Articaine Flashcards
Articaine was originally synthesised as …
carticaine
In what form is articaine available in?
4% solution
containing 1:100 000 or 1:120 000 adrenaline
What characteristic of articaine is responsible for its increased lipid solubility and thus increased potency?
contains a thiophene ring as opposed to a benzene ring
Briefly outline how articaine is inactivated
- articaine is an amide LA with an ester sidechain hence it can be inactivated by serum esterases; 90% of articaine is hydrolysed
- the amide linkaage undergoes liver transformation
How is articaine excreted?
- articaine following hydrolysis produces inactive articainic acid
- it is then excreted via the liver as articainic acid glucoronide
What is the elimination serum half life of articaine?
20 minutes
What is the elimination serum half-life of articainic acid?
64 minutes
Suggest the reason why articaine is permitted to be used in higher concentrations compared to other amide LAs
- equal analgesic efficacy
- lower systemic toxicity (a wide therapeutic range)
Suggest a reason for increased duration of activity of articaine
high degree of protein binding
There is no correlation between the serum concentration and the local anaesthetic effect of articaine. True or false
True
What is anaesthetic success of sound teeth defined as?
(in healthy volunteers) it is defined as the ability to achieve 2 or more consecutive EPT readings of 80
EPT- electric pulp testing
What supplemental injection increases the success rate of an IANB for articaine when compared to lidocaine ?
a supplemental buccal infiltration
(specifically adjacent to the mandibular 1st molar)
With regards to maxillary extractions, what type of LA may be forgone?
palatal infiltrations
Following a meta-analysis, what LA is most likely to achieve anaesthetic succes in the first molar region? What are the issues with this meta-analysis ?
articaine
(over lidocaine)
However, the meta-analysis did not take into account
* local inflammation
* varying LA administration techniques e.g. IANB
Why are teeth with irreversible pulpitis more difficult to anaesthetise?
- this is because nerves arising from inflammed tissue have altered resting potentials and decreased excitability thresholds
What does VAS refer to?
Visual Analogue scale
Articaine has not been shown to be superior to lidocaine or mepivacaine in achieving adequate pain control during endodontic treatment in mandibular teeth with irreversible pulpitis when IANB or Gow-Gates Block is delivered. True or false
True
VAB refers to …
Vazirani Akinosi Block
What common adverse articaine reactions have been reported in children?
- soft tissue injury
- prolonged numbness particularly in those <7
What is the age restriction of articaine (imposed by manufacturer)?
does not recommend articaine use for children under 4 years old
What does the current literature for articaine use on children conclude?
that it is safe and effective for clinical procedures in children of all ages
Outline some adverse effect of local anaesthetics
- dizziness
- disorientation
- tremors
- convulsions
- seizures
- hypotension
- cardiac and respiratory depression
Outline adverse reactions to articaine that have been reported
- hypersensitivity
- opthalmologic complications
- ischaemic skin necrosis
- fever
- chills
- arthralgia
It has been suggested by some restrospective reports that articaine is most commonly associated with …
parasthesia
Outline the proposed theories regarding the susceptibility of the lingual nerve to damage
- direct needle trauma
- intraneural haematoma formation
- local anaesthetic toxicity
- fascicular pattern
As of 2011 there is more than one RCT comparing articaine with other LAs reporting adverse effects. True or false
false
as of 2011 there is only one such RCT
There is no conclusive evidence demonstrating neurotoxicity or significantly superior anaesthetic properties of articaine for dental procedures.True or false
True
At this time, the decision to use articaine cannot be based on evidence of superiority over other LA drugs. What will the decision to usea articaine depend on ?
- personal preference
- experience of individual clinicians
