consciousness.

Most often, these drugs are used in injecting form. In pediatric dentistry, it is possible to use appliquational and aerosol anesthesia.

Top 10 drugs from the pharmacy

The choice of drug for local anesthesia is produced on the basis of the patient's history, taking into account the existing diseases and intolerance to the drugs.

• in diabetes mellitus and the pathologies of the thyroid gland, drugs that do not contain epinephrine must be seamless;
• with high allergy, anesthetics without preservatives (most often it is sodium disulfide, which is introduced into the stabilization of epinephrine);
• in hypertension, it is preferable to drugs containing adrenaline, but with decomposed diseases of the heart - without it.

Novocaine

Novocaine is one of the oldest local anesthetic drugs, which was introduced into therapeutic practice at the beginning of the 20th century. This anesthetic is included in the list of ZHHVLP, in budget dentists most often used it. Concentration of solutions and maximum doses are shown in the table below.

Concentration,%	Maximum single dosage, ml	Application
0,25	500	Direct injection anesthesia into soft fabric of the operating field in the treatment of medium and deep caries, pulpitis, periodontitis
0,5	150
1	100	For the introduction of anesthetic directly to the nerve in the treatment of neurostomatical pathologies, inflammatory infiltrates
2	25-30

The anesthetic effect occurs after 10-15 minutes. After administration and lasts an average of 20-30 minutes.

This anesthetic is unstable and quickly disintegrates to para -aminobenzoic acid and diethylaminoethanol. The first substance is the main cause of allergic reactions. On the other hand, the lack of metabolism in the liver allows you to use novocaine for patients with severe diseases of this organ.

In recent years, there has been an increase in allergic reactions to this drug, and some patients are insensitive to it.

Among the side effects are allocated as follows:

• inflammation of the mucous membrane of the mouth;
• skin rash, dermatitis;
• swelling quinque;
• anaphylactic shock.

Signs of individual intolerance, as a result of which shock arises, are the following:

• dizziness;
• general weakness;
• loss of consciousness;
• sharp drop in blood pressure.

This drug has a high risk of cross allergies with anesthesia and dicain, so it is necessary to pay attention to their tolerance.

Contraindications for applying Novocaine are the following:

• a genetically determined lack of pseudocholinesterase enzyme;
• simultaneous reception of sulfonamide antibiotics;
• autoimmune disease miastic gravis;
• resistant reduced blood pressure;
• severe cardiovascular pathologies;
• template to allergies.

The average price for the preparation in 0.5% concentration (10 ml) - 30 rubles.

Lidocaine

Lidocaine refers to a group of amide painkillers. Its efficiency is 4 times higher than that of novocaine, it has a deeper and long-term effect (up to 1.5 h), as slowly metabolized in the body. At the same time, this drug in and concentrations 1% and 2% toxic than 50%. Anesthesia occurs after 1-5 minutes after administration.

With its decomposition, para-aminobenzoic acid is formed, therefore the frequency of allergic complications is lower. It can be used in patients taking sulfonamide antibiotics. The drug also has a sedative and antiarrhythmic effect.

For injection anesthesia in dentistry, 2% solution is used (maximum one-time dose - 20 ml), and for an application - 10% aerosol solution (lidestin).

Contraindications for this anesthetic:

• severe liver diseases;
• sinus node weakness syndrome;
• bradycardia (slowdown heart rhythm);
• increased sensitivity to amide anesthetics.

Anesthesia in dentistry, preparations for which contain lidocaine can cause such side effects as:

• reduction of blood pressure, cardiovascular failure;
• tremor;
• convulsions;
• psychomotor excitation;
• anaphylactic shock (with individual intolerance);
• vision impairment;
• hives;
• bronchospasm.

The drug can not be combined with the reception of the following drugs:

• beta-adrenoblasts, which are prescribed with hypertension, tachycardia and extrasystole;
• antiarrhythmic agents;
• antidepressants;
• antibacterial drug Polymixin B;
• antiepileptic means of diphenin.

The price of lidocaine in pharmacies on average is 25 rubles. For 10 ampoules 2 ml.

Ultrakain

The drug ultrakain is produced by the French pharmaceutical company Sanofi in 3 varieties:

• Ultrakain D - without the introduction of epinephrine;
• Ultrakain D-C - with epinephrine at a concentration of 1: 200,000;
• Ultrakain Dr. Forte - with epinephrine at a concentration of 1: 100,000.

Along with Lidokain and Novocaine, it is one of the most popular anesthetics in dentistry. The main component in the composition is articain, having a high pain medication. This substance began to apply in dental practice in the late 70s. XX century. Preparations based on it is stronger than novocaine and lidocaine 6 and 3 times, respectively.

Anesthetic effect occurs very quickly - for 0.5-3 minutes. After administration, and its duration can reach 3 hours with the addition of epinephrine (adrenaline). The latter is entered in order to increase the depth of anesthesia and the duration of action.

This reduces the dosage, the maximum value of which for adults is:

• Ultrakain Dr. Forte - 2 ml;
• Ultrakain D-C - 2.5 ml;
• Ultrakain d - 3 ml.

In pediatric dentistry, up to 5 years old is allowed to use ultrahary without adrenaline, as it can dramatically increase blood pressure, worsen heart rhythm and cause other disorders. Children after 5 years allowed to introduce ultrakain D-s.

The following phenomena may occur as side effects:

• headache;
• split vision and clouding in the eyes, blindness;
• breath disorders up to its complete stop;
• convulsions;
• tremor;
• allergic reactions are inflammation of the mucous membrane, swelling at the injection site, rash, anaphylactic shock.

Ultrakain is contraindicated in the following diseases and states:

• increased sensitivity to the drug;
• bronchial asthma;
• hypoxia;
• the presence of tumors consisting of chromaffine cells;
• anemia;
• myocardial infarction and aorticon-artery shunting in history, transferred over the past 3-6 months;
• increased methemoglobin in the blood;
• heavy degree arrhythmia;
• increased thyroid function;
• acute heart failure;
• clothing glaucoma.

The drugs with ultrakain do not apply in children under 4, since there are no clinical studies on their safety at this age. It is impossible to combine its use with the reception of beta adrenobloclars (since it is high the risk of developing a hypertensive crisis and bradycardia) and antidepressants.

Ultrakin with caution is assigned to those patients who have the following diseases:

• angina;
• insufficiency of the enzyme splitting the esters of choline;
• atherosclerosis;
• a history of history;
• diabetes;
• chronical bronchitis.

1 ampoule ultrakina d-with 2 ml volume on average costs about 110 rubles.

Killesin

Cleverness is a complete analogue of ultrakina D-s.

This drug is produced by the German company ZM ESPE AG in two forms:

• Killing (concentration of adrenaline 1: 200,000);
• Clearing forte (adrenaline concentration 1: 100000).

The price for one apmula is killed by Forte the volume of 1.7 ml - 44 rubles.

Overt

ORABLOC is another trading name of anesthetic composition of artician with epinephrine. This is an anesthetic - Italian production (Pierelle Pharma company). It is produced in two versions: with epinephrine 1: 100 000 (red packaging) and 1: 200,000 (blue packaging).

Interest in preparations with american in modern dentistry is related to the fact that the funds of this group have the following advantages:

• fast and long action;
• good tolerability among patients;
• minimal vesseloring effect;
• a slight effect on the cardiovascular system: change in pressure and heart rate almost does not occur.

1 ampoule volume of 1.8 ml with adrenaline at a concentration 1: 100 000 costs about 35 rubles. Other analogues of this composition, artician and adrenaline are a sepantist (SeptaNest Adrenalinee AU 1 / 100000.1 / 200,000), Primakain with adrenaline and articain of Inibes (Articain inIBSA).

Xilonor gel

Xylonor Gel - anesthetic gel of production of France (SEPTODONT) based on lidocaine (5%) and antiseptic agent zetrimide, active in terms of gram-negative and gram-positive bacteria. This drug is most often used in pediatric dentistry.

It is also used in the following cases:

• preliminary anesthesia before injection;
• for patients who have allergies to para-aminobenzoic acid (anesthesin, dicaine, novocaine);
• anesthesia before excision gums, when cleaning gums pockets;
• to facilitate the reinforcement of the oral cavity with an increased vomit reflex.

The maximum daily dose should not exceed 4 g, and the contraindication for its use is increased sensitivity to lidokain. Analogue of this anesthetic is the domestic preparation of the desensyl gel anest, the main component of which (lidocaine) is contained in a higher concentration - 12%. The average price for the Tseloror Tube 15 g is 2000 rubles.

Skandonest

Skandonest (Scandonest) - anesthetic short action (30 min.), The main active component of which is MEPIVACINA hydrochloride.

The drug is produced in 3 modifications:

• Scandonest 2% Na (with norerained at a concentration of 1: 100,000);
• Scandonest 2% SP (with adrenaline at a concentration of 1: 100,000);
• Scandonest 3% SVC (without adrenaline).

Just like ultracaine, it has a stronger anesthetic effect. The average dose is 1.3 ml. Maximum daily dosage for adults - 10 ml.

Anesthesia in dentistry with the use of MEPIOVACAIN-based drugs may be accompanied by the following side effects:

• state of euphoria or depression;
• convulsions;
• dizziness;
• vomiting;
• drowsiness;
• impairment;
• sharp pressure drop;
• dyspnea;
• slowdown or accelerating cardiac rhythm;
• loss of consciousness;
• coma.

Allergic reactions are marked very rarely. This drug is actively used to treat patients with the pathology of the cardiovascular system. 1 ampoule volume 1.8 ml Scandonest 3% costs about 45 rubles.

Scandinibsa

Anesthetic Scandinibs is produced by the Spanish pharmaceutical company Laboratory IniBSA S.A. The main component of the drug is MEPIOLKAIN hydrochloride. This substance refers to tertiary amines, but on clinical properties anesthetic is more like lidocaine.

The drug causes a moderate narrowing of blood vessels, so its action is about 25% longer than that of lidocaine, and it can be used without adrenaline. This property allows you to prescribe a drug to people, patients with closed-core glaucoma, diabetes mellitus and cardiovascular pathologies.

The anesthetic effect is manifested in 2-3 minutes, and its duration is at least 45 minutes. After decay in the tissues, most of the exchange products are excreted through the liver. In the presence of diseases of this body, their accumulation is possible. The average dosage for adults is 1 ampoule (1.8 ml). Maximum daily dose - 5.4 ml.

Contraindications for the use of anesthetic are the following diseases and conditions:

• increased sensitivity to the active component and to other anesthetics of the amide series;
• miasti;
• severe liver pathologies;
• children's age up to 4 years.

Side effects are the same as Skandones; Additionally, the following negative manifestations may occur:

• violation of lip and language sensitivity;
• pain in the chest;
• involuntary urination or defecation;
• apnea in a dream;
• methemoglobinemia;
• swelling and inflammation at the injection site;
• allergic reactions (extremely rare).

There is also a form of release with epinephrine - Scandinibs Forte. The price for 1 ampoule of 1.8 ml is an average of 35 rubles.

Bupivacaine

Anesthesia in dentistry, preparations for which are made on the basis of bipuvacaine, serves for long-term anesthesia. Anesthetizing effect is developing slower, for 5-10 minutes, but also keeps much longer compared to lidocaine and pepivacaine - up to 12 hours.

Another advantage of the drug is smaller toxicity with respect to the cardiovascular system with proper administration.

The most long-lasting anesthesia in dentistry is considered to be the drug Bupivacaine

Possible side effects:

• feeling of numbness in the mouth;
• dizziness;
• vision impairment;
• apnea;
• tremor muscles or convulsions;
• drowsiness;
• drop in blood pressure;
• arrhythmia;
• heart failure;
• fainting;
• allergic reactions - from skin rash to anaphylactic shock.

The drug is contraindicated in dentistry in the following cases:

• increased sensitivity to components;
• purulent lesions at the injection site;
• inflammation of the shells of the brain;
• tumors;
• heart failure;
• low blood pressure.

The average price for 1 ampules of 4 ml - 130 rubles.

Chirosal

Chirokaine (Chirocaine) produces a pharmaceutical company Ebbvi LLC (Russia). The main active ingredient of this anesthetic is the Levochloride hydrochloride. By clinical action, it is similar to Bipuvakain. As the experiments on animals show, its toxicity with respect to the cardiovascular system is less, however, when he gets into a vein, it can also cause serious violations in the work of the heart.

Chicooner, like Bipuvakain, is an analgesic for a long action. The blockade of the transmission of nerve pulses occurs mainly due to the effect on sodium channels of cell membranes. The drug is almost completely metabolized in the liver and is not detected in feces and urine. Metabling products are displayed mainly through the kidneys.

The anesthetic effect is developing for 10-15 minutes, and its average duration is 6-9 hours. Maximum daily dose - 150 mg.

Side effects are similar to those using Bipuwacain:

Contraindications to the use of this anesthetic are:

• increased sensitivity to the active component and drugs of group amides;
• reduced blood pressure;
• heavy liver diseases.

Anesthesia in dentistry, long-term preparations with left-stop and bipuvacaine have a common drawback - with incorrectly administration during dental manipulations (enter into vein), they can cause severe systemic complications.

Therefore, the means of this group are applied less often. During the procedure, the doctor must constantly monitor the cardiac and respiratory performance in patients. The average price for 1 ampule is 10 ml on this drug is 110 rubles.

Anesthesia in dentistry is one of the most relevant problems of therapeutic technologies. Until recently, essential series preparations (novocaine) were most widely used, but they have low efficiency. The most promising anesthetics, which quickly pain relieve with a minimum number of complications, are anesthetics with artician.

Article clearance: Vladimir Great

Video about anesthesia in dentistry

Anesthesia in dentistry:

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Local anesthetics There are blockers of sodium channels in sensitive nerve endings and conductors. From a chemical point of view, these drugs are salts of weak grounds, the property of which is good solubility in water. When administered to the tissue, the local anesthetic is hydrolysis, the release of anesthetic base, which, by virtue of lipotropy, penetrates the nerve fiber membrane and is associated with the ending groups of phospholipids of the sodium channel, violating the capacity generation capacity of the action potential.

The degree of penetration depends on the ionization, dose, concentration, location and rate of administration of the drug, the presence of a vasoconstrictor, which is usually used by adrenaline. The latter slows down the admission of anesthetic in blood, reduces systemic toxicity and extension effect. The release of anesthetic-base occurs easier with the weakly alkaline values \u200b\u200bof the hydrogen indicator of the medium, therefore, under the conditions of tissue acidosis, the penetration of the anesthetic through the membrane of the nerve fiber slows down and its clinical effect is reduced.

Local anesthetics in the chemical structure are divided into 2 groups: esters and amides. The ester group includes novocaine, anesthesine, dikain and benzofurocaine. Amidam include: Lidocaine, Trimkain, MEPIVACAIN, Plilokain, Bupivacaine, Ethydocaine, Artics. By duration of action distinguish local anesthetics: i) short action (30 min and less) - Novocaine, MEPIVACAIN; 2) an average action (1-1.5 h) - lidocaine, trimecain, sublocaine, artics; 3) long-term action (more than 2 hours) - bupivacaine, etyhydocaine. When choosing the drug, take into account the duration of the upcoming intervention, the possibility of using a vasoconstrictor, an allergic agent of the patient. In dentistry, along with surface (appliquational), infiltration and conductor anesthesia, methods of intraligent, intra-pasted and intracable administration of local anesthetics are used. Methods of extended conductor blockade of the 2nd and 3rd branches of a trigeminal nerve are also developed.

Under the application anesthesia of the mucous membrane and the wound surface, preparations are used, which are well penetrated into tissue and create an active concentration in the membrane of nervous fiber and sensitive endings. For such anesthesia, dikaine, pyromekine, anesthesine, lidocaine are used.

For infiltration and conducting anesthesia, novocaine, trimecain, lidocaine, MEPIOVACAIN, sublocaine, bupivacaine, etyhydocaine, articain are used.

For extended conductor blockade of the 2nd and 3rd branches of a trigeminal nerve, lidocaine and articain are used, for intraligent anesthesia - articain, lidocaine, nepivacaine in a volume of 0.2-0.3 ml.

Novocaine (0.5-2% solution) is used by the method of electrophoresis (from a positive pole) in neuralgia of a trigeminal nerve, paresthesies, periodontal disease. Dicain is prescribed with hyperesthesia of solid tooth tissues in the form of 2-3% solution, anesthesine - for the treatment of deskvamative glossite (as suspension with hexamethylenetetramine).

Anesthesin (Anaesthesinum). Synonyms: Aethylis aminobenzoas, benzocaine (Benzocain).

pharmachologic effect: causes superficial anesthesia of the skin and mucous membrane.

Indications: Apply with stomatitis, alveolites, gingivitis, glossites and for appliquational anesthesia.

Mode of application: In dentistry, it is used locally in the form of 5-10% of ointments or powders, 5-20% of oil solutions, as well as tablets of 0.005-0.01 g (for sucking). The maximum dose for local application is 5 g (25 ml of 20% oil solution). It is part of (3%) Fastin anti-foam ointment.

Side effect: When applied to a large surface due to suction may cause methamoglobinemia.

: manifests itself in the weakening of sulfonamide action. Strengthening action is observed after the preliminary use of hypnotic agents and tranquilizers.

Contraindications: Not used for individual heightened sensitivity, sulfonilamine treatment drugs.

Form release: Powder, tablets (0.3 g).

Storage conditions: in a dry, cool place. List B.

RP: Anaesthesini 3.0
Dicaini 0.5.
Mentholi 0.05
AETHERIS PRO NARCOSI 6.0
SPIRITUS AETHYLICI 95% 3.3
Chloroformii 1.0
M.D.S. For surface pain relief mucosa.
RP: Mentholi 1,25
Anaesthesini 0,5
Novocaini 0,5
Mesocaini 0,5
Spiritus Vini 70% 50.0
M.D.S. Liquid for L. A. Khalafov for application anesthesia of solid tooth tissues.
RP: Anaesthesini 1.0
01. Persicorum 20.0
RP: Anaesthesini 2.0
Glycerini 20.0
M.D.S. For anesthesia of the mucous membrane.

Benzofurokaia (Benzofu Rocaipum).

pharmachologic effect: It is a local anesthetic with a central analgesic component.

Indications: In dentistry, used for infiltration anesthesia, with pulpits, periodontitis, to open abscesses, postoperative anesthesia. It can also be used to relieve spastic pains with renal and hepatic colic, traumatic pain.

Mode of application: for infiltration anesthesia and other Indicationsm is introduced 25 ml of 1% solution, it is possible to add 0.1% adrenaline hydrochloride to this solution. For anesthesia, intramuscularly and intravenously drip 0.1-0.3 g (10-30 ml of 1% solution) are prescribed 1-3 times a day. The maximum daily dose is 100 ml of 1% solution (1 g of preparation). In an intravenous drip administration, a solution of the drug is bred in an isotonic solution of sodium chloride or a 5% glucose solution for injections. The speed of intravenous drip administration is 10-30 drops per minute.

Side effect: With quick intravenous administration, dizziness, weakness, nausea and vomiting occur.

Contraindications: Pathology of liver and kidney, brain circulation disorders, atrioventricular blockade.

Interaction with other drugs: Benzofurocaine solutions are not combined with drugs that have an alkaline reaction.

Form release: 1% solution in ampoules 2, 5 and 10 ml.

Storage conditions: In the place protected from light. List B.

Bupivacaine hydrochloride (Bupivacaine Hydrochloride). Synonyms: Angain (Ancain), Markain (Marcain), Durakain (Duracain), Narcain (Narcain).

pharmachologic effect: Local anesthetic from the group of aminoamides is a butyl counterpart of MEPIVACAIN. Anesthetic longer action (up to 5.5 hours with conductive and 12 hours of infiltration anesthesia). Acts slower than lidocaine solutions, MEPIOVACAIN and cytanese. 6-16 times more active and 7-8 times toxic novocaine. It has a strong vasodilator effect and therefore applied in combination with adrenaline. In dentistry used in the form of a 0.5% solution. Anesthetic effect occurs rapidly (for 5-10 minutes). The mechanism of action is due to the stabilization of the neuron membranes and the prevention of the occurrence and carrying out the nervous impulse. Analgesic action continues and after the cessation of anesthesia, which reduces the need for postoperative anesthesia. Metabolized in the liver, not split by plasma esterase.

Indications: Used for postoperative analgesia, conducting therapeutic blockade, anesthesia during surgery, when there is no need for miolaxation, as well as for infiltration and conductor anesthesia.

Mode of application: For infiltration anesthesia, 0.125-0.25% solutions are used. If adrenaline does not apply, the maximum total dose of bupivacaine can be up to 2.5 mg / kg body weight. When adding adrenaline to a solution (in a ratio of 1: 200, OOO), the total dose of bupivacaine can be increased by 1/3.

For conductor anesthesia, 0.25-0.5% solutions are used in the same general dose as with an insfigal anesthesia. With the anesthesia of mixed nerves, the effect develops after 15-20 minutes and lasts 6-7 hours.

For epidural anesthesia, 0.75% solution is used in the same total dose of the drug.

Side effect: Typically, the drug is well tolerated, but with a massive overdose there is a depression of the central nervous system, loss of consciousness, stopping the breath. It is possible to reduce blood pressure, tremor, oppression of cardiac activity up to the stop. When adrenaline adds to solutions, its possible side effects (tachycardia, an increase in blood pressure, arrhythmia) should be taken into account.

Interaction with other drugs: Does not affect the antimicrobial effect of sulfonamide (unlike novocaine). With simultaneous use with barbiturates, it is possible to reduce the concentration of bupivacain in the blood.

Form release: 0.25; 0.5 and 0.75% solutions in ampoules, bottles of 20, 50 and 100 ml.

Anecain - a solution for injection in bottles of 20 ml, in the package of 5 pcs (1 ml contains 5 mg of bupivacain chloride).

Storage conditions: List B.

Dikain (Dicainum). Synonyms: Tetrakain (Tetracainum), Rexokain (Rexocaine).

pharmachologic effect: It is a topistanisy tool, which is active superior novocaine, but more toxic. Well absorbed through the mucous membrane.

Indications: It is used for stomatitis, alveolitis, gingivitis, glossites, for the local anesthesia of the tooth solid tissues, as part of the paste for the devital of the pulp, with an increased vomiting reflex before removing the impulsions or performing intrarocal radiographs to anesthetize the injection site.

Mode of application: Apply to the mucous membrane in the form of 0.25; 0.5; 1 and 2% of solutions or rubbed into solid tooth tissue.

Side effect: The drug is toxic, when inxication arises, concern, convulsions, respiratory disorders, cardiovascular insufficiency, hypotension, nausea, vomiting. The cytotoxic effect in the epithelial layer and deeper layers can be locally.

Interaction with other drugs: Weakens the effect of sulfonamide preparations. Strengthening action is observed after the preliminary use of hypnotic agents and tranquilizers.

Contraindications: Not used in individual intolerance, appointment, sulfonamides.

Form release: powder, solutions of different concentrations (0.25; 0.5; 1; 2%).

It is part of the combined drugs;

- anesthopulpe fibrous paste (anesthopulpe), consisting of several components (Solynoskisy Tetrakain - 15 g, thymol - 20 g, Govelak - 10 g, filler up to 100 g - at the rate of 100 g), I am backed in jars 4, 5 G. has anesthetic and antiseptic effect and is applied mainly as painful in the preparation of carious cavity without its pretreatment and as an additional means after machining carious cavity in the treatment of pulpitis (in the cavity, washed with a solution of hydrogen peroxide after removal of dentin, a ball is placed "Anestopulips" and is closed by a temporary seal);

- Perealene Ultra (Perylene Ultra) - a means for surface anesthesia (composition at the rate of 100 g; tetrakain hydrochloride - 3.5 g, ethyl para-aminobenzoate - 8 g, mint oil - 3 g, filler up to 100 g), in bottles of 45 ml.

It is intended to eliminate the sensitivity and antiseptic processing of the mucous membrane before injections, surface anesthesia to remove dairy teeth and dental sediments, suction of non-removable designs of dentures (crowns, bridges, etc.), suppressing a vomit reflex when removing implications, opening abscesses under the mucous membrane, Additional anesthesia when extirpation of pulp.

Mode of application: Pre-dried mucous membrane lubricate the tampon strolled into the ball pullee ultra:

- Rail-spray (peryl-spray) - vial in aerosol packaging with a capacity of 60 g (3.5% tetrakain hydrochloride).

Storage conditions: In a well-visited container. List A.

RP: Dicaini 0.2
Phenoli Puri 3.0
Chloroformii 2,0
M.D.S. Liquid number on E.E. Platonov
RP: Dicaini 0.2
Spiritus Vini 96% 2.0
M.D.S. Fluid No. 2 by E. E. Platonov.

Mode of application: Liquids No. 1 and No. 2 are mixed and rubbed with a cotton swab into sensitive surfaces of the teeth. Lidocaine (lidocaine). Synonyms: xylocaine (xylocaine), xycaine (xycaine), lidocaine hydrochloride (Lidocaini Hydrochloridum), Lignojain Chlorohydrate (LIGNOCAIN NS1), Lidocaton (Lidocaton).

pharmachologic effect: It is a local anesthetic group of amides, an amide derivative of xylidine. Anesthetic effect is 4 times more than that of novocaine, toxicity is 2 times higher. Quickly absorbed, slowly decomposes, acts longer than novocaine, usually 1-1.5 hours. Use for all types of local anesthesia: terminal, infidentiary, conductor. Stabilizes cell membranes, block soda channels. Adding adrenaline prolongs the effect of the drug by 50%. Lidocaine is metabolized mainly in the liver and is escructed through the kidneys.

Indications: Apply for application, infiltration or conductor anesthesia before the dental removal, cuts and other dental operations, before the preparation of solid tissues and the dentalization of the pulp of the tooth, before the treatment of stomatitis and periodontopathops, removing the impulses and obtaining intrarocarditors with an increased vomit reflex (in the latter case, can be used When using elastic impression materials, when removing gypsum implications, they do not use pieces of gypsum to avoid aspiration). Apply with novocaine intolerance. 10% solution is applied intramuscularly as an antiarrhythmic agent.

Mode of application: For anesthesia, intramuscularly, subcutaneously, submucous in the form of 0.25-0.5-1-2% of solutions, 2.5-5% ointment, 10% aerosol. The introduction of the drug should be carried out slowly with the preliminary or constant aspiration to avoid accidental intravascular administration. In most cases, to achieve an optimal painkillery effect, it is recommended to introduce a physically healthy adult 20-100 mg, children under the age of 10 - 20-40 mg of the drug. After the applique of Lidocaine in the aerosol form on the oral mucous cavity, local anesthesia is provided with a duration of 15-20 minutes. With an increased sensitivity of dentin before the imposition and fixation of non-removable prosthesis, it is better to use a heated 10% solution, and not an aerosol, since the air oil-contained mint oil is irritate on the pulp and reduces the cement adhesion to the wound surface of the dentin.

Side effect: Safety and efficacy of local anesthesia using lidocaine hydrochloride depend on the correct selected doses and techniques of administration, adopted precautions and readiness of emergency care. Lidocaine can cause acute toxic effects with random intravascular administration, fast absorption or overdose.

The reaction from the CNS may manifest itself by excitation or depression, ringing in the ears, euphoria, drowsiness, while pallor, nausea, vomiting, decrease in blood pressure, muscle shakes can occur. Such phenomena can be more pronounced (up to the collapse) with a rapid hit of concentrated lidocaine solutions in the bloodstream. In this regard, during the administration of the drug, an aspiration test should be carried out, as well as to a minimum limit the possible movement of the patient after anesthesia.

Patients need to be explained how to avoid random injuries of lips, tongue, mucous membranes of cheeks, soft sky tissues after anneasiating. Meal must be postponed until the sensitivity is restored.

Allergic reactions are possible, however, they occur less often than when applying novocaine, although lidocaine in high concentrations is more toxic.

Interaction with other drugs: Lidocaine should be used with caution in patients receiving antiarrhythmic drugs, such as toocainide, since it is possible to enhance the toxic effect. It is recommended to avoid the use of adrenaline solutions in patients who receive monoaminoxidase inhibitors or tricyclic antidepressants, because long-term arterial hypertension can develop. When using the drug with adrenaline during or after conducting inhalation anesthesia, various heart arrhythmias can develop a halotan.

Contraindications: It is not recommended for severe miastic, cardiovascular failure, severe violations of liver and kidney functions, an atrio-ventricular blockade of 11-III degree, as well as with increased sensitivity to this anesthetic. With caution to apply in patients with an untreated arterial hypertension.

Form release: Domestic lidocaine is performed as 1% and 2% solution in ampoules 2, 10 and 20 ml; 10% solution in ampoules 2 ml; 2.5-5% ointment and aerosol (cylinder capacity of 65 g).

The imported analogue of Lidocaine Xylocaine (xylocaine) is produced without adrenaline in the form of 0.5%, 1% and 2% solution (1 ml of the preparation contains 5, 10 and 20 mg of lidocaine hydrochloride) and with adrenaline (5 μg per 1 ml). In dental practice, a predominantly 2% solution with adrenaline (20 mg / ml + 12.5 μg / ml) is used.

The imported analogue of Lidocaine Xylonor (xylonor) is available in the karpulas (a box of 50 carriages of 1.8 ml, packed under vacuum): ""

- xylonor without vasoconstricneur (Xylonir Sans VasoconstricNEUR), containing 36 mg of lidocaine;

- xylonor 2% special (xylonor 2% special), containing lidocaine hydrochloride (36 mg), adrenaline (0.036 mg) and norepinephrine (0.072 mg);

- xylongor 2% (xylonor 2% Noradrenaline) containing lidocaine hydrochloride (36 mg) and norepinephrine (0.072 mg);

- Xylongor 3% (xylonor 3% NORADRENALINE), containing lidocaine hydrochloride (54 mg) and norepinephrine (0.072 mg). To achieve anesthesia, it is usually 1 karpula. Maximum dose - 2 kartulas.

Lidocaine is part of combined drugs having 2 or more active substances: lidocaine + benzalconium chloride (see Dyneksan A); lidocaine + zetrimide (bactericidal substance of the type of four-component ammonium), which is recommended for use in patients with allergies to para-aminobenzoic acid derivative; Produced in the following form:

- xylonor 5%, in bottles with a capacity of 12 and 45 ml;

- dragee, 200 pcs in a bottle;

- xylonor-spray, contains 15% lidocaine (aerosol packing capacity 60 g).

Mode of application: Xylonor in solution and xlongor-gel are applied to a mucous membrane on a cotton swab; Xilonor in dragee - placed for a few seconds for a pre-dried mucous membrane; Xilonor spray - the cannula of the sprayer is placed in 2 cm from the mucous membrane and produce 23 pressing (1 pressing corresponds to 8 mg of lidocaine on the surface of the mucous membrane with a diameter of 1 cm) not more than 45 different places of the mucous membrane in the continuation of one visit.

Storage conditions: Preparation without adrenaline stored at room temperature. The drug with adrenaline is stored in a cool, protected place. List B.

MEPIVACAIN (Mepivacaine). Synonym: Mepikaton (Mepicaton), Scandicain (Scandicaine), Skandonest (Scandonest).

pharmachologic effect: topless amide type of a short action (30 min and less). Apply for all types of local anesthesia: terminal, infiltration, conductor. It has a stronger anesthetic effect than Novocain. Its toxicity is lower than that of Lidocaine. Compared with Novocaine and Lidokain, anesthetic effect is achieved faster.

Indications: For local anesthesia with various therapeutic and surgical interventions in the oral cavity, including the lubrication of the mucous membranes in the intubation of trachea, bronchoesophagoscopy, tonsilctomy, etc.

Mode of application: The amount of solution and total dose depend on the type of anesthesia and the nature of operational intervention or manipulation. For the MEPIKATON drug, the average dose is 1.3 ml, if necessary, the dose can be increased. Maximum daily dose for adults and children with a body weight over 30 kg - 5.4 ml; For children with a body weight up to 20-30 kg - 3.6 ml.

Side effect: possible (especially when the dose or the preparation in the vessel is exceeded) - euphoria, depression; violation of speech, swallowing, view; convulsions, oppression of breathing, coma; Bradycardia, arterial hypotension; Allergic reactions.

Contraindications: Increased sensitivity to local amide type preparations and parabens. Caution is prescribed during pregnancy and elderly patients.

Interaction with other drugs: With the joint use of MEPIOVACAIN with beta-adrenobloclars, calcium channel blockers and other antiarrhythmic agents, an inhibitory effect on the conductivity and the reduction of myocardium is enhanced.

Form release: The injection solution (MEPIKATON), in vials (in 1 ml of solution contains 30 mg of MEPIOCAIN hydrochloride).

ScandoNest - 2% solution in 1.8 ml kapulos (contains 36 mg of methods of hydrochloride and 0.018 mg of adrenaline); 2% solution in 1.8 ml karps (contains 36 mg of methods of hydrochloride and 0.018 mg of norepinenaline tartrate); 3% solution in carps of 1.8 ml (contains 54 mg of methods for hydrochloride without a vesseloring component).

Storage conditions: in a cool place.

Novocaine (Novocainum). Synonyms: Procaine Hydrochloride (Procaini Hydrochloridum), Aminocaine (Aminocaine), Pankain (Pancain), Syntocaine (Syntocain).

pharmachologic effect: topiancestrating remedy with moderate anesthetic activity and high latitude of therapeutic action. Lowering the excitability of the engine zones of the brain, myocardium and peripheral cholinoreactive systems. It has a gangli-blocking effect, including antispasmodic on a smooth muscles, reduces the formation of acetylcholine.

Indications: It is used for infiltration or conductor anesthesia before the preparation of solid tissues of teeth, amputation and extirpation of pulp, dental removal, cuts and other dental operations, as well as to relieve pain in diseases of the temporal mandibular joint, stomatitis, gingivitis, glossites.

Mode of application: For anesthesia, intramuscularly is used, subcutaneously, submucous in concentrations of 0.25% (up to 500 ml in the first hour of operation). 0.5% (up to 150 ml in the first hour of operation); 1-2% (up to 25 ml), for rinsing the oral cavity 23 ml of 0.25-5% solution. The drug is also administered by electrophoresis in the area of \u200b\u200bthe temporomandibular joint (5-10%), and is also used to dissolve Penicillin (0.25-0.5%). With anesthesia, you can add 1 drop of 0.1% adrenaline solution by 2.5-3% ml of novocaine solution.

Side effect: may cause dizziness, weakness, hypotension, allergic reactions.

Interaction with other drugs: Strengthening action is observed after the preliminary use of hypnotic agents and tranquilizers. Reduces the bacteriostatic effect of sulfanimamides.

Contraindications: Individual intolerance.

Form release: 0.5%, 1% and 2% solution in ampoules 1, 2, 5, and 10 ml; Flookes with a sterile 0.25% and 0.5% solution of 400 ml preparation; 0.25 and 0.5% solution in ampoules of 20 ml.

Storage conditions: Ampoules and bottle are stored in a cool, protected from light place. List B.

Pyromekain (Pyromecainum).

pharmachologic effect: is a local weighing tool.

Indications: Apply for application anesthesia during stomatitis, gingivitis, glossites, residual pulpits, to attenuate an increased vomit reflex before removing impulsions or performing intrarocardiographs, for annexiation of the injection site.

Mode of application: 1% solution or 5% ointment lubricates the oral cavity tissues or the root pulp is anesthesia through the carious cavity.

Side effect: Sometimes acute inflammatory reactions in the subepitial connective tissue and muscle layer can occur.

Interaction with other drugs: Strengthening action is observed after the preliminary use of hypnotic agents and tranquilizers.

Contraindications: Individual intolerance and increased sensitivity to the drug.

Form release: 0.5%; 1% and 2% solution in ampoules of 10 ml, 5% ointment in tubes for 30 g.

Storage conditions: List B.

Plilokaine (Prilocain). Synonyms: Cytonest, Xilons.

pharmachologic effect: Local anesthetic amide type (Toluidida derivative) with a rapid effect of the effect and average duration of action. The drug is approximately 30-50% less toxic than lidocaine, but less active, with a longer action. A 3% solution of IITANEST with octapressin provides the duration of the topically escaped effect on the pulp of the tooth for 45 minutes. Unlike norepinephrine and adrenaline octapressin does not interact with tricyclic antidepressants. When combined with it, the cytone does not cause ischemia at the injection site, so the hemostatic effect is not expressed. When used in a dose, over 400 mg, cytanese metabolites contribute to the formation of methamoglobin.

Indications: Used for conductor and infiltration anesthesia.

Mode of application: For local anesthesia (infiltration and conductor anesthesia) use 2-3-4% solution with adrenaline 1: 100,000, 1: 200,000, with Felipressin (octapressin).

Side effect: Quickly passing ailments may appear: headache, chills, alarm feeling. Allergic reactions are possible.

Contraindications: Not recommended to prescribe with increased sensitivity to local anesthetics of amide type, congenital or idiopathic methemoglobinemia. It should be used with caution in anesthetizing in children, pregnant women and elderly.

Form release: Karpula 1.8 ml, 2-3-4% solution with adrenaline 1: 100,000, 1: 200,000, with Felipressin.

Storage conditions

Trimekain (TrimeCainum). Synonym: Mesocaine (Mesocain).

pharmachologic effect: Local anesthetic. Causes a quick advancing, long-term conductive, infiltration, peridural, spinal anesthesia. Does not have an irritant action, relatively little toxic. Adding norepinephrine to trimekinium solution causes a local narrowing of the vessels, which leads to a slowdown in the suction of trimeskain, ensuring amplification and prolongation of anesthetic and reduced system action.

Indications: It is used for application, infiltration or conductor anesthesia before the removal of teeth, cuts and other dental operations, before the preparation of solid tissues and the devotation of the pulp of the tooth, the treatment of stomatitis and partontopathops, withdrawing the impositions and the receipt of intrarocarditors with an increased vomit reflex (in the latter case, can be applied at The use of elastic impression materials, when removing gypsum impulsions, do not use pieces of gypsum to avoid aspiration).

It is used in the intolerance of novocaine.

Mode of application: for anesthesia is used intramuscularly, subcutaneously, submucosally as 0.25; 0.5; one; 2% solutions. The maximum allowable dose of 2% solution is 20 ml. 0.1% adrenaline solution is added to slow down suction at the rate of 1 drop by 3-5 ml of anesthetic. For the application anesthesia of solid tooth tissues, 70% of the paste (according to the Cabil N. M. et al.), As well as a 10% solution for electrophoresis in the carious cavity.

Side effect: May cause pale, headache, anxiety, nausea, allergic reactions in the form of urticaria.

Interaction with other drugs: See Pyromequain.

Contraindications: Not used in sinus bradycardia (less than 60 UD / min), full transverse blockade of the heart, diseases of the liver and kidney, as well as with increased sensitivity to the drug.

Form release: 0.25% solution in ampoules of 10 ml, 0.5 and 1% solution in ampoules of 2.5 and 10 ml, 2% solution in ampoules 1, 2, 5, and 10 ml, 2% solution from 0.004% Norainerenaline solution 2 ml.

Storage conditions: In the cool, protected place.

List B.

RP: TrimeCaini 2.5
Dicaini 0.5.
Prednizoloni 0.25.
Natrii HydroCarbonatis 1.0
Lydasi 0,3.
Glycerini 5.0
M.D.S. Pasta for applical pain relief solid tooth tissues. Rub in the wound surface of Dentin.
RP: TrimeCaini 6.0
Dicaini 0,3.
Natrii Bicarbonici 1.0
Lydasi 0,2
Glycerini 3.0
M.D.S. Anesthetic paste "Medinalgin-1".

Ultrakain (Ultracain). Synonyms: Articine Hydrochloride (Articaine Hydrochloride), Ultrakin D-S (Ultracain D-S), Ultrakain D-S Forte (Ultracain D-S Forte), Septanest (Septanest).

pharmachologic effect: It is a strong local anesthetic amide type with a rapid start of action (0.3-3 minutes after injection). Ultrakain is 6 times stronger than novocaine and 3 times lidocaine and scandicine (MEPIVACAIN), due to the exceptional diffusion in the connecting and bone tissue. This allows you to reduce artica Indications The conductor methods of anesthesia, which not only simplifies the anesthesia technique (for example, in children), but also reduces the likelihood of potential complications associated with conductive anesthesia, the number of postoperative bite of lip and language.

Articain does not contain a preservative paraben, which most often causes allergic reactions. The content of metabisulphite (adrenaline antioxidant), compared with other anesthetics, is minimally (0.5 mg per 1 ml solution). The stability of anesthetic is achieved by high glass quality, carpula rubber parts and high chemical purity of the active substance.

Inactivation of ultrakina is (by 90%) by hydrolysis in the blood immediately after the administration of the drug, which practically reduces the risk of systemic intoxication in cases of re-administering anesthetic during dental intervention. The duration of local anesthesia Depending on the concentration of the solutions used and the method of administration is 1-4 hours. In addition to the anesthetics properties in resorption, there may be a gangli-blocking, antispasmodic, as well as a weak anticholinergic effect.

Indications: It is used for infiltration, conduction, epidural, spinal anesthesia. In dentistry are used in the preparation of solid teeth tissues under fillings, tabs, half-skewers, crowns; When the oral mucosa is cut, amputation and extirpation of pulp, removal of teeth resection of the tip root, cystotomy, primarily in patients with severe somatic diseases

Mode of application: In dental practice, they are injected into the submucosal layer, intraligative, substandard, in the projection of the root of the root. Disposable maximum dose of the drug adults - 7 mg / kg body weight (up to 7 karpul), which is approximately 0.5 g of the drug or 12.5 ml of 4% solution. For the anesthesia in the preparation of solid tooth tissues, with an intraligendum or substitute for the drug, a sufficient dose of 0.12-0.5 ml is sufficient, and the time of the maximum effect is 0.4-2 minutes, and the duration of effective anesthesia is 20-30 minutes. In the endopulpar administration of 0.06 ml of ultrakina, the effect manifests itself after 5-6 s, the duration of effective anesthesia is 10 minutes. In the subclosure of the introduction, 0.5-1 ml is used (the maximum effect occurs after 10 minutes, and the duration of effective anesthesia is 30 minutes). For conductor anesthesia, 1.7 ml of ultrakina is introduced (the maximum effect of anesthesia occurs after 10-15 minutes, the duration of effective anesthesia is 45-6 0 min). When removing the upper teeth and lower premolars, in most cases there is enough only vestibular injection.

Side effect: The drug is moved well, but in overdironments are possible nausea, vomiting, muscle tremor. Massive resorption causes heartfelt depression, reduced blood pressure and respiratory depression up to the stop. Allergic reactions, anaphylactic shock are not excluded. Adrenaline's side effects should also be taken into account, which is part of the solutions "Ultrakin D-S" and "Ultrakin D-S Fort".

Contraindications: Increased sensitivity to articiane and epinephrine (adrenaline). Considering the presence of epinephrine, there are following

Contraindications: Decompensated heart failure, narrow-edge shape of glaucoma, tachyrhythmia, Adams-Stokes syndrome, bronchial asthma. Intravenous administration is contraindicated. Injecting in the inflammation area should be avoided.

Form release: "Ultrakin A" - 1 and 2% solution for injection in ampoules in 20 ml (1 ml contained 10 and 20 mg of artician and 0.006 mg of adrenaline).

"Ultrakin DS" - a solution for injections in ampoules in 2 ml, karpula of 1.7 ml, in the package of 100 and 1000 pcs (1 ml contained 40 mg of artician hydrochloride and 6 μg of adrenaline hydrochloride, i.e. 1: 200 000).

"Ultrakin DS Forte" - a solution for injection in ampoules in 2 ml, karpula 1.7 ml per pack of 100 and 1000 pcs (1 ml contained 40 mg of artician hydrochloride and 12 μg of adrenaline hydrochloride, i.e. 1: 100 000).

A solution for injection "Ultrakin hyperbar", containing in 1 ml of 50 mg of artician and 100 mg of glucose monohydrate (for spinal anesthesia).

Storage conditions: In the place protected from light. Store at a temperature not higher than + 25 ° C. The drug can not be frozen or enjoy racing. The anesthetic solution in the carpool is stored from 12 to 24 months. Partially used carpulas are not subject to storage for use in other patients due to the risk of infection.

Disinfection Carpool: Rubber Cork and Metal Cap before injection should be wiped with gauze dipped in 91% isopropyl or 70% ethyl alcohol. It is impossible to autoclave, store in disinfectant solutions. When using anesthetic, packed in blisters, the sterility of each karpula is ensured, which eliminates the need for additional processing.

Ethidocaine (Ethidocaine). Synonym: Durast (Duranest).

pharmachologic effect: It is a topistanisy drug (lipophilic lidocaine homolog). In dentistry, a 1.5% solution with a vasoconstrictor is used. When conducting anesthesia on the lower jaw is equal to 2% lidocaine, but with infiltration anesthesia on the upper jaw does not give satisfactory teeth anesthesia. The anesthesia of soft tissues in the field of infiltration is sufficiently long - by 2-3 hours more than when using 2% lidocaine with adrenaline. It has a pronounced vasodilatory action.

Indications: Apply for infiltration and conductor anesthesia.

Mode of application: for infiltration and conductor anesthesia and other Indicationsm is used 1.5% solution with a vasoconstrictor (1: 200,000).

Side effect: In addition to side effects, peculiar to local anesthetics of amide type, possibly postoperative bleeding (for example, after removing the tooth).

Contraindications: It is not recommended to apply in cases of potentially large operating injury due to possible bleeding in patients with blood diseases, after states accompanied by blood loss, in violation of the functions of the cardiovascular system, with individual intolerance to the drug and during pregnancy.

Form release: 1.5% injection solution with vasoconstrictor 1: 200 LLC.

Storage conditions: at room temperature.

Certificate of Medicinal Doctor Dental
Edited by the Honored Worker of Science of the Russian Federation, Academician Ramne, Professor Yu. D. Ignatova

The modern pharmaceutical industry offers a large selection of high-quality anesthetics, thanks to which fears associated with the treatment of teeth went into the past. Today, dentists pain relieve sensitive patient tissues with new generation preparations that cause the minimum amount of adverse reactions and allowing to remove the tooth or begin its treatment a few minutes after the introduction of the substance.

Indications for anesthesia in dentistry

Anesthesia in dentistry is used in the treatment of caries, depug, extraction, any surgical intervention. Solving, what anesthesia is better, take into account the degree of sensitivity of the enamel and dentine layers of the patient's teeth. Before the introduction of the drug, the doctor clarifies whether patient suffers from cardiovascular diseases, diabetes, violations in the work of the endocrine system.

In the presence of these pathologies, they resort to general anesthesia. Indications for anesthesia are:

• individual intolerance to the patient components that are part of the local anesthetic;
• insufficient effectiveness of local anesthetics;
• disorders of psyche.

The use of a particular type of anesthesia is due to the presence of special indications, the state of health and age of the patient.

So, in the treatment of kids and elderly patients, complicated tooth extraction wisdom, it is better to use general anesthesia. The complexity of the clinical case and localization of the pathological process also take into account solving what anesthetic to choose.

Types and methods of anesthesia in the treatment and removal of teeth

The basis of the classification of modern anesthetics is the principle of distribution of "freezing" components by spraying on the mucous membrane or administration to the gums with the help of an injection. Depending on the degree of loss of sensitivity and control of the patient over its consciousness, there is a partial (local) and complete (general) anesthesia.

Local

This is the most secure and frequently used anesthesia. The substance is valid only in the field of intervention. After the administration of the drug, the patient is in consciousness and feels numbness in the oral cavity. The efficiency of "freezing" is due to the use of carpool - ampoules with precisely dosed painkillers.

The method of frost consisting in applying anesthetic to mucous membranes without injections. To reduce the sensitivity of the nerve endings, concentrated preparations with lidocaine and benzocaine in the form of sprays and gels, sulfidine and glycelophosphate ointment are applied. In this case, the sense of numbness occurs after a few seconds and continues for 30 minutes.

Due to the absence of needles, appliquancy anesthesia is often used in children's dentistry. The difficulty of dosage and insufficient effectiveness of substances are the main disadvantages of this method. For this reason, it is not used in severe clinical cases requiring long-term treatment, when the wisdom teeth removes, and replace the carpool anesthesia.

This method provides for blocking the nerve endings by introducing a medical examination under the periosteum, under the mucous or spongy bone tissue. An experienced doctor makes an injection as close as possible to a neuro-vascular beam, thereby increasing the duration of "freezing".

To reduce the sensitivity of tissues, a minor number of anesthetic is required, which reduces the risk of adverse reactions.

Conductive anesthesia

Conductive anesthesia is used in severe clinical cases requiring long surgery. This method provides for the introduction of a novel solution in tissues surrounding the nerve or directly into the nerve, which ensures the "freezing" of the teeth group. The method is not used in the treatment of children and in the presence of extensive inflammations in the places of alleged injections.

Intracitial, or intraligent anesthesia is in the introduction of analgesic in a periodontal space. Fabrics lose sensitivity for 30 seconds without causing a patient a familiar sense of numbness. This method allows you to introduce a drug in a small amount, which is used in the therapy of pregnant women and children.

Intraseptal anesthesia

Intraseptal anesthesia involves the introduction of the drug to the area between the wells of the teeth. During intraosseous anesthesia, the substance blocks not only soft, but also bone tissue. Intra view "freezing" is distinguished by the rapid numbness of the site (within 1 minute) and greater efficiency compared to other types of anesthesia.

The disadvantages of intraseptal anesthesia include:

Sverhead anesthesia

The most complicated, and therefore the rarely used anesthesia method. It provides for the introduction of an anesthetic drug directly to the base of the skull or cheekbone to block the trigeminal nerve. It is characterized by the strongest anesthetic effect and is shown in severe jaw injuries, neoplasms and purulent processes in deep tissues.

The trunk anesthesia when removing the tooth is characterized by an extensive area of \u200b\u200banesthesia, a long action and a minimum side effect. In rare cases, the patient experiences dizziness, muscle pain, heart rate disruption. Complications such as anaphylactic shock and nerve damage are even less likely, since this type of anesthesia is applied only by experienced doctors.

General anesthesia

Narcosis is shown in the intolerance to local anesthetics and in severe clinical cases.

The patient is immersed in a dream, and the anesthesiologist observes its condition. The use of general anesthesia, on the one hand, facilitates the treatment of teeth, excluding the patient's nervousness. On the other hand, the doctor has to adapt to the patient who cannot turn his head and open the mouth wider.

The use of general anesthesia requires greater preparation. Before starting treatment, the patient gives blood for analysis and passes the ECG to eliminate heavy heart pathologies. A few days before visiting the dental office, drinking alcoholic beverages and smoking is prohibited. It is necessary to stick to the diet, and 8 hours before the use of the drug and stop eating.

Anesthetics in modern dentistry

Today in dentistry uses a carpill technology for administering an anesthetic substance. The carpool is called a cartridge with a dosage amount of anesthetic, which is inserted into a disposable syringe. Anesthesia carpill is distinguished by less discomfort, sterility and safety due to the inclusion in its composition of the thoroughbating components.

On the basis of artikain (kilifesin, septant, etc.)

Due to the low percentage of adverse reactions and preservatives, destroying Forte is popular among new generation anesthetics. The drug is used for any operational interventions in the oral cavity: removal of wisdom teeth, extracting tooth debris and even such long operations such as cystectomy and apocectomy.

The anesthetic effect of the tariff Forte continues for 45 minutes after administration. The presence of thorough-resistant properties in the drug makes it possible to use a smaller amount of adrenaline, which reduces the risk of complications. The use of killaine forte does not provoke blood pressure and heart rate disruption.

The sepantist is most often used in the extraction, disintegration of teeth, simple operations providing for interference exclusively in the oral mucous membrane. The anesthetic effect occurs a few minutes after the introduction of septonesst and reaches its peak by 15-17 minutes of anesthesia.

Using the sepantist, the doctor can count on 30-45 minutes of anesthesia. To continue treatment, an additional dose of medication is introduced. Anesthetic is used with caution for pain reliefing patients taking antiguchaukomatous preparations that increase blood pressure.

Based on MEPIVACAIN (Skandonest, MEPIOVACAIN, MEPIOVASIN, etc.)

MEPIOVACAIN-based drugs have less pronounced painkillers compared with the means with the artician. This explains why some patients do not take this anesthesia. Medicines of this group do not contain adrenaline, and therefore are used in pregnancy and lactation, in childhood, at high pressure and during diseases of the endocrine system.

Skandonest is a local anesthetic used in clinical cases of various complexity. The carpula with the drug is introduced by means of an infiltration method and is valid for 30-45 minutes after entering anesthetic in tissue. Skandonest is metabolized within one and a half hours. A more medication disintegrates into simple components and only 5-10% is removed from the urine.

MEPIVASIIN is used in simple removal and teeth processing for further restoration. The use of this drug in patients suffering from hypotension, epilepsy and acute heart failure is contraindicated. This means of caution is prescribed to patients taking blood clotting inhibitors.

Use of MEPIVASIN for carpill pain reliefing of individual categories of patients is characterized by the following features:

Based on novocaine (aminocaine, synthocaine, etc.)

Preparations based on novocaine are characterized by extension of vessels, which reduces the anesthesia time. To extend the anesthetics time, they are mixed with adrenaline. For this reason, the means with Novocaine is rarely used in dentistry today. They are replaced by MEPIOVACAIN-based drugs.

Why do vasoconstrictors need?

The use of most local anesthetics is accompanied by extension of vessels, which leads to a decrease in the concentration of painkillers in the field of intervention and reduce treatment time. To increase the "freezing" time, anesthetics are mixed with vasoconstrictors - substances that narrow blood vessels.

The list of vesseloring components includes adrenaline, vasopressin, korbadrin, levonordeofrine. Acceptance of these funds is invalid for diseases of the cardiovascular system, epilepsy, diabetes mellitus. With such contraindications, the patient is prescribed drugs that reduce the harmful effects of vasoconstrictors - hypotensive and antihistamines, or anesthesia without adrenaline is carried out.

Choosing the best dental anesthetic, especially before planned treatment, the patient should be familiar with the instructions of famous drugs. Studying tables with the names of anesthetics are guided, first of all, contraindications and complexity of a clinical case. The anesthetic anesthetic time should be enough for the dentist's manipulations.