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still an added antioxidant in all solutions containing epinephrine or levonordefrin. 9 Patients with true local anesthetic allergies have been treated in the past with the use of antihistamines as a local anesthetic. Their use was initially described in 1939 by Rosenthal and Minard. 10 Diphenhydramine's (DPH's) anesthetic properties are thought to be due to its similar structure to other neural blocking agents. 11 DPH contains an aromatic ring, an intermediate chain, and an amino terminus in its molecular structure. Figure 1 compares the structures of

-gauge peripheral IV was secured on the dorsum of the right hand and administration of a Lactated Ringers solution was initiated. The patient was slowly induced with IV boluses of diphenhydramine 50 mg and ketamine 50 mg, plus a dexmedetomidine 70 mcg bolus given over 10 minutes that was converted to a continuous infusion of 0.7 mcg/kg/h with an infusion pump and titrated to achieve deep sedation. She maintained a patent unobstructed airway and spontaneous ventilations, achieving an SpO 2 of 98 to 100% with supportive neck and shoulder rolls to facilitate head

In the rare event an allergist cannot identify an acceptable local anesthetic, one additional option is available to avoid a general anesthetic. Diphenhydramine (Benadryl) is an antihistamine that has demonstrated clinical efficacy in blocking sodium channels in peripheral nerves. 16 – 19 It is not as effective as traditional local anesthetics, but has been used successfully following infiltration; evidence for efficacy following nerve block is less convincing. Diphenhydramine is very irritating to tissues and must be used as a 1% (10 mg/mL) concentration when

. The actual sedative efficacy of these agents is generally less than that with benzodiazepines. Hydroxyzine (Atarax, Vistaril) is an antihistamine (H 1 -antagonist) sedative which has an onset of action within 15 to 30 minutes. The maximum effect is achieved after approximately 2 hours, and drug effect wanes after 3–4 hours. The incidence of side effects with hydroxyzine is low. Other than drowsiness, hydroxyzine has minimal effect on cardiovascular or respiratory function. Usual adult doses range from 50 mg to 100 mg. 62 Diphenhydramine (Benadryl) is

multimodal approach potentiating minimal and moderate sedation without the risk of major respiratory depression when used within recommended dosing ranges. An added benefit with antihistamines is their anticholinergic and antiemetic effects. The antiemetic effects are most evident with promethazine; however, all of the antihistamine agents discussed here display anticholinergic effects including antisialagogue effects, increased heart rate, and slowed GI motility. Diphenhydramine Available as an over-the-counter medication, diphenhydramine is a

. DISCUSSION Conventional IANB is the most popular technique used for anesthetizing mandibular molars. However, its anesthetic efficacy for teeth with SIP is as low as 15–57%, leading to research focused on improving the efficacy of IANBs. 1 – 3 Previous studies have investigated adjuvants such as meperidine, diphenhydramine, hyaluronidase, and sodium bicarbonate without any significant improvement over standard lidocaine with epinephrine solutions. 12 – 15 This study sought to compare the anesthetic efficacy and the success rate of lidocaine and epinephrine with