Parenteral Drug Administration Department of Anaesthesia University of Glasgow

Parenteral Route in Dentistry General Dental CouncilGeneral Dental Council –Intravenous sedation drugs –Emergency drugs

Drug Administration Absorbtion Plasma water Metabolism Excretion Site of ActionTissue oral intramuscular subcutanous topicalintravenous

Parenteral Injection Sites subcutanously intramuscularly intravenously

Subcutaneous Route Absorption depending on blood flowAbsorption depending on blood flow –Constant & slow absorption –Prolonged effect Drugs –Insulin –Heparin

Subcutaneous Injection Sites Abdominal wallAbdominal wall ThighThigh Deltoid areaDeltoid area

Intramuscular Route Absorption depending on blood flowAbsorption depending on blood flow –Rapid onset & shorter duration –Shock DrugsDrugs –Glucagon –Adrenaline

Intramuscular Injection Sites

Intramuscular Route LimitationsLimitations –Neurovascular damage –Bleeding (eg anticoagulant therapy) –Pain –Infection –Delayed absorption in shock –Interpretation of diagnostic tests

Intravenous Route Rapid immediate onsetRapid immediate onset Permits titrationPermits titration Administer slowlyAdminister slowly DrugsDrugs –Midazolam

Intravenous Injection Sites PeripheralPeripheral CentralCentral

Intravenous LimitationsLimitations –May be more difficult to obtain –Increased risk of adverse effects –Requires intravenous access –Infection –Pain

Anaphylaxis DefinitionDefinition –Immunologically mediated reaction to antigen causing systemic symptoms Potentially life threateningPotentially life threatening Frequent AntigensFrequent Antigens –Antibiotics –Latex –Anaesthetic agents –Colloid fluids

Anaphylaxis DiagnosisDiagnosis –Collapse –Difficulty breathing –Wheeze –Angio-oedema –Urticaria

Management Anaphylaxis PreventionPrevention –Avoid unnecessary drugs particularly iv –Take drug history Adequate staff training and facilitiesAdequate 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 supportBasic life support –Check airway, breathing, circulation –Oxygen Give adrenaline (0.5-1mg im)Give adrenaline (0.5-1mg im) Elevate legsElevate legs (Give intravenous fluids)(Give intravenous fluids)

Subsequent Management AntihistaminesAntihistamines –Chlorpheniramine iv SteroidsSteroids –Hydrocortisone iv Intensive care unitIntensive care unit Immunological TestingImmunological Testing

Summary Parenteral drug administrationParenteral drug administration –Sites –Drug availability –Limitations AnaphylaxisAnaphylaxis

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