Local anesthetic news

It never fails!  When asked by a pharmacist what was the dose of the local anesthetic given, the dentist’s reply is always given in number of cartridges. Yet when the same question is asked of Ibuprofen, the answer is in mg/day. Why is there a dual standard for local anesthetics? Are they not drugs also?

If you read “My first syncope”( posting of July 29), you will note that the amount of local anesthetic given was listed as cartridges. I can only assume that most dentist use Lidocaine as the standard and therefore all other products contain the same mg/ml as lidocaine. This assumption can result in giving a toxic dose.

You owe it to yourself to attend a CE course, to be aware of how some locals perform “in a world of changing medical prescriptions”. (Please see “About us”) on the Home page. -  www.anestheticsnews.com  You can e-mail us at localanesthetics@yahoo.ca

I initially met the patient during the hygiene recall.  I diagnosed for 4Q SRP due to heavy bleeding and pocketing (4-5mm), and replacement of a few bad overhang amalgams that shred floss.  She has complained of bad odor and bleeding in those areas.

Today, before treatment, I reviewed medical history with the patient.  She stated that she has fainted in the past after anesthetic injection.  I took it to heart, but I wasn’t ready for what about to happen.

I gave 3 carpules of 4% septocaine (articane) with 1:100,000 epinephrine.  One for LR block, one for LL block via ART technique, aspirated as always (negative for intravascular injection), and one for UR infiltration.  Before I could infiltrate the UL, the patient said “I don’t feel well.”  I asked her if she was ok.  I was prepared, and sat her upright immediately.  She went blank on me!  Just like that!  Her legs were twitching!  I was so nervous…ready to call 911.  After 1-2 minutes, I aksed if she was ok and could hear me, she said “yeah.”  Her face was pale and was sweating and her palms very warm, she complained that she had difficulty breathing, and saw “stars” as well as having stomach cramps. I checked her blood pressure. Please e-mail us at localanesthetics@yahoo.ca

Ref. www.docere.com

WATERLOO, ON Canada (Jul 11, 2007)

Male 18 yrs went to a Waterloo dental surgeon to have three wisdom teeth pulled.While his mother settled into the waiting room, the Waterloo teen sat back in the dentist’s chair and slipped under a general anesthetic.Then something went so wrong that he was left struggling for breath. Soon, a call was going out to 911, and the anesthesiologist present for the procedure was trying to resuscitate him.Paramedics, then doctors at Grand River Hospital tried everything, but by the next evening, the 18-year-old was dead.Now, the Waterloo Region coroner, assisted by regional police, is trying to determine what happened to the healthy young man, who was undergoing a dental procedure routinely performed on patients his age.“This is such an anomaly,”  The registrar for the Royal College of Dental Surgeons of Ontario, said of the death last Thursday.“It’s so unusual and rare. We are all in a state of shock and sadness. This is a safe procedure.” The oral surgeon performing the extraction, said the tragedy that occurred in his office is “once in a lifetime.” A practitioner, for 32 years, would not discuss what went wrong, saying only that the surgery hadn’t started when patient got into trouble. Within seven minutes, an ambulance arrived. Five minutes later a second ambulance with more advanced equipment was on scene.But when paramedics arrived, the patient’s heart had stopped beating. They frantically tried to resuscitate the teen but couldn’t. Someone then noticed a kink in the tube that was to supply oxygen to the patient. The tube was blocked. At Grand River Hospital, doctors put the patient on life support. With help, his heart started beating again but his organs weren’t functioning.“We made the decision to disconnect,” said the patient’s father.“I watched his heart fade away. Our life will never be the same. It’s too short a life”. Please e-mail us at localanesthetics@yahoo.ca

 Author Dr. Stan Malamed.

Haynes Darlington worked with regulatory agencies in 1983 to have Articaine Hcl accepted in North America