Medically reviewed by Kovalenko Svetlana Olegovna, PharmD. Last updated on 2022-04-08
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Articain with Epinephrine
The dose of the drug is set individually, taking into account the severity and duration of the surgical intervention. With uncomplicated removal of the upper jaw teeth (no inflammation), infiltration anesthesia with Ultracaine is performed at a dose of 1.7 ml (for each tooth), in some cases, additional administration of 1 to 1.7 ml of the drug may be required to achieve complete anesthesia. In most cases, there is no need to perform anesthesia with a palatine approach, for anesthesia on palatine incisions and sutures to create a palatine depot, about 0.1 ml of anesthetic per injection is necessary. When removing several adjacent teeth, the number of injections can usually be limited. In the case of removal of the premolars of the lower jaw (in the absence of inflammation), mandibular anesthesia can be dispensed with (infiltration anesthesia, provided by an injection of 1.7 ml per tooth, is usually sufficient, if necessary,additional administration of 1-1. 7 ml of anesthetic is possible, and in the absence of an effect — blockade of the mandibular nerve). To prepare the cavity or prepare for the crown of any tooth (with the exception of the lower molars), a dose of 0.5 to 1.7 ml per tooth is administered according to the type of infiltration anesthesia from the vestibular side. When performing a single treatment procedure, adults can be administered up to 7 mg/kg of body weight. A dose of up to 500 mg (12.5 ml of injection solution) is well tolerated when performing an aspiration test before injection in order to exclude the possibility of intravascular administration (for its implementation, the most suitable is the "Unijet K" syringe for carpules)
Hypersensitivity, paroxysmal tachycardia and other tachyarrhythmias, angle-closure glaucoma, bronchial asthma (in patients with hypersensitivity to sulfite).
. Side effects caused by the action of epinephrine (tachycardia, arrhythmia, increased blood pressure) are extremely rare at low-1:200000 (0.5 mg/100 ml) and 1:100000 (1 mg/100 ml) concentrations of epinephrine. Nerve damage (up to the development of facial nerve paralysis) occurs only when the injection technique is violated
If the first signs of side effects or toxic effects (dizziness, motor restlessness, impaired consciousness) appear, immediately stop the injection and place the patient in a horizontal position, careful monitoring of hemodynamic parameters (pulse, blood pressure) and airway patency is necessary. Even if the symptoms do not seem severe, it is necessary to prepare everything necessary for intravenous infusion and at least perform venipuncture. Depending on the degree of respiratory impairment, oxygen should be given, artificial respiration ("mouth to nose") should be performed, and, if necessary, endotracheal intubation with controlled ventilation of the lungs. The use of analeptic drugs of central action is contraindicated. In case of involuntary muscle twitching or generalized convulsions, the administration of short-or ultrashort-acting barbiturates is indicated (under the control of hemodynamic and respiratory parameters, oxygen supply and simultaneous intravenous fluid infusion). In severe circulatory disorders and shock, the injection of the drug should be stopped, the patient should be provided with a horizontal position with raised legs, oxygen inhalation and intravenous infusion of balanced electrolyte and plasma-substituting solutions, intravenous administration of glucocorticoids (250-1000 mg of methylprednisolone). In the case of threatening vascular collapse and increasing bradycardia, inject 25-100 mcg of epinephrine (0.25–1 ml of a solution with a concentration of 100 mcg/ml, slowly, under the control of pulse and blood pressure), do not inject more than 100 mcg of epinephrine (1 ml of the solution) at a time. Severe forms of tachyarrhythmia and tachycardia can be eliminated by the use of antiarrhythmic drugs (but not non-selective beta-blockers). With an increase in blood pressure in patients suffering from arterial hypertension, peripheral vasodilators should be used
It has a high diffusion ability when submucosally injected into the oral cavity. Protein binding is 95%. T1/2 — 25.3 min. It penetrates the placental barrier to a minimal extent, and is practically not excreted in breast milk.
- Local anesthetics in combinations
The hypertensive effect of epinephrine is enhanced by tricyclic antidepressants and MAO inhibitors. The risk of developing a hypertensive crisis and severe bradycardia increases against the background of non-selective beta-blockers.