Parenteral Drug Parenteral Drug AdministrationAdministration

Department of AnaesthesiaDepartment of Anaesthesia

University of GlasgowUniversity of Glasgow

Parenteral Route in DentistryParenteral Route in Dentistry

• General Dental CouncilGeneral Dental Council– Intravenous sedation drugsIntravenous sedation drugs– Emergency drugs Emergency drugs

Drug AdministrationDrug Administration

Absorbtion

Plasma water

Metabolism

Excretion

Site of ActionTissue

oral intramuscular subcutanous topical intravenous

Parenteral Injection SitesParenteral Injection Sites

                            

                     

subcutanously

intramuscularly

intravenously

Subcutaneous RouteSubcutaneous Route

• Absorption depending on blood flowAbsorption depending on blood flow– Constant & slow absorptionConstant & slow absorption– Prolonged effectProlonged effect

DrugsDrugs– InsulinInsulin– HeparinHeparin

Subcutaneous Injection SitesSubcutaneous Injection Sites

• Abdominal wallAbdominal wall• ThighThigh• Deltoid areaDeltoid area

Intramuscular RouteIntramuscular Route

• Absorption depending on blood flowAbsorption depending on blood flow– Rapid onset & shorter duration Rapid onset & shorter duration – ShockShock

• DrugsDrugs– GlucagonGlucagon– AdrenalineAdrenaline

Intramuscular Injection SitesIntramuscular Injection Sites

Intramuscular Injection SitesIntramuscular Injection Sites

Intramuscular Injection SitesIntramuscular Injection Sites

Intramuscular RouteIntramuscular Route

• LimitationsLimitations– Neurovascular damageNeurovascular damage– Bleeding (eg anticoagulant therapy)Bleeding (eg anticoagulant therapy)– PainPain– InfectionInfection– Delayed absorption in shockDelayed absorption in shock– Interpretation of diagnostic testsInterpretation of diagnostic tests

Intravenous RouteIntravenous Route

• Rapid immediate onsetRapid immediate onset

• Permits titrationPermits titration

• Administer slowlyAdminister slowly

• DrugsDrugs– MidazolamMidazolam

Intravenous Injection SitesIntravenous Injection Sites

• PeripheralPeripheral• CentralCentral

IntravenousIntravenous

• LimitationsLimitations– May be more difficult to obtainMay be more difficult to obtain

– Increased risk of adverse effectsIncreased risk of adverse effects

– Requires intravenous accessRequires intravenous access

– InfectionInfection

– PainPain

AnaphylaxisAnaphylaxis

• DefinitionDefinition– Immunologically mediated reaction to antigen Immunologically mediated reaction to antigen

causing systemic symptomscausing systemic symptoms

• Potentially life threateningPotentially life threatening• Frequent AntigensFrequent Antigens

– AntibioticsAntibiotics

– LatexLatex

– Anaesthetic agents Anaesthetic agents

– Colloid fluidsColloid fluids

AnaphylaxisAnaphylaxis

• DiagnosisDiagnosis– CollapseCollapse

– Difficulty breathingDifficulty breathing

– WheezeWheeze

– Angio-oedemaAngio-oedema

– UrticariaUrticaria

Management AnaphylaxisManagement Anaphylaxis

• PreventionPrevention– Avoid unnecessary drugs particularly ivAvoid unnecessary drugs particularly iv– Take drug historyTake drug history

• Adequate staff training and facilities Adequate staff training and facilities

Immediate Management 1

Remove trigger agent – Stop injection or infusion of

drug – Remove triggering materials

Remember latex allergy Chlorhexidine

– Summon assistance

Immediate Management 2Immediate Management 2

• Basic life supportBasic life support– Check airway, breathing, circulationCheck airway, breathing, circulation– OxygenOxygen

• Give adrenaline (0.5-1mg im) Give adrenaline (0.5-1mg im)

• Elevate legsElevate legs

• (Give intravenous fluids)(Give intravenous fluids)

Subsequent ManagementSubsequent Management

• Antihistamines Antihistamines – Chlorpheniramine ivChlorpheniramine iv

• Steroids Steroids – Hydrocortisone ivHydrocortisone iv

• Intensive care unitIntensive care unit

• Immunological TestingImmunological Testing

SummarySummary

• Parenteral drug administrationParenteral drug administration– SitesSites– Drug availability Drug availability – LimitationsLimitations

• AnaphylaxisAnaphylaxis

Questions ?Questions ?