History of anesthesia: from henbane to vino (13 photos)

Anesthesia without adrenaline has been used in dentistry for quite a long time; it allows painless treatment even for those patients who have contraindications to common means of local anesthesia.

Typically, drugs that do not contain adrenaline are used in cases where it is necessary to treat teeth in patients with high blood pressure, heart disease, and pregnant or breastfeeding women.

Types of anesthesia in dentistry

Anesthesia is divided into local and general. These types of anesthesia in dentistry are divided, in turn, into subtypes. Local anesthesia in dentistry can be application (superficial) and injection. Application anesthesia

in dentistry it is performed before an injection. This is the application of a gel, ointment or spray. The effect of such anesthesia occurs instantly, after which the injection itself is not felt.

Application anesthesia lasts up to 20 minutes and allows the hygienist, therapist or surgeon to perform simple manipulations, for example, removing tartar or suturing a gap. For superficial anesthesia in dentistry, drugs such as dicaine, lidocaine and anesthesin are used. Indications for local anesthesia in dentistry are treatment of caries, tooth extraction, oral surgery and other dental procedures.

Injection anesthesia in dentistry

There are 4 types:

• infiltration;
• conductor;
• intraligamentary (intraligamentous);
• intraosseous

Infiltration anesthesia in dentistry

used most often in the treatment of caries and tooth extraction. The doctor injects painkillers using a syringe with a thin short needle. The injected anesthetic blocks the transmission of impulses from the nerve endings of the anesthetized area.

Types of infiltration anesthesia in dentistry differ according to the area of ​​influence: lower or upper jaw, intraligamentary, intrapapillary, subperiosteal. With intragalimentary anesthesia, an anesthetic is injected into the ligaments of the tooth. The drug is delivered under high pressure into the bone of the alveolar ridge. During intrapapillary, the drug is injected into the papilla between the teeth, and during subperiosteal, the needle enters between the base of the root and the gum.

Conduction anesthesia in dentistry

is performed by injecting an anesthetic at a distance from the desired area, thereby blocking the transmission of nerve impulses to parts of the nerve fiber. Numbs a large area with one injection of a small amount of the drug.

Types of conduction anesthesia in dentistry:

For the upper jaw, there are the following types: infraorbital (anesthesia of canines, incisors and premolars), tuberal (for molars), palatal, incisive (incisors and canines). For the lower: mandibular (the half of the jaw in which the injection is made is anesthetized), Bershe-Dubov technology (long-lasting, used for maxillofacial operations), torusal (for premolars and molars), mental (for incisors, canines and premolars).

For intragalimentary (intraligamentous) anesthesia, a special syringe is used. A small amount of painkiller is given slowly, under pressure, the number of injections corresponds to the number of tooth canals that need to be treated. Such injections are almost painless, sensitivity is eliminated instantly. Intragalimentary anesthesia acts locally, and there is no numbness of the tongue, lips and mucous membranes, and there are no problems with diction. This method is suitable for patients with cardiovascular and endocrine diseases, as well as children.

Intraosseous anesthesia is performed when treating complex teeth. The anesthetic is injected into the bone, completely removing the sensitivity of the tooth. A special syringe is used, with a rotating bur. In addition to the complex tooth, the anesthesia covers the area of ​​two adjacent teeth, gums and roots, and “freezing” does not occur. Mainly used for complex extractions, including wisdom teeth, caries complications, restorations and periodontal surgeries.

All types of local anesthesia in dentistry are similar in the drugs used, but differ in the method of their administration (or application). Methods of local anesthesia in dentistry are selected for each patient individually, based on the time and area of ​​exposure, as well as the specifics of the procedure being performed. The answer to the question of which anesthesia is best in your case can only be given by a qualified specialist.

Anesthetics without adrenaline

This group of anesthetics includes Scandonest and Mepivastezin (Mepivacaine).

They have a moderate vasodilator effect, so they are used without a vasoconstrictor. After administration of the drug, anesthesia occurs quickly (3–5 minutes), the effect lasts 3–40 minutes for pulp anesthesia, and up to 3 hours for soft tissue anesthesia. It is used for all types of manipulations, as well as during maxillofacial operations. Indicated for children weighing at least 15 kg.

Scandonest has the following side effects:

• headaches, dizziness;
• change in heart rate;
• allergic reactions;
• hypotension;
• disturbances in the gastrointestinal tract.

For patients with a complicated medical history, the elderly, pregnant and lactating women, the drug is prescribed with caution, as it penetrates into the blood.

It poses less danger during infiltration anesthesia (the drug is injected directly into the site of the intended manipulation).

Ultracaine (Articaine) is used for local and general anesthesia and is considered a leader.

It is reliable and is used for pain relief in children, the elderly and pregnant women.

There are 3 versions of the drug available:

• Ultracaine D, which does not contain preservatives and epinephrine;
• Ultracaine DS, with epinephrine;
• Ultracaine DS forte, with increased vasoconstrictor content.

Ubistezin is similar to Ultracain in composition and properties. Suitable for patients of all ages, except children under 4 years of age. The effect of the drug appears 1-3 minutes after injection and lasts 45-240 minutes - this depends on the type of anesthesia. The patient's health status dictates the choice of drug form.

Both drugs labeled “D” (without adrenaline) are used for the following diseases:

• bronchial asthma;
• tendency to allergies;
• thyroid diseases;
• diabetes;
• hypertension;
• cardiac decompensation.

For high blood pressure, moderate heart disease, and pregnant and nursing mothers, Ubistezin and Ultracain labeled “DS” can be used, since a low concentration of the vasoconstrictor will not cause as much harm as the penetration of the anesthetic into the blood.

General anesthesia in dentistry

Sedation is used for general anesthesia in dentistry. What it is? Sedation is a drug-induced sleep during which all reflexes are preserved, the patient can turn his head and open his mouth wider. If necessary, it can be quickly removed from this state. During sedation, a large number of teeth can be treated without discomfort. An anesthesiologist is constantly in the office; pulse, blood pressure, ECG, and blood oxygen saturation are monitored. After the operation, the patient feels only slight drowsiness and relaxation, there is no pain. This method is optimal in the presence of severe fear, hypertension, allergies to any type of anesthesia, and is suitable for children.

Comfortable and painless dental treatment

The Mendeleev Clinic offers high-quality dental services with an individual and attentive approach to each patient. Qualified dentists ensure the complete absence of painful and unpleasant sensations when performing treatment procedures. We use modern painkillers and anesthesia drugs that are non-toxic, do not cause allergic reactions and are completely safe for humans. Even pregnant women and young children do not need to undergo treatment without anesthesia, since such drugs can be used with virtually no restrictions.

Dentists, taking into account the specific situation and individual characteristics of the body, select the optimal type of anesthesia or anesthesia. In modern dental practice, treatment and removal of teeth without the use of anesthesia is performed only when minor manipulations are necessary that do not cause pain. They also treat teeth without pain relief and anesthesia in the presence of such contraindications as:

• intolerance to anesthetics;
• chronic pathological disorders of the endocrine system;
• stages of exacerbation of diseases of the cardiovascular system.

How is dental treatment performed without anesthesia?

In some cases, it is impossible to use anesthesia or anesthesia, for example, if there is a severe allergic reaction to drugs. The doctor, in agreement with the patient, may decide to carry out the procedure on the teeth without anesthesia - using alternative methods. Thus, to remove carious lesions of teeth, instead of an outdated drill, laser therapy or chemical dissolution of diseased tissues is used. These are painless methods that do not cause pain or discomfort to the patient, even if there is no anesthesia.

Using a laser, caries and periodontitis are treated, implantation is performed and tooth enamel is whitened without using anesthesia. Laser technologies do not involve mechanical impact during manipulations. The main advantages of this method: no anesthesia or anesthesia is required; the impact is made as accurately as possible; healthy tissues are not affected.

Dentistry "Mendeleev" guarantees a complete absence of pain and discomfort during treatment. You can find out the specifics of performing certain procedures without or with pain relief during a consultation with a doctor. You can make an appointment by phone or by leaving a request for a call back on the website.  

me-dent.ru

Contraindications to anesthesia

Contraindications to local anesthesia in dentistry: allergies to any drug, cardiovascular and endocrine diseases, bronchial asthma, liver failure, taking beta-blockers, tricyclic antidepressants, mental illness, recent coronary bypass surgery, trauma to the maxillofacial area .

Temporary contraindications to dental operations under anesthesia:

• drinking alcohol on the day of surgery or the day before;
• colds;
• period of menstruation in women due to deterioration of blood clotting.

Anesthesia for bronchial asthma

in dentistry requires special knowledge and training from the doctor. This is one of the cases when safe anesthesia in dentistry is necessary.

If a patient with bronchial asthma needs dental treatment, before starting the procedures, the dentist will refer him to an allergist to clarify the status and contraindications. It is necessary to clarify what medications the client is using. In this case, before treatment, premedication is mandatory, either as prescribed by the allergist, or, in the absence of these, with Xezazal 5 mg, Zyrtec 10 mg or Kestin 10 mg 5 days before surgery, on the day of admission and 5 days after, 1 tablet 1 once a day. Immediately before dental procedures, you need to inhale a fast-acting drug from the salbutamol or fenoterol group (Ventolin, Berotec).

If an attack of suffocation develops, at the beginning of which chest pain, coughing or sneezing appears, then the inhalation shortens, the exit lengthens, wheezing is heard, the patient becomes anxious and cannot speak. The patient leans forward, rests his elbows on his knees, turns pale, sweats, and his lips turn blue. Exhalation is difficult. During an attack, the doctor should open the windows to allow fresh air in, if there is contact with the allergen, exclude it, give warm water to drink, and help inhale the medicine from the inhaler.

For bronchial asthma, an anesthetic without preservatives, for example, Ultracaine D, is best suited. Acetylsalicylic acid and other substances that provoke bronchospasm, such as morphine and indomethacin, are contraindicated.

Features of anesthesia for pregnant and nursing mothers in dentistry

Pregnant women definitely need to have their teeth treated, because caries or other inflammatory processes in this area are a threat to the health of the baby. Treatment with special anesthesia, tooth extraction, removal of plaque and stone, and rinsing according to doctor’s indications are allowed. Implantation, x-rays, the use of dental gels and ointments without medical advice, and the unauthorized use of antibiotics and painkillers without a doctor’s prescription are prohibited. Prosthetics and orthodontic treatment during pregnancy are questionable. Various complications and inflammations may occur, which are especially dangerous during this period.

The second trimester is the most favorable for dental treatment - there is no toxicosis, the formation of the main organs and systems of the fetus is behind. If you suffer from toothache, there is no need to postpone treatment at any time during pregnancy; the doctor will select a special anesthesia. Pregnant women often have gingivitis (inflammation and bleeding of the gums, severe sensitivity), which must be treated. Without treatment, the risk of premature birth increases up to 6 times. In the last trimester, dental treatment is especially dangerous; any stress can trigger labor before term.

Anesthesia in dentistry during pregnancy is characterized by the use of anesthetics without adrenaline (it can cause uterine hypertonicity). Articaine drugs are used, for example, primacaine and ultracaine. These substances do not penetrate the placenta, but at the same time they provide excellent pain relief, soothe inflammation of the oral cavity, and are hypoallergenic. Similar anesthesia in dentistry is also used during breastfeeding.

Modern drugs for anesthesia

The choice of anesthetic depends on the patient's individual treatment plan and the method of anesthesia. For local topical anesthesia, gels, ointments and sprays based on lidocaine, dicaine, bumecaine, and benzocaine are currently used. For example, diplen - LH, topex gel, disilane, diseptin, xylonor.

For injection anesthesia, drugs such as procaine, lidocaine, mepivacaine, ultracaine, ubistezin, trimecaine, articaine, chirocaine, bipuvacaine are used. Inhalational sedation uses a mixture of nitrous oxide and oxygen. If you are afraid of visiting the dentist, you can take tranquilizers orally in the form of tablets, for example, diazepam, oxazepam, hydroxyzine, hexobarbital, as prescribed by the doctor.

Means and preparations for general anesthesia

The most popular drugs for general anesthesia are xenon, sevoran and nitrous oxide:

1. Sevoran is a liquid for inhalation anesthesia, causes a rapid loss of consciousness (up to 2 minutes), has virtually no effect on intracranial pressure. Well tolerated by adults and children.
2. Nitrous oxide is a gas-narcotic mixture characterized by strong anesthetic properties and low toxicity, reaching maximum effectiveness 5-8 minutes after administration.
3. Xenon is an inert gas, does not irritate the respiratory tract, and causes virtually no side effects. Xenon anesthesia is considered one of the safest in dentistry. However, it has a high price compared to alternative drugs.

Electronic anesthesia in dentistry

This is a technique of anesthesia in dentistry in which the rate of administration of the anesthetic is under electronic hardware control. The anesthetic is delivered dropwise, without injury or stress, the needle moves smoothly. The advantages of using an anesthesia device in dentistry are the absence of pain, fast response (two minutes for pain relief), complete patient comfort (no discomfort before, after, or during the process), and accuracy of the injection.

Dental Guru clinics use an innovative method of computer anesthesia using the MEG-INJECT device, which allows you to accurately calculate the dose of the drug and the speed of its delivery. A thin needle ensures painless injection; application anesthesia is not required before the injection.

Control and safety during complete anesthesia

Dental treatment under anesthesia is absolutely safe, since the patient’s condition is monitored by 3 doctors at once: a dentist, an anesthesiologist and a nurse. During the procedure, pulse, breathing and temperature are regularly checked.

At the end of treatment, the doctor reduces the concentration of the narcotic substance to 50%, and then completely stops supplying it. Awakening occurs within 2-3 minutes.

Before anesthesia:

For complete safety, the patient should undergo special training:

• take a blood and urine test;
• do an electrocardiogram of the heart;
• for children - consult a pediatrician.

You should also stop eating food 4 hours (liquids 2 hours) before the procedure. If all the doctor’s recommendations are followed, the risk of complications will be reduced to zero.

Anesthesia without adrenaline in dentistry

Why is adrenaline needed in painkillers? It enhances the effect of the anesthetic by constricting blood vessels and capillaries, so that the anesthetic is concentrated at the injection site. In addition, adrenaline reduces bleeding, so drugs with adrenaline are optimal for operations with large blood losses. The most commonly used drugs with adrenaline are ultracaine, ubistezin and alfacaine.

Adrenaline anesthetic will not harm a healthy person. But if you have cardiovascular diseases (heart attack in the next six months), endocrine disorders (diabetes mellitus) or pregnancy, then adrenaline should not be used. Therefore, anesthetics such as lidocaine, pyromecaine, bupivacaine, trimecaine, prilocaine, and articaine are used. Non-adrenaline anesthetics begin to act more slowly than adrenaline ones, and their effect ends faster. At the same time, the safest anesthesia in dentistry is adrenaline-free.