Features of the use of artician in dentistry. Application in old age

N.01.B.B.58. Artictic in combination with other drugs

The drug Artikin-Eugen with adrenaline used for local infiltration and conductor anesthesia in dentistry is combined drugThe composition of which includes (local anmetic agent of amide type) and (adrenaline) (vasoconstrictor).

Epinephrine is added to the preparation for prolongation of anesthesia.

Artictic has a plastic resourcing effect due to the blockade of potential-dependent sodium channels in the cellular membrane of neurons, which leads to a reversible inhibition of the conductivity of pulses by nerve fiber and reversible loss of sensitivity.

The drug Artikain-Eugen with adrenaline has a quick (latent period - from 1 to 3 minutes) and a strong anesthetic effect and has good tissue tolerability. The duration of anesthesia is at least 45 minutes.

Children

The use of the drug containing epinephrine (40 mg + 0.005 mg) / ml, in a dose of 5 mg / kg of body weight in children aged 3.5 to 16 years, provided a sufficient local substrate effect during the mandibular infiltration or maxillary conductor anesthesia (according to clinical studies).

The duration of anesthesia was comparable in all age groups and depended on the injected volume of the drug.

Artictic quickly and almost immediately after administration is metabolized (by hydrolysis) with nonspecific plasma-eserators in tissues and blood (90%); The remaining 10% dose of artician is metabolized by microsomal liver enzymes. The main metabolite of articaina - arsonic acid - does not possess local weselves and systemic toxicity, which allows repeated administration drug.

The concentrations of articia in the blood in the region of the alvetol of teeth after the sublitting administration hundreds of times higher than the concentration of artician in the systemic blood flow.

The binding of artician with plasma proteins is approximately 95%.

Artictic is excreted through the kidneys, mainly in the form of americanic acid. After the subflipse administration of the period, half-life is approximately 25 minutes. It penetrates through the placental barrier, almost does not stand out with breast milk.

Showing for local anesthesia (infiltration and conductor anesthesia) in dentistry.

Planned interventions, such as uncomplicated removal of one or several teeth, processing carious cavities and teeth scratching before prosthetics.

Hypersensitivity to the articain or to other local amide-type facilities, with the exception of cases when, with hypersensitivity, allergic to the articiane, allergies, was excluded with the help of appropriate research carried out in compliance with all the necessary rules and requirements.

Increased sensitivity to epinephrine.

Increased sensitivity to sulfites (in particular, in patients with bronchial asthma and increased sensitivity to sulphites, as it is possible to develop sharp allergic reactions, such as bronchospasm) and any other auxiliary components of the drug.

Contraindications related to artistic

Heavy disorders of the function of the sinus unit or severe conductivity impairment (such as pronounced bradycardia, an atrioventricular blockade of the 2nd or 3rd degree).

Acute decompensated heart failure.

Heavy arterial hypotension.

Children's age up to 4 years (lack of sufficient clinical experience)

Contraindications related to epinephrine

Paroxysmal tachycardia, tahiaritium.

Recently transferred (3-6 months ago) Myocardial infarction.

Recently spent (3 months ago) Aorticoronary simulatory shunting.

Simultaneous reception of non-temperature β-adrenoblockers, for example, propranolol (risk of development hypertensive crisis and severe bradycardia).

Clothing glaucoma.

Hyperthyroidism.

Feochromocytoma.

Heavy arterial hypertension.

In patients with chronic heart failure, ischemic disease Hearts, angina, atherosclerosis, myocardial infarction in history, violations of the heart rhythm, arterial hypertension.

In patients with cerebrovascular disorders, a history of history.

In patients with chronic bronchitis, emphysema lungs.

In patients with diabetes mellitus (the potential risk of changing the concentration of glucose in the blood).

In patients with non-sufficiency of cholinesterase (application is possible only in case of extreme necessity, since it is possible to prolongize and pronounced strengthening the action of the drug).

In patients with blood clotting disorders.

In patients with severe disorders of the liver and kidney function.

In patients with severe excitation.

In patients with epilepsy in history.

With co-use with halogen-containing means when conducting inhalation anesthesia (see section "Interaction with drugs").

Pregnancy

Gatalon can increase the sensitivity of myocardial to catecholaminams and increase the risk of developing heart rate disorders after the injection of the drug Artikain-Eugen with adrenaline.

With disinfecting solutions containing heavy metals

When processing the injection site of the local anesthetic by disinfecting solutions containing heavy metals, the risk of developing local reactions - edema, soreness increases.

To prevent infection (including viral hepatitis) It is necessary to ensure that with the fence of the solution from the ampoules, new sterile syringes and needles have always been used.

Open cartridges cannot be reused for other patients!

You can not use damaged cartridges for injections.

In patients with diseases of cardio-vascular system (chronic heart failure, pathology of coronary vessels, angina, violation of heart rhythm, myocardial infarction in history, arterial hypertension), atherosclerosis, cerebrovascular disorders, a history of stroke, chronic bronchitis, emphysema, diabetes, hyperthyroidism, and in the presence of severe concern It is advisable to use artician drugs that do not contain, or artician containing 0.005 mg / ml.

You can take food only after termination of local anesthesia (sensitivity recovery).

The drug contains sodium disulfite, therefore its use is contraindicated in patients with bronchial asthma and increased sensitivity to sulfites, since it is possible to develop acute allergic reactions, such as bronchospasm (see the section "Contraindications").

In order to avoid the risk of development adverse ReactionsIt is necessary to use minimal effective doses of the drug and before administration of the drug, it is necessary to carry out a two-stage aspiration sample (see "Method of Application and Dose" section).

Children and their parents should be warned about the risk of random damage to the soft tissues of teeth (oxidation) due to a long reduction in tissue sensitivity due to the preparation.

In 1 ml of the drug, articain-egen with adrenaline is contained less than 1 mmol (23 mg) sodium.

Regional and local anesthesia should be carried out by experienced specialists in the appropriately equipped room with the availability of ready-made equipment and drugs needed to monitor cardiac activity and resuscitation activities.

The personnel performing anesthesia should be qualified and trained by the technique of performing anesthesia should be familiar with the diagnosis and treatment of systemic toxic reactions, unwanted phenomena and reactions and other complications.

The decision on when the patient after dental intervention can return to management vehicles and the exercises of other potentially hazardous types of activities requiring increased concentration and speed of psychomotor reactions, the doctor should take.

1.7 or 1.8 ml of the drug in the cartridges from a transparent colorless glass, closed on one side with rubber plungers, and on the other hand, the corks are rubber, rolled aluminum caps.

2 ml of the drug in ampoules from transparent colorless glass.

5 ampoules or 10 cartridges in the contour plastic packaging (pallet) from a film of polyvinyl chloride or from a polyethylene terephtalat film.

2 contour plastic packaging (pallet) with ampoules along with instructions for use in a pack of cardboard.

1, 5, 10 contour plastic packaging (pallets) with cartridges with the instructions for use in a pack of cardboard.

Two protective labels with a firm logo are placed on a pack with cartridges (first autopsy control).

In the place protected from light, at a temperature not higher than 25 ° C, prevent freezing.

Keep out of the reach of children.

2.5 years - cartridges; 3 years - ampoules.

Do not use the expiration date specified on the package.

Articain Inibes is a topistanistic agent.

Release form and composition

Dosage form - an injection solution: transparent, slightly colored or colorless, without mechanical inclusions (1.8 ml in a cartridge from a colorless borosilicate glass, which at one end has a gray elstomer plunger, on the other - the elastomer disc and the corresponding slope with an aluminum cap With anodized coating, 10 cartridges in hermetically attached cell contour packaging made of transparent thermoplastic and paper with laminated coating, in a pack of 10 packs 10 packs complete with the instructions for the use of articain inhibs).

Composition 1 ml of solution:

• active substances: Artician hydrochloride - 40 mg, epinephrina hydrothatrate (in terms of epinephrine) - 0.005 * or 0.01 ** mg;
• auxiliary components: sodium hydroxide, sodium metabisulphite, sodium chloride, hydrochloric acid, water for injection.

* Corresponds to the epinephrine content in solution 1: 200,000.

** corresponds to the epinephrine content in solution 1: 100 000.

Pharmacological properties

Pharmacodynamics

Articain Inhibs is a combined drug. His therapeutic action due to the properties of active ingredients:

• artician hydrochloride is a local anesthetic amide type of the thiafen group;
• epinephrina Hydrothatrate is a vasoconstrictor.

The drug has a local anesthetic effect. The action is developing in 1-3 minutes after the injection and is preserved for a minimum for 45 minutes.

It has a minimal vesseloring effect. It is characterized by good tissue tolerability.

Epinephrine is part of the Inhibsian artica in a small dose, so its impact on the cardiovascular system is minimal (not marked significant increase arterial pressure and increasing heart rate).

Pharmacokinetics

Articsin is characterized by a high diffusion ability in the subbelicist introduction in the oral cavity. Plasma proteins are binding to 95%.

The half-life from the body is 25 minutes.

The active substances of the Inhibsian artician across the placental barrier penetrate the minimum quantities, almost not distinguished with breast milk.

Indications for use

Artikin Inhibs is used for infiltration and conductor anesthesia in dentistry (especially in patients with accompanying severe somatic diseases), including if necessary for the following manipulations:

• uncomplicated removal of one or more teeth;
• the preparation of carious cavities and teeth before prosthetics.

Contraindications

Absolute:

• clotted glaucoma;
• bronchial asthma increased sensitivity to sulphites;
• paroxysmal tachycardia and other tachyarhythmias;
• hyperthyroidism;
• heavy form liver failure (Porphyria);
• hypoxia;
• methemoglobinemia;
• In 12-identical anemia;
• the simultaneous use of non-selective beta-adrenobloclars, tricyclic antidepressants or monoaminoxidase inhibitors (MAO);
• intolerance sulfo groups;
• children's age up to 4 years;
• hypersensitivity to any component in the artician of the Inibes or sulfites.

The drug should be applied with caution in children, in patients with diabetes, arterial hypertension, renal failure and cholinesterase deficiency.

Artikin Inibes, Application Instructions: Method and Dosage

With uncomplicated removal of the upper jaw teeth (without availability inflammatory process) Articain Inhibs is introduced into the region of transitional fold from the vestibular side at a dose of 1.8 ml per tooth. In some cases, additional administration of 1-1.8 ml of the drug is required to achieve complete anesthesia.

Perform painful injections from the sky, as a rule, there is no need. To ensure anesthesia in pavements and the imposition of seams in order to create a sky depot, approximately 0.1 ml of a solution per injection is required.

In the case of removal of several teeth located nearby, the number of injections is usually possible to reduce.

When the lower jaw premolar is removed (without the presence of an inflammatory process), mandibular anesthesia is usually not required, since infiltration anesthesia, which is administered to 1.8 ml of the inhibs, is usually enough. If there is no needed effect, an additional injection is carried out with 1-1.8 ml of the drug into the sublifting - to the region of the transitional fold of the lower jaw from the vestibular side. If it is not possible to achieve the desired effect and in this case, the blockade of the mandibular nerve is required.

To prepare a carious cavity or preparation under the crown of any tooth, with the exception of the lower molars, the articain of the inhibs is used by the type of infiltration anesthesia from the vestibular side. They are injected in a volume of 0.5-1.8 ml per tooth, the exact amount of the preparation is determined depending on the desired depth of anesthesia and the duration of the procedure. On one therapeutic procedure, the allowed dose for adults is 7 mg of artician on each kg of body weight. The duration of anesthesia is 30-45 minutes.

In children, the amount of injected drug depends on age, body weight and anesthesia method. The maximum dose for patients aged 4-12 years should not exceed 5 mg / kg (articain).

• 20-30 kg: 0.25-1 ml (1/6-1 / 4 cartridge). Maximum single dose - 1.5 ml, daily - 2.5 ml;
• 30-45 kg: 0.5-2 ml (1/3-1 cartridge). Maximum one-time dose - 2 ml, daily - 5 ml.

Side effects

Articain Inhibs is preferably well. However, in some cases, the following side effects can cause:

• from the heart and vessels: moderately pronounced hemodynamic disorders (reduction in blood pressure, bradycardia, tachycardia, depression of cardiovascular activities), which in some cases can cause a collapse and a heart stop;
• from Central nervous system: violations of consciousness (up to loss), muscular tremor, disruption of breathing (up to the stop), nausea, vomiting, involuntary muscle twitching (in some cases it can progress to generalized convulsion);
• from the body of the vision: rarely - clouding in the eyes, diplopia, transient blindness;
• local reactions: inflammation, swelling at the injection site; with random intravascular administration - ischemia at the injection site, sometimes progressive to fabric necrosis; When nerve damage (due to violation of injection techniques), paralysis is possible;
• allergic reactions: skin itch, redness of the skin, rhinitis, conjunctivitis, angioedema edema of various degrees of severity (including the uterus, swelling of the cheek and / or the top and / or lower lip, swelling of the voice gap with difficulty swallowing, the difficulty of breathing) - all these reactions can progress to anaphylactic shock;
• others: often - headaches (due to probably the action of epinephrine); Extremely rarely - characteristic epinephrine effects, such as an increase in blood pressure, arrhythmia, tachycardia.

Overdose

In the case of any symptom of a developing side or toxic action (violation of consciousness, motor anxiety, dizziness), the administration of the inhibs is urgently stopped and putting the patient into a horizontal position. It is necessary to carry out careful control of hemodynamics indicators (blood pressure and pulse), as well as the patency of the respiratory tract. Even with the apparent uncomplicated violations, it is necessary to prepare everything necessary for intravenous (in / c) infusion and at least carry out venopunction.

Depending on the degree of impairment of the respiratory function, oxygen is supplied or artificial respiration is carried out, if necessary, endotracheal intubation with the lung ventilation controlled.

The use of Analeptikov is contraindicated central action. With the development of involuntary muscle twitching or generalized convulsions, barbiturates of ultra-screws or short action are introduced, constantly monitoring respiratory and hemodynamics. Through a predetermined cannula, simultaneously is carried out in a fluid infusion. Also, the patient is given oxygen.

In the case of a pronounced reduction in blood pressure, the development of tachycardia or bradycardia patients should be given a horizontal position with raised legs.

With severe circulatory disorders and shock, the oxygen is inhalation, glucocorticoids are injected (for example, methylprednisolone at a dose of 250-1000 mg) are carried out in an infusion of balanced electrolyte and plasma-substituting solutions.

With a threatening vascular collapse and increasing bradycardia, adrenaline at a dose of 0.025-0.1 mg (0.25-1 ml of a solution with a concentration of 0.1 mg / ml) is introduced slowly to / B, controlling the pulse and blood pressure. 1 time is allowed to introduce no more than 0.1 mg of adrenaline (1 ml of solution). If necessary, applying additional adrenaline doses should be added to an infusion solution. The rate of infusion depends on the blood pressure and pulse.

Heavy forms of tachyarhythmias and tachycardia can be eliminated antiarrhythmic means, with the exception of non-selective beta adrenoblockers. Oxygen is also required. In case of increasing blood pressure in patients with arterial hypertension, it may be necessary to assign peripheral vasodilators.

special instructions

Each cartridge with the drug is intended for individual use. It is forbidden to use damaged cartridges. It is impossible to make an injection in the inflammation area. It is impossible to introduce articain inhibs intravenously.

In order to avoid intravascular administration, when the drug injections, a test for aspiration should be carried out.

Local and regional anesthesia must exercise qualified specialistTrained anesthesia performance technique familiar with diagnosis and treatment side phenomena, toxic reactions and other complications. Anesthesia should be held in the room where there are necessary medication tools and equipment for resuscitation activities and monitoring of cardiac activity.

Articsin contains sulfites that are able to strengthen anaphylactic reactions. Hypersensitivity to sulfites is more often observed in patients with bronchial asthma.

In individuals with a cholinesterase deficiency, Articin Inhibs can be used only in the presence of urgent indications, since the risk of prolongation and enhance its action.

In the following cases, it is recommended to use drug Treatmentcontaining a smaller epinephrine in composition: the presence of severe concern, diseases of the cardiovascular system (arterial hypertension, heart rate violation, angina, pathology of coronary vessels, myocardial infarction in history, chronic heart failure), cerebrovascular disorders, diabetes, hyperthyroidism, emphysema, chronical bronchitis, The presence of paralysis is a history.

Impact on the ability to control vehicles and complex mechanisms

According to the results of special tests, Artikin Inhibs does not have a negative impact on the cognitive and psychomotor functions of a person. However, a preoperative anxiety can affect the patient's condition; therefore, the degree of restrictions on driving a car and performing potentially dangerous species The work is determined by a dentist physician individually.

Application during pregnancy and lactation

The safety of the use of the artician of the Inhibs in pregnant women to date is definitely not established, so care must be taken. The doctor in the treatment of female patients should be taken into account possible pregnancy, especially the first months.

The active substances of the Artician of Inhibs in significant quantities do not penetrate breast milkTherefore, nursing mothers do not need to interrupt feeding during the use of the drug.

Childcare

Articain Inhibs should be used in pediatric patients. The effectiveness and safety of the drug in children under the age of 4 years is not installed, therefore its use in patients in this age category contraindicated.

With violations of the kidney function

In people with renal failure, Articain Inhibs should be used with caution.

When violations of the liver function

Articain Inhibsa is contraindicated in the severe form of hepatic insufficiency (porphyria).

Application in old age

There is no data that indicate the need to adjust the administration of the articain of the Inhibs for the elderly patients.

Medicinal interaction

Articain Inhibs should not be used in patients receiving non-selective beta adrenoblays, since such a combination increases the risk of developing severe bradycardia and a hypertonic crisis.

Mao inhibitors and tricyclic antidepressants can enhance the hypertensive effect of sympathomimetic amines of adrenaline type. The interaction of this type is also dangerous for norepinephrine and epinephrine when applied as vasoconstricts in concentrations 1:80,000 and 1:25,000, respectively.

Analogs

The analogues of the articain of the Inhibs are: ARTICAL DF, ARTICINEN WITH ADRENENIN, Artifrine, Brillocaine-Adrenaline, Alfakain JV, ORDER, Primacain with adrenaline, sepantist with adrenaline, kilifesin, ultrakain D-s, curtacain, cytocarthin, etc.

Terms and conditions of storage

Store in an inaccessible for children, dry, protected from light place at a temperature not more than 25 ° C.

Shelf life - 2 years.