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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Local Anesthetics: Adverse Effects01:12

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While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
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Local Anesthetics: Pharmacokinetics01:13

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The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
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Anticholinesterase Agents: Poisoning and Treatment01:26

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Anticholinesterases, also known as cholinesterase inhibitors, work by blocking the breakdown of acetylcholine, leading to its accumulation in the synaptic cleft. This accumulation indirectly enhances both muscarinic and nicotinic actions. These agents are classified as reversible or irreversible based on their mechanism of action.     
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Local Anesthetics: Common Agents and Their Applications01:23

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Dental Local Anesthesia-Related Pediatric Cases Reported to U.S. Poison Control Centers.

Janice A Townsend1, Henry Spiller2, Kim Hammersmith3

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Summary

This study analyzed dental local anesthetic adverse events in children, finding seizures were the most common issue. Fortunately, no permanent damage or fatalities were reported in the analyzed cases.

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Area of Science:

  • Dentistry
  • Toxicology
  • Pediatric Medicine

Background:

  • Local anesthetics (LA) are widely used in pediatric dentistry.
  • Adverse events from LA administration in children require careful monitoring and analysis.
  • Understanding these events is crucial for improving patient safety.

Purpose of the Study:

  • To identify and analyze adverse events related to local anesthetic use in children undergoing dental procedures.
  • To utilize the National Poison Data System (NPDS) for identifying pediatric dental LA-related incidents.
  • To assess the severity and nature of these adverse events.

Main Methods:

  • Querying the National Poison Data System (NPDS) for human cases involving parenteral LA agents in children aged 12 and younger between 2004 and 2018.
  • Filtering cases with medical outcome classifications from moderate to death.
  • Reviewing deidentified case records with available notes for 27 eligible dental cases.

Main Results:

  • The study reviewed 27 pediatric dental cases, with most subjects being female (74%) and an average age of 6.8 years.
  • The majority of cases (74%) resulted in moderate effects, while 26% had major effects; no fatalities were reported.
  • Seizures were the most frequent clinical effect (48%), with one identified case of LA overdose. No permanent damage was documented.

Conclusions:

  • Seizure activity is the most common adverse event following pediatric dental local anesthetic administration.
  • These events may indicate intravascular administration or a toxic dose of the local anesthetic.
  • While serious outcomes like permanent damage or fatalities were not observed, vigilance in LA administration is warranted.