Local or regional anesthesia in odonto-stomatological practice.

Reserved for adults and children aged 4 years and older due to type of anesthesia unsuitable before this age

Dosage

Adult

The quantity to be injected shall be adapted according to the importance of the intervention.

As a general rule, one to three cartridges per session.

Do not exceed the dose of 7 mg of articaine hydrochloride per kilogram of body weight.

Child (more than 4 years old)

The amount to be injected depends on the age, weight of the child and the type of intervention to be performed.
The maximum dose is 5 mg of articaine hydrochloride (0.125 ml solution, anesthetic) per kilogram of body weight.
The mean dose in mg of articaine hydrochloride, which may be administered in children, may be calculated as follows:
· Weight of child (in kilo) × 1,33.

Elderly subject

Reduction of the adult dose by half.

Mode of administration

LOCAL OR REGIONAL INJECTION, INTRA-BUCCALE UNDER MUCOSE

Check that there is no vascular break-in by repeated aspiration tests, especially during regional anesthesia (truncate).
The injection rate should not exceed 1 ml of solution per minute.
LOCAL ANESTHETICS / ARTICAINE (ATC Code N01BB58).

Articain hydrochloride is a local anesthetic with amide function which interrupts the propagation of nerve impulses along the nerve fiber at the site of injection. Br>
Adrenaline (diluted to 1: 100,000) added to the articaine solution slows down the passage of the articaine into the general circulation and thus ensures the maintenance of an active tissue concentration, To obtain a small hemorrhagic surgical field.

The anesthesia installs in 2 to 3 minutes. The duration of the anesthesia, allowing the surgical procedure is about 60 minutes. It is 2, 3 times shorter for anesthesia, pulpary

This product may modify the reaction capacities for the driving of the vehicle or the use of machinery.

This medicinal product is contraindicated in case of hypersensitivity to local anesthetics or to any of the components and in the following situations

· Disorders of atrio-ventricular conduction, severe and unpaired

· Epilepsy not controlled by a treatment

· Acute intermittent porphyria.

This medication is generally not recommended in combination with certain drugs such as guanethidine and related products (see section Interactions with other medicinal products and other forms of interaction).

Special warnings

THIS PRODUCT CONTAINS ADRENALINE to 1/100 000.

Take into account the risk of local necrosis in hypertensive or diabetic subjects

Risk of anesthesiophagia: bites, various (lips, cheeks, mucous membranes, tongue), prevent the patient from chewing gum chewing or food as long as persists; >

The use of this product is not recommended in children under 4 years of age because of the unsuitable anesthetic technique before this age. >
Avoid injection into infected and inflammatory areas (decrease in the effectiveness of the local anesthetic).

The attention of athletes should be drawn to the fact that this medicinal product contains an active ingredient which may induce a positive reaction to the tests carried out during anti-doping tests.
Precautions for use

The use of this product imperatively requires prior

· An interrogation intended to know the field, the therapeutics in progress and the patient's history

· To perform a 5 to 10% dose injection in case of allergic risk

· To inject slowly and strictly out of the vessels, by controlling by repeated aspirations

· To maintain verbal contact with the patient.

Surveillance should be increased, in subjects under anticoagulants (INR surveillance)

Due to the presence of adrenaline, increased precautions and surveillance

· In case of rhythm disorders, except for bradycardia

· Coronary insufficiency

· Severe arterial hypertension

In case of severe hepatocellular insufficiency it may be necessary to decrease the doses of articaine due to the mainly hepatic metabolism of the amide functional anesthetics. Br>
The dosage should also be decreased in case of hypoxia, hyperkalaemia or metabolic acidosis

The concomitant administration of this anesthetic with certain medicinal products (see section 4.3.3), interactions with other medicinal products and other forms of interaction, requires rigorous monitoring of the patient's clinical and biological condition.

Associations, deprecated

Due to the presence of adrenaline

+ Guanethidine and related (anti-glaucoma)

Significant increase in arterial pressure (hyper-reactivity related to reduction of sympathetic tone and / or inhibition of adrenaline entry in sympathetic fiber)

If the combination can not be avoided, use cautiously lower doses of sympathomimetics (adrenaline).

Associations, subject to precautions for use

Due to the presence of adrenaline

Halogenated volatile anesthetics

Severe ventricular rhythm disorders (increased cardiac reactivity)

Precautions: Limit intake, for example: less than 0.1 mg of adrenaline, in 10 minutes or 0.3 mg in one hour in adults

+ Antidepressants, imipraminic

Paroxysmal hypertension with possibility of rhythm disorders (inhibition of the adrenaline entry in the sympathetic fiber)

Precautions: Limit intake, for example: less than 0.1 mg of adrenaline, in 10 minutes or 0.3 mg in one hour in adults

+ Antidepressants, serotonergic-noradrenergic (described for minalcipran and venlafaxine)

Paroxysmal hypertension with possibility of rhythm disorders (inhibition of the adrenaline entry in the sympathetic fiber)

Precautions: Limit intake, for example: less than 0.1 mg of adrenaline, in 10 minutes or 0.3 mg in one hour in adults

+ Non-selective MAOIs (iproniazide)

Increase in the hypertensive action of adrenaline, usually moderate.

To be used only under strict medical control.

+ Selective MAOIs A (moclobemide, toloxatone) by extrapolation from non-selective MAO's

Risk of increased action, hypertensive.

To be used only under strict medical control.

In the absence of compatibility studies, this drug should not be mixed with other medicines.
Toxic reactions indicative of an overdose in local anesthetic may occur in two conditions: either immediately, by relative overdose due to intravenous passage, accidental, or later due to a true overdose, An excessive amount of anesthetic.

What to do

As soon as signs of call appear, ask the patient to hyperventilate, put in position, lying down if necessary. With the appearance of clonies, oxygenation, injection of a benzodiazepine

Treatment may require intubation with assisted ventilation.

Pregnancy

Studies carried out in animals have not revealed any teratogenic effect.

In the absence of teratogenic effect in animals, a malformative effect in the human species is not expected. Indeed, to date, the substances responsible for malformations in the human species have been shown to be teratogenic in animals during studies, well conducted on two species
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In clinical terms, there is currently no adequate data to evaluate a possible malformative or fetotoxic effect of articaine when administered during pregnancy
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Therefore, in odonto-stomatology indications, the use of articaine should be considered during pregnancy only if necessary.
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Breastfeeding

Like other local anesthetics, the articaine passes into breast milk in very small quantities, however breastfeeding can be continued in the course of the anesthetic gesture.
As with all anesthetics used in odonto-stomatology, lipothymies may occur.
Due to the presence of sodium metabisulphite, risk of allergic reactions, including anaphylactic reactions and bronchospasms

In case of overdose or in certain patients, the following clinical signs may be observed:

Central nervous system nervousness, agitation, yawning, tremor, apprehension, nystagmus, logorrhea, headache, nausea, ringing, ears These call signs require the patient to be hyperventilated, Careful monitoring to prevent possible aggravation with convulsions, then depression of the CNS

· On the respiratory system, tachypnea and then bradypnea which may lead to apnea

Cardiovascular system, tachycardia, bradycardia, cardiovascular depression with arterial hypotension leading to collapse, rhythm disorders (ventricular extrasystoles, ventricular fibrillation), conduction disturbance (block, atrioventricular) These cardiac manifestations can lead to cardiac arrest.

Local or regional anesthesia in odonto-stomatological practice.