Short communication: Graph for calculating maximum local analgesic dose in millilitres for the paediatric population

Local anaesthetics risks perception: A web-based survey

Background

The use of local anaesthetics (LAs) is usually associated with few adverse effects, but local anaesthetic systemic toxicity (LAST) can result in serious harm and even death. However, practitioner awareness regarding this risk has been little studied.

Methods

This was a closed, web-based study carried out at two Swiss university hospitals using a fully automated questionnaire. The main objective was to evaluate LAST awareness and LA use among various medical practitioners. The secondary objective was to determine whether these physicians felt that a tool designed to compute maximum safe LA doses should be developed.

Results

The overall participation rate was 40.2 % and was higher among anaesthesiologists (154/249, 61.8 % vs 159/530, 30.0 %; P < .001). Anaesthesiologists identified the risk of LAST and the systems involved more frequently than non-anaesthesiologists (85.1 % vs 43.4 %, P < .001). After adjusting for years of clinical experience, age, country of diploma, frequency of LA use, clinical position and being an anaesthesiologist, the only significant associations were this latter factor (P < .001) and clinical position (P = .016 for fellows and P = .046 for consultants, respectively). Most respondents supported the development of a tool designed to compute maximum safe LA doses (251/313, 80.2 %) and particularly of a mobile app (190/251, 75.7 %).

Conclusions

LAST awareness is limited among practitioners who use LAs on a regular basis. Educational interventions should be created, and tools designed to help calculate maximum safe LA doses developed. The actual frequency of unsafe LA doses administration would also deserve further study.

Epinephrine-reduced articaine solution (1:400,000) in paediatric dentistry: a multicentre non-interventional clinical trial

AIM

In paediatric dentistry, epinephrine may contribute to systemic and local side-effects. On the other hand it is necessary to provide good and safe local analgesia. Therefore, an articaine solution with reduced epinephrine concentration was tested in a clinical setting.

METHODS

In a non-interventional clinical study, dental treatment was performed in children and adolescents (4-17 years). For local analgesia, articaine 4 % plus epinephrine 1:400,000 was used in the technique chosen by the dentist. Efficacy and tolerance as well as duration of soft tissue analgesia and side-effects were evaluated.

RESULTS

999 patients (50.5 % male, 49.5 % female) with a mean age of 7.9 (SD 2.34) years were treated. Two hundred seventy six patients (27.6 %) received sedation prior to treatment. The mean treatment time was 15 min (SD 10). In 93.5 % of cases, initial local analgesia was sufficient to perform the planned treatment. In 99 % of cases (n = 989) the planned treatment could be completed. A second injection was necessary in 6.5 % of cases. A mean duration of soft tissue analgesia of 2.19 h (SD 1.01) was seen. Slight side-effects occurred in 3.1 % of subjects.

CONCLUSIONS

Due to high efficacy, tolerance and safety, the articaine 4 % solution with the reduced epinephrine concentration (1:400,000) was a safe and suitable drug for paediatric routine treatment.