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KMID : 0980220010010010026
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Journal of the Korean Dental Society of Anesthesiology
2001 Volume.1 No. 1 p.26 ~ p.31
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Primary Closure of Deep Penetrating Wounds under Local Anesthesia with Dental Lidocaine HCL 28 Ampules in Maxillofacial Regions - Report of two cases -
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Kim Jong-Bae
Yoo Jae-Ha
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Abstract
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The wide deep penetrating wound of maxillofacial region should be early closed under emergency general anesthesia for the prevention of complications of bleeding, infection, shock & residual scars.
But, if the emergency general anesthesia wound be impossible because of pneumoconiosis, obstructive pulmonary disease & hypovolemic shock, early primary closure should be done under local anesthesia by use of much amount of the anesthetic solution.
The maximum dose of dental lidocaine (2% lidocaine with 1:100,000 epinephrine) is reported to 7 mg/kg under 500 mg (13.8 ampules) in normal adult.
But the maximum permissible dose of dental lidocaine can be changed owing to the general health, rapidity of injection, resorption, distribution & excretion of the drug.
The blood level of overdose toxicity is above 4.0 μg/ml in central nervous & cardiovascular system.
The injection of dental lidocaine 1-4 ampules is attained to the blood level of 1 μg/ml in normal healthy adult.
The duration of anesthetic action in the dental 2% lidocaine hydrochloride with 1:100,000 epinephrine is 45 to 75 minutes and the period to elimination is about 2 to 4 hours.
Therefore, authors selected the following anesthetic methods that the first injection of 6 ampules is applied into the deeper periosteal layer for anesthesia action during 1 hour, the second injection into the deeper muscle & fascial layer, the third injection into the superficial muscle and fascial layer, the fourth injection into the proximal skin & subcutaneous tissue and the fifth final injection into the distal skin & subcutaneous tissue.
The total 26-28 ampules of dental lidocaine were injected into the wound as the regular time interval during 5-6 hours, but there were no systemic complications, such as, agitation, talkativeness, convulsion and specific change of vital signs and consciousness.
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KEYWORD
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Emergency care, Maxillofacial injury, Lidocaine, Local anesthesia, Penetrating wound
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