Is there any substantial study demonstrating that , in patients over 65 years of age, the physiological metabolic activity of their liver is approximately 50% of that in a 25 year old patient ( hence reducing considerably the ability to eliminate the local anesthetic injected during dental care)?
I think there is not any problem at all, because is a very low dose and poor absorption to the general circulation
Thank you, Don Luis, for your answer.
The problem I point out is, more precisely, that the metabolic process of lidocaine, mepivavacaine (amines)occurs in the liver. Their rate of bio-transformation depends upon the liver function and hepatic perfusion. Therefore, patients with low hepatic blood flow, or significant liver disease (ASA III) cannot correctly transform them leading to systemic toxicity.
My question is: is there any evidence that liver function is “physiologically” reduced by 50% with patients over 65, so that we should reduce the amounts of amide local anesthetics (except articaine, with a different metabolic process) for all patients over 65?
I don´t think so, because the absorption is very low and the decrease in the liver function is very small in relation to the older age
Thank you to both of you for your comments.
Now, remains the core of the problem : do you have any idea of where this (false, as you assume) statement comes from? Is it written in any available textbook or paper by an author with high skills and reputation?
Your follow-up would be greatly appreciated.
All the best,
Thierry.
I can recommend a good review about all the possible clinical situations :
Selection factors for local anesthetic agents.
Budenz AW.
J Calif Dent Assoc. 2008 Oct;36(10):735-8.
PMID: 19044094
My best regards.
Luis Rodrigo MD
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