The American Heart Association (AHA) guidelines, last updated in 2017, recommend antibiotic prophylaxis for select patients with underlying cardiac conditions undergoing dental procedures that involve manipulation of the gingival tissue or periapical region of the teeth or perforation of the oral mucosa.
Key points from the guidelines include:
It's important to note that these guidelines are subject to periodic review and update, so clinicians should stay informed about the latest recommendations from relevant professional organizations, such as the AHA or local dental associations. Additionally, individual patient factors and preferences should always be considered when making decisions about antibiotic prophylaxis for dental procedures.
Lidocaine (Xylocaine): - Maximum Dose without Epinephrine: 4.5 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine) - Toxicity: Symptoms of lidocaine toxicity may include dizziness, confusion, seizures, cardiovascular collapse, and cardiac arrest.
Bupivacaine (Marcaine): - Maximum Dose without Epinephrine: 2 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 3 mg/kg (with epinephrine) - Toxicity: Bupivacaine toxicity can cause significant cardiotoxicity, leading to cardiac arrhythmias, cardiac arrest, and central nervous system (CNS) effects such as seizures and dizziness.
Mepivacaine (Carbocaine): - Maximum Dose without Epinephrine: 4.5 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine) - Toxicity: Symptoms of mepivacaine toxicity are similar to other local anesthetics and may involve CNS and cardiovascular effects.
Procaine (Novocaine): - Maximum Dose without Epinephrine: 7 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: Not typically used with epinephrine - Toxicity: Procaine toxicity may present with symptoms similar to other local anesthetics but is less frequently used today due to its shorter duration and higher allergenic potential.
Articaine (Septocaine): - Maximum Dose without Epinephrine: 7 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine) - Toxicity: Articaine has a longer duration of action but can cause similar toxicity symptoms as other local anesthetics if administered excessively or if there's accidental intravascular injection.
Hypokalemia (Low Potassium Levels):
- Mild to Moderate Hypokalemia (3.0-3.5 mEq/L):
- Oral potassium supplementation: Potassium chloride tablets or liquid, 20-40 mEq orally per day in divided doses.
- Severe Hypokalemia (<3.0 mEq/L):
- IV potassium chloride: Start with 10-20 mEq/hour, under continuous cardiac monitoring.
Hyperkalemia (High Potassium Levels):
- Mild Hyperkalemia (5.1-6.0 mEq/L):
- Dietary potassium restriction and discontinuation of potassium supplements.
- Severe Hyperkalemia (>6.0 mEq/L or with ECG changes):
- Calcium gluconate or calcium chloride IV to stabilize cardiac membranes.
- Insulin with glucose IV, beta-agonists (e.g., albuterol), or sodium bicarbonate to shift potassium into cells. - Loop diuretics or exchange resins (e.g., sodium polystyrene sulfonate) to enhance potassium removal.
Hypocalcemia (Low Calcium Levels):
- Mild Hypocalcemia (8.0-8.5 mg/dL):
- Oral calcium supplements: Calcium carbonate or calcium citrate, doses vary based on elemental calcium content.
- Severe Hypocalcemia (<8.0 mg/dL or symptomatic):
- IV calcium gluconate or calcium chloride, dosages depend on severity and symptoms.
Hypercalcemia (High Calcium Levels):
- Mild Hypercalcemia (10.5-11.9 mg/dL):
- Hydration with IV saline and loop diuretics.
- Severe Hypercalcemia (>12 mg/dL or symptomatic):
- Bisphosphonates, calcitonin, or corticosteroids may be used for severe cases.
Hypomagnesemia (Low Magnesium Levels):
- Mild to Moderate Hypomagnesemia (1.2-1.8 mg/dL):
- Oral magnesium supplements: Magnesium oxide, magnesium citrate, or magnesium glycinate, dosages vary.
- Severe Hypomagnesemia (<1.2 mg/dL or symptomatic):
- IV magnesium sulfate, doses vary based on severity and response.
Hypermagnesemia (High Magnesium Levels):
- Mild to Moderate Hypermagnesemia (2.5-3.0 mg/dL):
- Discontinuation of magnesium-containing medications.
- Severe Hypermagnesemia (>3.0 mg/dL or with symptoms):
- IV calcium gluconate for severe symptoms.
- Dialysis may be necessary in extreme cases.
