Local Anesthesia with Sedation, General Anesthesia, and/or Nitrous Oxide/oxygen Analgesia/anxiolysis

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

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