Outline Introduction Anaesthetic Techniques G. A. L. A. Acupuncture TIVA Cryotherapy Acutherapy Indications & Contra-indications for G. A.

Contra-indications to Anaesthesia in the chair G. A. Procedures Pre-Op Assessment NPO, Premedication Induction Maintenance Termination Post-Op recovery Local Anaesthesia Introduction Methods of Regional Anaesthesia/ Analgesia 1. Application of cold (refrigeration) 2. Application of pressure (compression of nerve) 3. Acupuncture 4. Hypnotism 5. Audio-analgesia 6. Electric Anaesthesia/ analgesia 7. Application of chemical agents (drugs) Local Anaesthesia (contd.) Mechanisms of Local Anaesthetic agents (L. A. )

Properties of an ideal Local Anaesthetic agent Classification of Local Anaesthetic agents Other classifications: based on duration of action Local Anaesthesia (contd.) Physicochemical properties of local anaesthetics which affects effectiveness a. Lipid solubility b. Protein binding c. PKa Local Anaesthesia (contd.) Non-physicochemical properties a. L.A. with high tissue diffusible property b. Inherent vasoactive properties c. Volume and concentration d. Addition of vasoconstriction agents e. The diameter of the nerve fibre Site of action of Local anaesthetics Pharmacokinetic properties of some local anaesthetic agents Pharmacokinetic properties of some local anaesthetic agents (Contd) Metabolism and Excretion of local Anaesthetic Drugs: Ester Group (Procaine) Amide group (Lidocaine/Prilocaine) Systemic effects of L. A. agents: Effects of the CVS: Effects on CNS: Other side effects: Pharmacology of specific local anaesthetic agents Esters PROCAINE

C2H5

|| H2N C O CH2CH2N C2H5

Pharmacology of specific local anaesthetic agents(Contd) AMETHOCAINE (Tetracaine) H CH3(CH2)3 N O O CH2-CH2 N CH3 Pharmacology of specific local anaesthetic agents(Contd) CHLOROPROCAINE Cl O || H2N COCH2-CH2N C2H5 Pharmacology of specific local anaesthetic agents(Contd) AMIDES LIDOCAINE (XYLOCAINE, LIGNOCAINE) CH3 CH3 H | O || CH2 C2H5 CH3

N C CH2 N CH3 CH2 CH3 Pharmacology of specific local anaesthetic agents(Contd) MEPIVACAINE (Carbocaine} CH2 H | O || CH2 CH2

 NC HC CH3 N | CH2

CH2 CH2

Pharmacology of specific local anaesthetic agents(Contd) BUPIVACAINE (Marcain) CH3 H | O || CH2 CH2 CH2 N CH2 CH3 HCl Pharmacology of specific local anaesthetic agents(Contd) PRILOCAINE (Citanest} CH3 NCCHNCH2CH2CH3 | CH3 Pharmacology of specific local anaesthetic agents(Contd) Vasoconstrictor Epinephrine (Adrenaline) Norepinephrine (Noradrenaline) Felypressin (Beta pressin) Reducing Agent Preservative Fungicide Vehicle | \ C4H9

NC HC

Surgical Anatomy

Instrument for Local Anaesthesia Dental Syringes Dental cartridges containing L. A. Needle Application of Topical and Infiltration L. A. Topical (Surface) Anaesthesia

Infiltration Anaesthesia Application in the mouth Palatal infiltration Complications of Local Anaesthesia in Dental Practice Localized adverse reactions Systemic adverse effects Localized adverse reactions Breakage of needle or cartridge Failure of Anaesthesia Severe pain on injection Intra-arterial injection Prolonged pain, Paraesthesia or Numbness Intravascular injection Haematoma Trismus Soft tissue injury Facial nerve paralysis Infection Systemic adverse effects Psychogenic Allergy Toxicity Methaemoglobinaemia

Drug interactions Infection Recommended Maximum doses of common L. A. Recommended Maximum doses of common L. A. (Contd) CPR