Maximum recommended doses LOCAL ANAESTHESIA

RECOMMENDED DOSE...LA

1. Maximum recommended doses Vishal Gohil Nancy Hirpara -Bhakti Jivani

2. Maximum doses of local anesthetics Doses of local anesthetic drugs are presented in terms of milligrams of drug per unit of bodyweight – as milligrams per kilogram(mg/kg) or as milligrams per pound(mg/Ib) These numbers, similar to the once presented for duration, reflect estimated values because there is a wide range in patient response to blood levels of local anesthetics

3. For patients whose responses to anesthetic blood levels lie within the middle of normal distribution curve, administration of a maximum dose based on body weight produces a local anesthetic blood level below the usual threshold for an overdose reaction Patients who are hyporesponders to elevated local anesthetic blood levels may not experience any adverse reaction until their local anesthetic blood level is considerably above this normal overdose threshold

4. These patients represent little increased risk when local anesthetics are administrated in usual dental doses To increase safety for all patients during administration of local anesthetics, but especially in this latter group, one should always minimize drug doses and use the smallest clinically effective dose

5. Two groups of patients however, represent potentially increased risk from overly high local anesthetic blood levels The smaller, lighter-weight child, and the debilitated elderly individual Considerable attention must be given to drug administration in these two group The maximum recommended dose calculated should always be decreased in medically compromised, debilitated, or elderly persons

6. Changes in liver function, plasma protein binding, blood volume and other important physiologic functions influence the manner in which local anesthetics are distributed and biotransformed in the body A point that has come up in several medicolegal situations related to overdosage(OD) of local anesthetics involves the maximum number of milligrams administered and the effect on the patient

7. Anesthetic Maximum dosage mg/kg Maximum dosage mg/Ib Maximum total dosage mg /carpule Lidocaine 2% 1:000,000 epi 4.4 2.0 300mg 36mg Mepivacaine 3% plain 4.4 2.0 300mg 54mg Articaine 4% 1:100,000 epi 7.0 3.2 500mg 72mg Prilocaine 4% plain 6.0 2.7 400mg 72mg Bupivacaine 0.5% 1:200,000 epi 1.3 0.6 90mg 9mg