Aseptic and dental anesthesia in dentistry. The product is recommended for simple extractions and for the development of cavities and pillar teeth. The preparation is recommended especially in patients who are contraindicated in the use of vasoconstrictive agents, in particular hemodynamically unstable patients.
Composition:
1 ml of solution contains 30 mg of mepivacaine hydrochloride.
Action:
Locally anesthetic agent for use in dentistry. It is characterized by a rapid onset of anesthesia (latent period of 1-3 minutes), elimination of pain sensation and good local tolerance. The duration of anesthesia in the case of pulp is at least 20-40 min, and in the case of soft tissues 45-90 min. Mepivacaine is an amide-type local anesthetic characterized by a rapid onset of action and inducing temporary inhibition of the excitability of vegetative, sensory and motor nerve fibers and cardiac conduction. The probable mechanism of action is to block the voltage-dependent sodium channels in the nerve fiber sheath. The preparation is absorbed quickly and in large quantities. It binds to plasma proteins at 60-78%, T0,5 is about 2 hours. Mepivacaine is mainly metabolised in the liver, metabolites are removed by the kidneys. Mepivacaine diffuses through the nerve sheath to the nerve cell as a base; the active form of mepivacate is the mepivacate cation arising after the proton is reconnected. At low pH values, e.g. in the case of an inflammatory process in tissues, only a small amount of mepivacaine is present in the form of a base which may lead to insufficient anesthesia.
Contraindications:
Hypersensitivity to mepivacaine, local anesthetic amides or any of the preparation's excipients. Severe disturbances of nerve impulses and conductive heart systems, eg block AV IIst. and third century, marked bradycardia. acute decompensated heart failure (acute decrease in cardiac output). Severe hypotension.
Precautions:
The product should be used with extreme caution in the presence of severe renal and hepatic impairment, angina pectoris, arteriosclerosis (sclerosis), injections into sites undergoing inflammation, and severe bleeding disorders. Accidental administration should be avoided.
Pregnancy and lactation:
There are not enough studies to assess the safety of the use during pregnancy. In early pregnancy, mepivacaine should only be used after careful consideration of the risks and benefits of its use. Mepivacaine should not be expected to be significantly excreted in breast milk because it is rapidly broken down and removed.
Side effects:
Undesirable effects in the form of symptoms from o.u.n. and / or cardiovascular symptoms may arise as a result of an overdose, particularly as a result of careless delivery or changed absorption conditions, e.g. in the case of inflammation or strong vascularization of tissues. In addition, you may experience: mild symptoms from o.u.n .: metallic taste, tinnitus, dizziness, nausea, vomiting, anxiety, especially movement anxiety, increased respiratory rate. Moderately severe symptoms: drowsiness, confusion, convulsions, muscle tremors, tonic-clonic spasms, coma and respiratory depression. Severe complications from the cardiovascular system: reduction of blood pressure, tachycardia, bradycardia, cardiac arrest. Allergic reactions to mepivacaine are very rare.
Dosage:
Always use the smallest volume of the solution that is able to induce effective anesthesia. It is usually 1-4 ml of solution for adults to anesthetize. In children about the month approx. 20-30 kg is sufficient with 0.25-1 ml of solution; in children about the month of 30-45 kg, 0.5-2 ml solution. In elderly patients, plasma levels of mepivacaine may increase due to reduced metabolic rate and lower volume of distribution. The risk of accumulation of mepivacaine increases particularly in the case of repeated applications, e.g. an additional injection.Similar effects may occur in patients who are in a worse general condition and with impaired liver and kidney function. In all such cases it is recommended to give a lower dose (the minimum amount necessary to obtain anesthesia of the appropriate depth). In patients with certain existing diseases (angina pectoris, induced vascular sclerosis), the dose of mepivacaine should also be reduced. The maximum dose of the active substance mepivacaine is 300 mg (4 mg / kg). It is the equivalent of 10 ml of the preparation. Children about mc. 20-30 kg do not administer more than 1.5 ml in 2 hours or not more than 2.5 ml in 24 hours. For children. 30-45 kg do not administer more than 2 ml in 2 hours or 5 ml in 24 hours. To avoid accidental administration to the container, always carefully aspirate in two positions (needle rotation 180 degrees). A negative result of aspiration does not exclude the possibility of unintentional and imperceptible injection of the solution into the vessel. The injection rate should not exceed 0.5 ml within 15 seconds, i.e. 1 amp / min. Open ampoules should not be used in other patients.
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