Dental Tribune Israel Edition

10DentalTribune Israel Edition (diluted) in the classical injection. The response of heart rate in patients in the clinic, where "unusual" injection offset by one word "anesthesia" is interesting (Medvedev [32]; average data, n= 205; PE bpm: to ILA -75, immediately after the injection - 78 and after 15 min – 73). The changes are minor, they have an adrenergic orientation. The total average effect may give a misleading information, usually in the direction of increased frequency of emergency. Medvedev [32] classified the systemic complications to the sympathetic and parasympathetic. The reactions of the sympathetic (hypertensive) type were characterized by increased systolic blood pressure, the appearance of anxiety, tremor and tremor of the hands, increased the heart rate, headache, sometimes nausea and pallor. The parasympathetic response type was manifested by weakness, dizziness, pallor, syncope reaction, sometimes with the loss of consciousness, decrease in systolic blood pressure, decrease heart rate. They disguised under anesthetic toxicity. Medvedev [32] analyzed 36 complications in 205 ILA. To sympathomimetics (hypertensive) he carried 25 patients, to parasympathomimetics (hypotensive) – 11. Among the hypertensive patients 24 had increased SBP from 1 to 36 mm Hg, 20 had palpitations, and 12 - a headache. The cases of severe and prolonged headache were observed after intraligamentary anesthesia of articaine with epinephrine. Patient P.J., ASA 1, 23 years old in 2 min after ILA 1.2 ml of 4% articaine with epinephrine 1: 200 000 felt a sharp headache, nausea, denoting a pronounced widening of blood vessels in the whites of the eyes. Before injection, blood pressure was 138/91 mmHg, PE – 55bpm, immediately after the ILA - blood pressure - 128/91 mmHg and PE increased to 66 bpm. At the time of complaints - 2 min after injection, the blood pressure was 158/114 mmHg, PE 56 bpm. Intramuscular injection of Pipolphenum/dibazolum was made, but the headache did not diminish. After 40 minutes, blood pressure was 154/107 mmHg, PE - 58 bpm. Dental intervention was not carried out. An ambulance was called. In the group of hypotensive in 7 one had a fainting reaction with a transient loss of consciousness [32]. Our studies of the incidence of systemic complications during the spongy anesthesia compared with the classic infiltration and mandibular block anesthesia we summarized in the following table [20,33,34]. The final table shows a higher incidenceofcomplicationsafterbone injection (13%) in comparison with the classical (5,8%); t=2.11; p<0.05. The second feature was the absence of vegetative reactions among the classical complications. Conversely, the typical of the autonomic system complications appeared in groups of spongy anesthesia. There are two causal factors of such complications: the vascular distribution of the anesthetic and the formation of adrenaline depot of anesthetic. Despite the relative ease of systemic reactions they can be the initial link of serious current pathological complex. Example: after a brief sympathetic reaction immediately after ILA with 0.7 ml articaine with epinephrine 1:100000 a patient who had had a previous myocardial infarction, angina pectoris developed. SBP mm Hg: up to 124, immediately after -146, PE bpm; up to 65, after -72. In 2-3 minute pains in the chest appeared; the patient has taken nitroglycerin. The pain diminished and went away in 7 minutes. The example with the development of hypertensive crisis has been presented previously. Conclusion Spongy anesthesia due to the long- term experience of use, promise minimal systemic effect, despite of vascular in nature. Referring to the article of fifty years ago (Boakes et al 1972) it can be seen that a slight modification of the vasoconstrictor, can tragically affect the security of local dental anesthesia especially in the vascular distribution of drugs. Spongy anesthesia causes significant changes in a heart rate and blood pressure. They are not typical for classical anesthesia. All reactions-complications were mild, transient and reversible. It is not excluded the possibility of transformation reactions in a more difficult situation. An important factor in these systemic reactions is epinephrine, as an integral part of the anesthetic solution. Monitoring indicators CVS is necessary, since the moment of injection. The fourth minute is the second critical point of monitoring. Monitoring may be limited with the measurement of at least the pulse frequency. The complaints and a behavior of the subject are extremely important to assess his health status before and after injection. They are primary in a relation of monitoring. A headache is almost a specific symptom of a systemic reaction of spongy injection. A chestpain is the second threatening symptom. An important pattern of observed reactions to vascular introduction of adrenergic anesthetic, we discovered, is to divide them into two types: sympathetic and parasympathetic. The reactions of the sympathetic (hypertensive) type were characterized with the emergence of anxiety, tremor and tremor of hands, increased systolic blood pressure, increased heart rate, headache, sometimes nausea and pallor. Other conditions, manifested by weakness, dizziness, pallor, syncope reaction sometimes the loss of consciousness, decrease in systolic blood pressure, decrease heart rate could be a variant of vegetative stress or/ and direct toxic effects of anesthesia. After 293/431 classic and spongy anesthesia analyzed 17/56 systemic complications, respectively. Quantitatively, the complication on vascular (spongy) introduction were met more frequently. It is essential that the autonomic (sympathetic and parasympathetic) reaction took place only after spongy injections. A positive aspiration is not a criterion of danger of injection. On the contrary, it becomes a measure of the success of spongyanesthesia.Forthefirsttimein western literature a high frequency of positive aspirate during intraosseous anesthesia (61%) is presented instead of accepted in American literature of the zero frequency. References 1. Dental regional spongy (intraosseous) vascular anesthesia [electronicresource]:monograph / A.Zh. Petrikas [etc.]. – Electr. data – Tver, 2013 – . – accessmode: http://www.tvergma.ru ,Петрикас АЖ с соавт.2014, №10, №6 2. Lalabonova Hr., D. Kirova, D.DobrevaIntraligamentary anesthesia in general dental practice-.J.IMAB, 2005, book 2,р.22-24 3. Bangerter, C., Mines, P.Sweet, M. (2009). The use of intraosseous anesthesia among endodontists: results of a questionnaire. Autors Number n Anesthetic, vasoconstrictor Primary/supple mental % subjects since reased pulse rate average increase in pulse rate Bigby,et al 2006 [21] 37 patients Articaine/epinephrine 1:100000 after 1 min after 3 min Supple mental 83% 54% 32 bpm Brown R. 1999[27] review LА + vasoconstrictors - 46-100% Guglielmoetal 1999 [28] 40 patients Mepivacaine2% levonordefrine 1:200000. Supple mental 80% 23-24 bpm Chamberlain et al 2000 [25] 20 volun-teers Lidocaine 2% / epinephrine 1:100000 primary CVS HELL no significant changes 12 bpm Susi L et al 2008 [22] 61 volun-teers Lidocaine 2% epinephrine 1:100000 fast injection 45 sec slow injection 4min 45 sec primary 21-28 bpm 10-12 bpm Coggins,et al 1996 [29] 40 volun-teers Lidocaine 2% epinephrine 1:100000 primary 78% - Dunbar et al1996 [30] 40 patients Lidocaine 2% epinephrine 1:100000 Supple mental 80% heartbeat Replogle et al1999 [24] 42 volun-teers Lidocaine 2% epinephrine 1 :100000 Mepivacaine 3% primary 67% - 5 bpm р<0.05 - Reitzet al 1998 [31] 38 volun-teers Lidocaine 2% epinephrine 1 :100000 Supple mental 68% heartbeat Peñarrocha- Oltra et al, 2012 [19] 100 patients 200 injections Lidocaine 2% epinephrine 1 :100000 Mepivacaine3% Primary - 4,6 bpm р<0.05 1,6 bpm Pereira et al 2012 [26] 60 patients Articaine 4% epinephrine 1:100000,1:200 000 Supple mental CVS HELL no significant changes A 2007 [20] 76 patients Articaine 4% epinephrine 1:100000 epinephrine 1:200000 primary 83% 13,4 bpm 9,6 bpm Authors, year Anesthesia Change indicators CVS indicators CVS PE (beats/min) SBP (mmHg) Якупова Л.А . 2006 [20] Intraosse ous anesthesia IOA increase 8 7 decrease 5 6 number n 13 13 Медведев Д.В. 2011 [32] Intraliga mentary anesthesia ILA increase 8 7 decrease 5 6 number n 13 13 Ефимова О.Е. 2011 [33] Intraseptal anesthesia ISA increase 9 +(4-72) range, m=+27,8 5 +(5-8) range, m=+7, decrease 5 -(2-13) range, m=-6,5 9 -(3-4) range, m=-3,2 number n 14 14 Technique Number of anesthesia n(%) Complication (%) Hypotensive Parasympathic n.(%) Hypertensive Sympathic n.(%) infiltration 167 (100%) 8 (4,8%) 8 (4.8%) 0 (0%) mandibular 126 (100%) 9 (7,1%) 9 (7.1%) 0 (0%| The amount 293 (100%) 17 (5.8%) 17 (5.8%) 0 (0%) intraosseous 72 (100%) 8 (11,1%) 7 (9.7%) 1 (1.4%) intraligamentary 205 (100%} 36 (17,5%) 11 (5.4%) 25 (12.2%) intraseptal 154 (100%) 12 (7,8%) 10 (6.5) 2 (1.3%) The amount 431 (100%) 56 (13.0%) 28 (6.5%) 28 (6.5%) Table 1. Study the pulse rate (beats/min bpm) during spongy primary and supplemental anesthesia Table 2. The distribution of volunteers to increase or decrease the heart rate (PE) and systolic blood pressure (SBP) after spongy anesthesia (IOA,ILA, ISA) artikaine 4% with epinephrine 1:100000 on materials [20,32,33]. In group ISA presents the scope of the study parameters and its average values Table 3. The frequency of systemic complications during infiltration, mandibular, intraosseous, intraligamentary and intraseptal anesthesia according to the Tver authors (2006-2011) [20,33,34 ]. Research tribune with epinephrine 1: 200000 felt a 1:100000,1:200000 increase 87 decrease 56 number n 1313 increase 87 decrease 56 number n 1313 increase 9 +(4-72) range, m=+27,85 +(5-8) range, m=+7, decrease 5 -(2-13) range, m=-6,59 -(3-4) range, m=-3,2 number n 1414

Dental Tribune Israel Edition

Pages Overview