Local Anaesthesia with Sedation, General Anaesthesia, and/or Nitrous Oxide/oxygen Analgesia/anxiolytics

As local anaesthetics and sedative agents both depress the CNS it is recommended that the dose of local anaesthesia be adjusted downward when sedating children with opioids. Narcotics may decrease the amount of protein binding of local anaesthetics and elevated arterial carbon dioxide which increase CNS sensitivity to convulsions.

For patients undergoing general anaesthesia, the anaesthesia care provider must be made aware of to concomitant use of a local anaesthetic containing epinephrine as epinephrine can produce dysrthythmias when used with halogenated hydrocarbons (e.g., halothane). The dosage of local anaesthetic does not need to be altered if nitrous oxide/oxygen analgesia/anxiolysis is administered alone.7

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