Resident’s Name: Semantha Charles Date: 02/24/2016
Article Title: Pain Perception Control Chapter 7
Book: Pediatric Dentistry, Infancy Through Adolescence, 5th Edition
Author: Paul S. Casamassimo, DDS, MS, Henry W. Fields, Jr., DDS, MS, MSD, Dennis J. McTigue
• General anesthesia-Renders patient unconscious by depressing CNS. Whenever GA is administered it must be done so in the proper setting
• Local anesthesia-Primary mechanism of action is through interaction with sodium channels which inhibit depolarization and transmission of pain. They are weak bases and are supplied as a salt. Only the free-base form is effective and can permeate the nerve cell
• Esters-Not widely used anymore for injectables but are used for topical. Examples are cocaine, novocain, and benzocaine.
• Amides-Very widely used now. Examples are lidocaine, marcaine, and mepivicaine
• Potency-Concentrations vary depending on the chemistry of the agent. Care is needed to be sure to calculate dosages according to concentration
• Onset time-Time is required for the free base to penetrate the nerve. Care should be taken not to start the procedure too early.
• Duration-Increased protein binding and the use of vasoconstrictor will extend duration
• Block vs. Infiltration-Blocks generally take longer to set in and last longer
• Vasoconstrictors-Used to prolong anesthesia and keep agent localized. Concentrations of 1:100k are recommended for children. Care should be taken not allow agent into direct circulation
• Toxicity-Overdose is rare but can be avoided with weight based calculations. Symptoms include seizures, dizziness, generalized CNS depression, loss of spontaneous respiration
• Aspirin-Can be used for children but care must be taken with patients who bleeding is anticipated and with reyes syndrom
• Acteomenophin-Most commonly used analgesic for children. Dosage should be weight based. Excessive use will cause liver damage
• NSAIDs-Have antiinflammatory properties which tylenol does not. Are widely used but have not been as well studied as tylenol
• Narcotics-Primary narcotic for children is Codeine which is frequently mixed with tylenol. Side effects include nausea, constipation, and sedation. Care must be taken when prescribing narcotics as deaths due to overdoses have been documented.