Parenteral Drug

Administration

Department of Anaesthesia
University of Glasgow
Parenteral Route in Dentistry
• General Dental Council
– Intravenous sedation drugs
– Emergency drugs
 Drug Administration
oral intramuscular subcutanous topical intravenous

Absorbtion

Tissue Plasma water Site of Action

Metabolism

Excretion
Parenteral Injection Sites

                             

                     
subcutanously

intramuscularly

intravenously
 Subcutaneous Route
• Absorption depending on blood flow
– Constant & slow absorption
– Prolonged effect
Drugs
– Insulin
– Heparin
 Subcutaneous Injection Sites
• Abdominal wall
• Thigh
• Deltoid area
 Intramuscular Route
• Absorption depending on blood flow
– Rapid onset & shorter duration
– Shock
• Drugs
– Glucagon
– Adrenaline
Intramuscular Injection Sites
Intramuscular Injection Sites
Intramuscular Injection Sites
 Intramuscular Route
• Limitations
– Neurovascular damage
– Bleeding (eg anticoagulant therapy)
– Pain
– Infection
– Delayed absorption in shock
– Interpretation of diagnostic tests
 Intravenous Route
• Rapid immediate onset
• Permits titration
• Administer slowly
• Drugs
– Midazolam
 Intravenous Injection Sites
• Peripheral
• Central
 Intravenous
• Limitations
– May be more difficult to obtain
– Increased risk of adverse effects
– Requires intravenous access
– Infection
– Pain
 Anaphylaxis
• Definition
– Immunologically mediated reaction to antigen
causing systemic symptoms
• Potentially life threatening
• Frequent Antigens
– Antibiotics
– Latex
– Anaesthetic agents
– Colloid fluids
 Anaphylaxis
• Diagnosis
– Collapse
– Difficulty breathing
– Wheeze
– Angio-oedema
– Urticaria
 Management Anaphylaxis
• Prevention
– Avoid unnecessary drugs particularly iv
– Take drug history
• 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 2
• Basic life support
– Check airway, breathing, circulation
– Oxygen
• Give adrenaline (0.5-1mg im)
• Elevate legs
• (Give intravenous fluids)
 Subsequent Management
• Antihistamines
– Chlorpheniramine iv
• Steroids
– Hydrocortisone iv
• Intensive care unit
• Immunological Testing
 Summary
• Parenteral drug administration
– Sites
– Drug availability
– Limitations
• Anaphylaxis
Questions ?