1. Parenteral Drug Administration Department of Anaesthesia University of Glasgow

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

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

4. Parenteral Injection Sites subcutanously intramuscularly intravenously

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

6. Subcutaneous Injection Sites Abdominal wallAbdominal wall ThighThigh Deltoid areaDeltoid area

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

8. Intramuscular Injection Sites

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

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

13. Intravenous Injection Sites PeripheralPeripheral CentralCentral

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

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

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

17. Management Anaphylaxis PreventionPrevention –Avoid unnecessary drugs particularly iv –Take drug history Adequate staff training and facilitiesAdequate staff training and facilities

18. Immediate Management 1 Remove trigger agent –Stop injection or infusion of drug –Remove triggering materials Remember latex allergy Chlorhexidine –Summon assistance

19. 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)

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

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

22. Questions ?