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Endo > Anesthetic > Flashcards

Anesthetic Flashcards

1
Q

MARTIN & RAMSAY 1994

anesthetic

A

Patients who believe they are receiving 20% topical benzocaine gel anticipate significantly less pain during dental injection

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2
Q

Who said Patients who believe they are receiving 20% topical benzocaine gel anticipate significantly less pain during dental injection

A

Martin and Ramsay 1994

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3
Q

MCLEAN & READER 1993

different types of anesthetic in asymptomatic teeth

A

No significant difference in asymptomatic teeth between 4% prilocaine, 3% mepivicaine and 2% lidocaine (with 1:100K epi) in onset, success and failure of IAN blocks. Three solutions are equivalent for IAN block of 50 minutes.

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4
Q

Who said No significant difference in asymptomatic teeth between 4% prilocaine, 3% mepivicaine and 2% lidocaine (with 1:100K epi) in onset, success and failure of IAN blocks

A

McLean and REader 1993

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5
Q

AGGARWAL 2012

for IAN blocks

A

For irreversible pulpitis, IAN blocks using lido with 1:200K epi have a higher success rate with 3.6 mL (54%) compared to 1.8 mL (26%)

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6
Q

Who said For irreversible pulpitis, IAN blocks using lido with 1:200K epi have a higher success rate with 3.6 mL (54%) compared to 1.8 mL (26%)

A

Aggarwal 2012

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7
Q

HAASE & READER 2008

efficacy of supplemental infiltration

A

in ASYMPTOMATIC teeth, Following 4% septocaine block, buccal infiltration is more successful with 4% septocaine (88%) than with 2% lidocaine (71%) for mandibular first molars.

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8
Q

Who said : Following 4% septocaine block, buccal infiltration is more successful with 4% septocaine (88%) than with 2% lidocaine (71%) for mandibular first molars.

A

Haase and Reader 2008

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9
Q

Which article to use to support supplemental infiltration for irreversible pulpitis? for asymptomatic teeth?

A

irreversible pulpitis? Aggarwal 2009 (B and L), Matthews (B) 58%
Asymptomatic teeth? Haase and Reader 2008

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10
Q

Who said that following a 2% lido with 1:200K epi IAN block, a buccal and lingual infiltration of 2% lidocaine or 4% articaine increases anesthetic efficacy in irreversible pulpitis from 33 to 47 to 67%?

A

Aggarwal 2009

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11
Q

Aggarwal 2009

efficacy of supplemental infiltration?

A

in IRREVERSIBLE pulpitis, following a 2% lido with 1:200K epi IAN block, a buccal and lingual infiltration of 2% lidocaine or 4% articaine increases anesthetic efficacy from 33 to 47 to 67%

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12
Q

Who said that in irreversible pulpits, NSD in anesthetic success of PSA, buccal infiltration and buccal plus palatal infiltration using lido w/ 1:200K epi?

A

Aggarwal 2011

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13
Q

Aggarwal 2011

best method for max posterior injections?

A

in irreversible pulpits, NSD in anesthetic success of PSA, buccal infiltration and buccal plus palatal infiltration using lido w/ 1:200K epi

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14
Q

Who said pre-op admin of NSAIDs has no effect on efficacy of lido IAN block in irreversible pulpiits?
NSAID plus APAP -NSD?

A

Aggarwal 2010

Simpson 2011

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15
Q

Who said a labial and lingual infiltration with 4% septo w/ 1:100K epi is more effective than just a labial infiltration (in asymptomatic teeth)?

A

Nuzum 2010

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16
Q

Nuzum 2010

best for mandibular incisors?

A

a labial and lingual infiltration with 4% septo w/ 1:100K epi is more effective than just a labial infiltration (in asymptomatic teeth) 76 to 98%

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17
Q

Mason 2009

1:50K epi

A

Increasing epinephrine from 1:100k to 1:50k decreased pulpal anesthesia of short duration for the lateral incisor but not the molar (asymptomatic)

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18
Q

Who said: Increasing epinephrine from 1:100k to 1:50k decreased pulpal anesthesia of short duration for the lateral incisor but not the molar (asymptomatic)

A

Mason 2009

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19
Q

Who said that the use of topical anesthetic reduces pain of needle insertion for maxillary anteriors but not maxillary posteriors or IAN block?

A

Nusstein 2003

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20
Q

Nusstein 2003

topical

A

the use of topical anesthetic reduces pain of needle insertion for maxillary anteriors but not maxillary posteriors or IAN block?

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21
Q

Who said that 3.6 mL of lidocaine 1:100K provides a statistically longer duration of pulpal anesthesia than 1.8 mL for maxillary infiltrations? (asymptomatic)

A

Mikesell 2008

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22
Q

Mikesell 2008

Is more lido better for max?

A

3.6 mL of lidocaine 1:100K provides a statistically longer duration of pulpal anesthesia than 1.8 mL for maxillary infiltrations? (asymptomatic)
(But doesn’t affect onset or success97-100%)

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23
Q

Who said depositing 3.6 mL lidocaine is not significantly more painful than depositing 1.8 mL?

A

Mikesell 2008

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24
Q

Who said 3.6mL of lidocaine decreases non-continuous anesthesia compared to 1.8mL for max first molar (asymptomatic)?

A

Mikesell 2008

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25
Q

Who said pulpal anesthesia with lidocaine does not last as long in maxillary anteriors as maxillary posteriors?

A

Mikesell 2008

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26
Q

Evans 2008

is septo better?

A

asymptomatic: 4% articaine improved anesthetic success compared to 2% lidocaine for lateral incisors (88% v. 62%), but not for first molars (78% v. 73%)

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27
Q

who said in asymptomatic teeth : 4% articaine improved anesthetic success compared to 2% lidocaine for lateral incisors (88% v. 62%), but not for max first molars (78% v. 73%)

A

Evan 2008

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28
Q

Who said: IAN block is similar to the Gow-Gates and Vazirani-Akinosi techniques regarding anesthetic success of ant and post mandibular teeth, but has a faster onset of pulpal anesthesia (asymptomatic)

A

Goldberg 2008

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29
Q

Goldberg 2008

best technique for mandibular injections?

A

IAN block is similar to the Gow-Gates and Vazirani-Akinosi techniques regarding anesthetic success but has a faster onset of pulpal anesthesia (asymptomatic)

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30
Q

Who said: in mand post teeth with irreversible pulpits, a supplemental infiltration with 4% septocaine with 1:100K (after lido IAN block) is successful only 58% of the time

A

Matthews 2009

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31
Q

Matthews 2009

supplemental buccal infiltration?

A

In mand post teeth with irreversible pulpits, a supplemental infiltration with 4% septocaine with 1:100K (after lido IAN block) is successful only 58% of the time

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32
Q

who said For mandibular posterior teeth with irreversible pulpitis, a supplemental intraosseous injection of 3% mepivacaine increased anesthetic success from 25% to 80%. A second intraosseous injection, when necessary, further improved success to 98%.

A

Reisman 1997

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33
Q

Reisman 1997

Does intraosseous work?

A

For mandibular posterior teeth with irreversible pulpitis, a supplemental intraosseous injection of 3% mepivacaine increased anesthetic success from 25% to 80%. A second intraosseous injection, when necessary, further improved success to 98%.

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34
Q

Who said no difference in intrapulpal anesthesia using sterile saline or 2% lidocaine with1:50 or 1:100K (works because of pressure)

A

Birchfield 1975

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35
Q

who found: patients who receive an IO injection of the 2% lidocaine-epinephrine solution experience a transient increase in heart rate. No significant increase in heart rate was seen with the i.o. injection of 3 percent mepivacaine

A

Replogle 1999

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36
Q

Replogle 1999

intraosseous

A

patients who receive an IO injection of the 2% lidocaine-epinephrine solution experience a transient increase in heart rate. No significant increase in heart rate was seen with the i.o. injection of 3 percent mepivacaine

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37
Q

How much lidocaine is in a 2% solution?

A

20 mg/mL

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38
Q

Maximum recommended dose of septo? bupiv? lido? mepiv?

A

septo: 500 mg, bupiv: 90 mg, lido: 300 mg, mepiv: 300 mg

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39
Q

Who said patients with irreversible pulpitis who receive 0.5% bupivicaine w/1:200K epi have significantly less post op pain at 6 and 12 hours compared with patients who receive 2% lido w/ 1:80K epi?

A

Parirokh, Abbot 2012 JOE

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40
Q

Parirokh, Abbot 2012

bupivicaine?

A

patients with irreversible pulpitis who receive 0.5% bupivicaine w/1:200K epi have significantly less post op pain at 6 and 12 hours compared with patients who receive 2% lido w/ 1:80K epi

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41
Q

Basically, how do local anesthetics work?

A

They block voltage gated sodium channels, partitioning into the uncharged basic form (RN) which crosses cell membranes, and the charged acid form (RNH+) which binds to the inner pore of the sodium channel.

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42
Q

How many different voltage gated sodium channels? How do they differ(3)?

A
  1. Expression pattern, biophysical properties, and roles in mediating peripheral pain.
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43
Q

What are VGSC’s resistant to tetrodotoxin called?

Where are they found? Two facts about them?

A

TTX-R channels
Nocicepters (Wells 07)
Relatively resistant to local anesthetics(Reemers 08)
Sensitized by prostoglandins (Gold 96)

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44
Q

What happens when TTX-R VGSG are near prostaglandins?

A

Prostaglandings sensitize TTR-X channels, leading to depolarization at lower levels of stimulus strengths.

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45
Q

Two parts of a VGSC?

A

Alpha and Beta subunits. The alpha subunit is a voltage sensor that leads to channel activation and Na ion passage when the channel detects an electric field.

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46
Q

What is a second mechanism by which local anesthetics may help with odontogenic pain?

A

L.A.s modulate certain G protein-coupled receptors.

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47
Q

What are G protein-coupled receptors?

A

Major class of cell membrane receptors that many dental drugs and endogenous mediators produce their effects by activating specific ones.

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48
Q

Is bupivicaine long duration? Says who?

A

For IAN block, yes (Fernandez 05). For anterior infiltration, no (shorter duration than lido) (Gross 07)

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49
Q

Fernandez 2005

bupivicaine

A

For IAN blocks, Pulpal anesthesia averaged 4 hr for bupivacaine versus 2 hr and 24 min for lidocaine

50
Q

Gross 2007

bupivicaine

A

For maxillary infiltrations, bupivicaine has a lower success rate in the anteriors than 2% lido, and the duration for maxillary teeth is less than 60 minutes for lido and bupiv

51
Q

Reasons not to receive epinephrine in L.A. and consult physician instead:

A

unstable angina, history of MI or stroke in last 6 months, severe HTN, uncontrolled congestive heart failure, or heart transplant. (Naftalin 2002)

52
Q

Who said any of the commonalty available local anesthetics are safe for use in pregnant or lactating women?

A

Haas 2007

53
Q

Two changes in inflamed dental pulp that could make L.A. less effective?

A

More TTX-R sodium channels, more sodium channels in general (Warren 2008)

54
Q

What is oraverse?

A

Phentolamine mesylate-shortens duration of soft tissue anesthesia

55
Q

Cohen 1993

A

For irreversible pulpitis, 3% mepivacaine and 2% lidocaine with 1:100K epinephrine were equivalent for IAN blocks (success measured using DDM)

56
Q

who said For irreversible pulpitis, 3% mepivacaine and 2% lidocaine with 1:100K epinephrine were equivalent for IAN blocks (success measured using DDM)

A

Cohen 1993

57
Q

Claffey 2004

A

NSD in success rate of 4% articaine compared to 2% lidocaine for IAN blocks

58
Q

Who said NSD in success rate of 4% articaine compared to 2% lidocaine for IAN blocks

A

Claffey 2004

59
Q

who said The incisive nerve block at the mental foramen is successful for anesthetizing mandibular premolars, but not incisors?

A

Nist 1992

60
Q

Nist 1992

Incisive nerve block at mental foramen?

A

The incisive nerve block at the mental foramen is successful for anesthetizing mandibular premolars, but not incisors?

61
Q

Who said: A slow injection (60 seconds) does not increase success compared to a fast injection (15 seconds) for incisive nerve block at mental foramen

A

Whitworth 2007

62
Q

Whitworth 2007

speed of injection

A

A slow injection (60 seconds) does not increase success compared to a fast injection (15 seconds) for incisive nerve block at mental foramen but is more comfortable

63
Q

Meechan 2002

mandibular anterior anesthesia

A

A combo of labial and lingual infiltration of lidocaine significantly increases success in mandibular anterior teeth

64
Q

Who said: A combo of labial and lingual infiltration of lidocaine significantly increases success in mandibular anterior teeth

A

Meechan 2002

65
Q

who said…The mylohyoid nerve is the accessory nerve most often cited as a cause of failure of mandibular anesthesia.

A

Frommer 1970

66
Q

Fromer 1970

leading cause of failure of mandibular anesthesia?

A

Mylohyoid nerve

67
Q

who said: a slow IAN block injection (60 sec) resulted in higher success rates (using EPT) than a rapid injection (15 sec)

A

Kanaa 2006

68
Q

Kanaa 2006

A

a slow IAN block injection (60 sec) resulted in higher success rates (using EPT) than a rapid injection (15 sec)

69
Q

What best explains why IAN block failure occurs? Says who?

A

Central core theory (DeJong 1997)

70
Q

who said: The use of 3% mepivacaine as a supplemental intraosseous injection after IAN block significantly increased the success of pulpal anesthesia for 30 minutes

A

Gallatin 2000

71
Q

Gallatin 2000

intraosseous?

A

The use of 3% mepivacaine as a supplemental intraosseous injection after IAN block significantly increased the success of pulpal anesthesia for 30 minutes

72
Q

who said: For maxillary anesthesia, pulpal anesthesia usually occurs within 5 to 7 minutes, but slow onset occurs 20% of time

A

Gross 2007

73
Q

Gross 2007- how long for pulpal anesthesia to occur using lido in maxillary infiltrations?

A

5-7 minutes

74
Q

When does pulpal anesthesia start to decline in maxillary anteriors? maxillary posteriors?

A

Anteriors: 20-30 min
Posteriors: 30-45 min

75
Q

Meechan 2002

intraligamentary injection

A

Intraligamentary injection is not successful in mandibular anterior teeth

76
Q

How does the intraligamentary injection work?

A

It forces anesthetic solutions through the cribiform plate into the marrow spaces around the tooth. It is not via the PDL, and it’s not the result of pressure anesthesia. It should be considered intraosseous.

77
Q

Possible downsides to intraligamentary injections?

A

small risk of peril abscess and bone loss. localized areas of root resorption

78
Q

Two most common intraosseous systems

A

Stabident and X-tip

79
Q

Replogle 1999

A

No significant tachycardia occurs when 3% mepivacaine is used for IO anesthesia

80
Q

Which teeth are most difficult to anesthetize during irreversible pulpits?

A

mandibular molars, then mand/max premolars, then maxillary molars, then mandibular ant, then max ant.

81
Q

Can intraosseous be used for necrotic painful teeth?

Can intrapulpal?

A

Unknown.

No, it could force bacteria apically

82
Q

Why not inject into site of swelling (inject on either side instead?)

A

Very painful and not that effective.

83
Q

who said irreversible pulpitis pulpotomies restored with IRM or GI-pain present in 10% of people at 6 mos.

A

Malamed 2000

84
Q

Malamed 2000

pulpotomies?

A

irreversible pulpitis pulpotomies restored with IRM or GI-pain present in 10% of people at 6 mos.

85
Q 
Onset time for IAN in 
Mand 2nd molars?
Mand first molars?
Mand premolars?
Mand anteriors?
A

Mand 2nd molars: 6 minutes
Mand 1st molars: 10 minutes
Mand premolars: 10 minutes
Mand anteriors 19 minutes

86
Q

who said: primary intraosseous injection of 2% lidocaine with 1:100,000 epinephrine is more successful and results in a longer duration of pulpal anesthesia as compared with 3% mepivacaine in noninflamed mandibular first molars (30 min 3% mepiv, 60 min 2% lido)

A

Replogle 1997

87
Q

Replogle 1997

Duration and efficacy of intraosseous with lido v. mepiv

A

Primary intraosseous injection of 2% lidocaine with 1:100,000 epinephrine is more successful and results in a longer duration of pulpal anesthesia as compared with 3% mepivacaine in noninflamed mandibular first molars (30 min 3% mepiv, 60 min 2% lido)

88
Q

Who showed that the electric pulp tester can be a valuable tool in predicting potential anesthetic problems in operative (restorative) dentistry

A

Archer and Certosimo 1996

Also supported the central core theory–that it’s harder to get anterior teeth numb…?

89
Q

How much lidocaine and epi are in one 1.7 mL carpule of 2% lido with 1:100K epi?

A

34 mg lidocaine and .017 mg epi

90
Q

How much septocaine and epi are in one 1.7 mL carpule of 4% lido with 1:50K epi?

A

68 mg septocaine and .034 mg epi

91
Q

Percentage of nociceptive fibers in the pulp?

A 
A fibers (20%)  (90% A delta, 10% A beta)
C fibers (80%)
92
Q

what is oraverse?

A

L.A. reversal agent. Phentolamine mesylate.

93
Q

Guglielmo 2011

A

palatal injection increases pulpal anesthesia for maxillary posterior teeth

94
Q

If someone is allergic to local anesthetic, what are they probably allergic to? Says?

A

methylparaben (preservative in esther local anesthetic)

95
Q

Max dose of local anesthetic?

A

4.4 mg/kg (Malamed’s conservative dose.) True dose is 7 mg/kg.

96
Q

How to do gow gates?

A

Inject needle just inferior to ML cusp of 2nd maxillary molar, and direct towards the neck of the condyle, just under the insertion of the lateral pterygoid.

97
Q

What does the gow gates anesthetize?

A

Almost the entire mandibular division of the trigeminal nerve (IAN, lingual, mylohyoid)

98
Q

Hillerup 2011

A

Most nerve damage is caused by the percentage of L.A. (so consider not using 4% solutions for IAN blocks)

99
Q

Who said that most nerve damage is caused by the percentage of L.A. (so consider not using 4% solutions for IAN blocks)?

A

Hillerup 2011

100
Q

Three parts of a local anesthetic

A
  1. lipophilic aromatic residue, 2. hydrophilic amino group 3. intermediate hydrocarbon chain
101
Q

At rest, which ions are outside of the nerve membrane? Inside?

A

Na and Cl outside. K inside

102
Q

What is the resting potential of nerve membranes? How is it created?

A

-70 to -90 mV. The Na pump maintains the resting potential by pumping Na from inside to outside.

103
Q

What happens to the ions when a stimulus is produced?

A

Na moves in and K moves out, causing a depolarization, producing an action potential that travels down the nerve membrane.

104
Q

how do local anesthetics interfere with the ions involved in depolarization?

A

LAs competitively displace Ca from nerve membranes. Because Ca exerts a regulatory effect on the active transport of Na out, this interferes with conduction.

105
Q

Why is HCl added to anesthetics?

A

LA’s are weakly basic and poorly soluble in water. They are combined with HCl to form hydrochloride salts that are more soluble in water.

106
Q

what is pKa

A

the pH value at which there are equal parts of uncharged ion and charged cation.

107
Q

pKa of lidocaine? mepivacaine?
what is tissue pH
what happens to tissue pH during infection?

A

7.85, 7.6
7.4 (so there are more cations of L.A. in tissue).
pH 5.5–> increases cationic form to 99%

108
Q

Three reasons LA don’t work in infection

A

pH of tissues, dilution by blood or fluids, too rapid absorption into systemic circulation.

109
Q

Order of loss of function to local anesthetics (PTTPS)

A

Pain, temp, touch, proprioception, skeletal muscle tone

110
Q

metabolism of amides?

A

hydrolyzed in liver by microsomal enzymes, excreted by kidney.

111
Q

metabolism of esters?

A

hydrolyzed in plasma by pseudocholinesterase. excreted by kidney

112
Q

Three things in lidocaine besides anesthetic and epi?

A

Na metbisulfate (0.9 mg), Citric acid (preservative), Sodium chloride (preservative)

113
Q

most common cause of death with local anesthetic

A

respiratory depression

114
Q

Who showed that 4% local anesthetics are more likely to cause paresthesia?

A

Haas 1995

115
Q

What did Haas 1995 show about paresthesia?

A

4% L.A. more likely to cause paresthesia

116
Q

How does epi work to help with vasoconstriction?

A

stimulates gamma1 receptors in mucous membranes (from Haas 2002 review)

117
Q

Who described articaine, a new amide local anesthetic?

A

Malamed 2000

118
Q

Two studies that show articaine and lidocaine are equally effective for IAN blocks?

A

Claffey 2004 and Mikesell 2005

119
Q

Who looked at FDA records and found paresthesia occurs more commonly after the use of 4% L.A. solutions

A

Garisto 2010

120
Q

What did Garisto 2010 find about L.A.?

A

ooked at FDA records and found paresthesia occurs more commonly after the use of 4% L.A. solutions

121
Q

Who found that for PDL injections, injecting under back pressure produced the greatest frequency of success?

A

Smith, Walton 1983

122
Q

What did Smith, Walton 1983 say about PDL injections?

A

injecting under back pressure produced the greatest frequency of success

Endo (20 decks)

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