XYLOCAINE

Infiltration - the usual dose is 1 ml. 5 to 2 ml. The recommended maximum dose for Xylocaine when given with adrenaline is 500 mg. Children and elderly or debilitated patients require smaller doses.

In common with other local anaesthetics, adverse reactions to Xylocaine with adrenaline are extremely rare in dental practice and are usually the result of excessively high blood concentrations due to inadvertent intravascular injection, excessive dosage, rapid absorption or occasionally to hypersensitivity, idiosyncrasy or diminished tolerance on the part of the patient.

In such circumstances systemic effects occur involving the central nervous system and/or the cardiovascular system. CNS reactions are excitatory and/or depressant, and may be characterised by nervousness, dizziness, blurred vision and tremors, followed by drowsiness, convulsions, unconsciousness and possibly respiratory arrest.

The excitatory reactions may be very brief or may not occur at all, in which case the first manifestations of toxicity may be drowsiness, merging into unconsciousness and respiratory arrest. Cardiovascular reactions are depressant, and may be characterised by hypotension, myocardial depression, bradycardia and possibly cardiac arrest.

Allergic reactions are extremely rare. They may be characterised by cutaneous lesions, urticaria, oedema or anaphylactoid reactions. Detection of sensitivity by skin testing is of doubtful value.

In common with other local anaesthetics, Xylocaine with adrenaline should be used cautiously in patients with epilepsy, impaired cardiac conduction, impaired respiratory function, and in patients with impaired hepatic function if the dose or site of administration is likely to result in high blood levels.

Facilities for resuscitation should be available when local anaesthetics are administered. The effect of local anaesthetics may be reduced if an injection is made into an inflamed or infected area. Solutions containing adrenaline should be used with caution in patients with hypertension, cardiac disease, cerebrovascular insufficiency or thyrotoxicosis.

Solutions containing adrenaline should be used where possible so as to prolong anaesthesia and reduce systemic absorption. This is particularly important in highly vascular areas. Xylocaine 2% w/v with Adrenaline (Epinephrine) 1:80,000 DENTAL contains Sodium Metabisulfite (E223) which may rarely cause severe hypersensitivity reactions and bronchospasm.

This may be manifested as a rash, swelling, low blood pressure and breathlessness and may be more prevalent in people with a history of allergies and asthma.

Known hypersensitivity to anaesthetics of the amide type. The use of a vasoconstrictor is contra-indicated for anaesthesia of fingers, toes, tip of nose, ears and penis. Xylocaine with adrenaline should not be given intravenously.