Professional Documents
Culture Documents
Cartridge Warmers
-cartridge warmers are not necessary; the patient cannot
discern between warmed and room temperature local
anesthetic
-patients do not complain of the local anesthetic solution
feeling cold upon injection
-local anesthetics that are warmed too much, i.e., > 80 F will
be described as too hot or burning upon injection
-local anesthetic warmers are deceptive if they claim that the
injection will be less painful if the anesthetic is warmed
Problems
Bubble In The Cartridge: 1-2 mm bubble can be found in the
cartridge which is nitrogen gas that is inserted into the
cartridge when it is sealed to keep oxygen out; avoids
oxygen oxidizing the vasopressor
Extruded Stopper: liquid was frozen at some point leading to
extrusion sterile environment of the solution can no longer
be guaranteed; it only takes one day for alcohol to diffuse
through the diaphragm; alcohol is neurolytic and can cause
extended lengths of parasthesia; do not soak cartridges in
alcohol
Burning On Injection
1) Normal response to the pH of the drug
2) Cartridge contains sterilizing solution
3) Overheated cartridge (local anesthetic warmer)
4) Cartridge containing a vasopressor (decreased pH)
5) Vasopressor decreases the pH from 5.5 (plain) to 3.3 4.0
6) Sodium Bisulfite Sodium Bisulfate (much more acidic)
7) -ite -ate occurs by oxidation after local anesthetic expiration
-with the addition of silicone as a lubricant around the stopper instead of
paraffin this is not a problem anymore
Additional Armamentarium
1) Topical Antiseptic: betadine or thimerosal; 8% of
Dentists use it and is considered optional; eliminates
post-injection infections
2) Topical Anesthetic: disguises the initial introduction of
the needle into the tissues when applied for a minimum
of 1 minute; if left for 2 to 3 minutes, profound topical
anesthesia is achieved; studies have shown that less than
10 seconds does not provide any more anesthesia than
placebo
References
Malamed, Stanley: Handbook of Local Anesthesia. 5th Edition. Mosby.
2004