8. LA Symposium Flashcards
CNV1 branches
CNV2 branches
CNV3 branches
Nasociliary, lacrimal, frontal (supratrochlear, supraorbital)
Zygomatic (zygomaticotemporal, zygomaticofacial), nasopalatine, greater palatine, lesser palatine, pharyngeal, middle/anterior superior alveolar, infraorbital, inferior palpebral, superior lateral, lateral nasal
Muscular division, anterior division (masseteric, lateral pterygoid, deep temporal, anterior, posterior, buccal), auriculotemporal, posterior division (mylohyoid/anterior belly of digastric, lingual, inferior alveolar, mental)
Functions of LA (4)
Definition of pain
Advantage of vasoconstrictors in LA (2)
Operative pain control, haemorrhage control, diagnostic tool. Used to prevent pain
Unpleasant sensory and emotional experience associated with actual/potential tissue damage
Prevent LA resorption, which increases the length of action and encourages haemostasis
Function of infiltration
Function of nerve block
Types of maxilla blocks (3)
Types of mandibular LA (3)
Types of needles for injections (2)
Types of topical anaesthetic (2)
LA technique (6)
Function and orientation of bevel (2)
Function of aspiration
Landmarks for IDB (4)
Confirming anaesthsia for IDB
Soft tissue and pulpal anaesthesia in thin bone
Abolish sensation distal to site, soft tissue anaesthesia in thick bone
PSA, MSA, ASA
For 6-8 (IDB, long buccal), 3-5 (mental block, buccal infiltration), 1-3 (infiltration)
25mm 30G for infiltration, 35mm 27G for IDB
2% lidocaine, 20% benzocaine
Stretch mucosa, puncture quickly (distract), position tip at target, advance to bone, withdraw 2-3mm aspirate, inject slowly
Bevel provides a cutting surface that offers little resistance to mucosa as the needle penetrates and withdraws from tissue - bevel towards you = unobstructed lumen
Blood in cartridge - checks if BVs are perforated (which can lead to systemic effects)
Coronoid notch of mandibular ramus, posterior border of mandible, pterygomandibular raphe, lower contralateral premolars
Lip/chin - numb, rubbery, swollen/fat
Types of LA (4), working times for infiltration, block and soft tissue (4), maximum safe dose per kg (4), mg/cartridge (4) and maximum safe number of cartridges per 70kg adult (4)
2% lidocaine HCl amide with 1:80,000 adrenaline - 60mins, 90mins, 3-5hrs. 4.4mg/kg, 44mg/cartridge, 7 cartridges/70kg adult
3% prilocaine/citanest HCl amide with 1.2ug felypressin/octapressin - 30-45mins, 60mins, 3-6hrs. 8mg/kg, 66mg/cartridge, 8 cartridges/70kg adult
4% articaine HCl amide with 1:100,000 adrenaline - up to 2hrs, 75mins, 3-5hrs. 7mg/kg, 88mg/cartridge, 5 cartridges/70kg adult
3% mepivacaine HCl amide - 20mins, 40mins, 2hrs. 3mg/kg, 66mg/cartridge, 6 cartridges/70kg adult
Systemic LA complications (6)
Types of psychogenic/stress LA complications (4)
Cause
Signs and symptoms (4)
Interaction with other drugs (5)
Allergy is usually to what
What are these allergens also commonly found in (2)
Features of toxicity (2)
Which LA should not be given to pregnant women and why (2)
Psychogenic/stress, interactions with other drugs, cross infection, allergy, collapse, toxicity
Fainting, palpitations, cold sweat, restlessness
Due to lack of oxygenated blood to the brain
Lightheadedness, pallor, bradycardia, nausea
MAOIs, tri-cyclics, B-blockers, cocaine, non-K sparing diuretics
Preservatives
Antiseptics, blueberries (methyl parabéns)
Convulsions, loss of consciousness
Prilocaine/citanest - octapressin/felypressin can induce labour
Systemic effects of adrenaline (3)
Adrenaline should be avoid when (3)
Caution should be taken with adrenaline when (2)
Cause of facial palsy
Diagnosis
Management (2)
Increase HR, relax smooth muscle, skin contraction
Heartblock with no pacemaker, hypotension, impaired liver function
Diuretics, B-blockers
LA into parotid gland
CNVII test
Reassurance, cover eye with patch until blink reflex returns
Early local complications (3)
Late local complications (3)
Intra-vascular injections (2) and effects (3) of each
Pain, failure to achieve anaesthetic, blanching
Trismus, prolonged LA, oral ulceration
Intra-arterial - blanching, visual and aural disturbances
Intra-venous - palpitations, restelessness, headache
Types of surface anaesthesia (2)
Types of topical LA (4)
When is topical LA used (2)
Advantages (2) and disadvantages (2) of jet injector
Types of non-pharmacological pain management/anaesthetic (2)
Features of LA wand (3)
Topical LA, refrigeration LA
Intra-oral topical agents, skin topical agents (EMLA cream, ametop gel), controlled-release devices (patch), jet injectors
Pre-injection, rubber dam clamp (2-3mm anaesthesia depth)
Up to 10mm depth - bleeding diatheses, where deep injection is contraindicated. Soft tissue damage can occur if used incorrectly, frightening site/sound
TENS (Transcutaneous Electrical Nerve Stimulation - pain GCT), hypnosis (LA adjunct, can lower HR)
Computerised flow of LA, constant but reduced pressure (265psi vs 600psi) - reduces pain sensation (often for intraligamentary)
Paediatric injection behaviour management (4)
Differences between regional block in kids and adults (2)
Positive reinforcement, acclimatisation, desensitisation, distraction
For kids - aim into mandibular foramen - lower in children (below occlusal plane)
Method for achieving palatal anaesthesia
Advantage of intraligamentary LA
Advantage of intraosseous LA
Features of Gow Gates technique (3)
Features of Vazirani-Akinosi technique (3)
‘Chasing’ anaesthesia
Into PDL - quicker diffusion, quicker effect
Directly into bone - even quicker diffusion, quicker effect
Patient flat, open mouth, aim at neck of condylar process (higher than usual)
Closed mouth, useful for trismus - needle in buccally (needle in same side as injection site)
