calculating local anesthesia

Question 1

recommended max doses

Answer 1

1) only for healthy ASA1 individuals about 150 lbs
2) for children and older adults, need to adjust dosages

Question 2

which drugs are most commonly given to patients by dentists

Answer 2

1) local anesthetics
- 2% lidocaine 1:100k epi

Question 3

kg to lbs

Answer 3

1) 2.2 to 1
2) lbs to kg
- divide by 2
- subtract 10% from that amount

Question 4

epinephrine nomenclature

Answer 4

1) 1:100k
- 1 gram into 100,000 mL of diluent
- 1 mg / 100 mL
- 10 micrograms / mL

Question 5

percent solution

Answer 5

1) % solution x10 = #mg/ml x ml delivered = mg dose

Question 6

local anesthetic systemic toxicity

Answer 6

1 )very young, large, or old patients

Question 7

obese patient

Answer 7

1) for very obese, you need to base it on LEAN, not the actual body weight
2) 297 lbs = 130 lbs = 59 kg
max dose is 7 mg/kg for 2% lido

Question 8

modifications to dose

Answer 8

1) reduce for patients at risk for rapid uptake of LA
- pregnancy, uremia
2) low levels of alpha 1 acid glycoprotein
- neonates, pregnancy
3) patients with neural sensitivity
- pregnancy, older
4) risk for reduced clearance
- cardiac, renal, hepatic disease

Question 9

best practices for LA

Answer 9

1) use lean body weight
2) know the max dose
3) 2% lido 7 mg/kg for adults, 4.4 mg/kg for kids
4 )if you use more than one type, they become additive
5) caution in cardiovascular co-morbid patients

Question 10

how to manage LA toxicity

Answer 10

1) seizures, altered mental status, tinnitus, metallic taste, CV collapse, hypotension, arrhythmia, bradycardia
2) check pulse, check for poor perfusion, start CPR for pulse <60
3) if seizure, call 911
- antidote is not common in dental settings
- IV lipid emulsion bolus
- give low dose epinephrine and AVOID LIDOCAINE!!!!
4) if not, look for LA toxicity and anticipate seizure activity
- still call 911