Chapter 4 Flashcards
What are the 5 local anesthetics available in North America?
Articaine, Bupivacaine, Lidocaine, Mepivacaine, and Prilocaine
Are the local anesthetics we use esters or amides?
Amides
Define relative contraindications for local anesthetics
If someone has one of the following you can still use LA, just use less of it and use extra caution
Significant liver dysfunction, renal dysfunction, and cardiovascular disease
Is someone is ASA III or IV what don’t we use?
Racemic Epinephrine gingival retraction cords
What is an absolute contraindication for local anesthetics?
An true documented, reproducible allergy
If someone is allergic to bisulfite what do you do?
Don’t use local anesthetic with a vasoconstrictor
If the patient in your chair is allergic to red wine or packaged sliced fruit what local anesthetic should you use?
Anything thing that is plain (without a vasoconstrictor), usually 3% Mepivicaine or 4% Prilocaine
Duration of an injection is influenced by what?
Individual response, type of injection, accuracy of administration, status of oral tissue, and anatomical variation
In an individual response what do we base the numbers off of?
Bell curve
In the bell curve there are 3 types of responses, what are they?
Normo-responders: stay numb the appropriate amount of time
Hyper-responders: stay numb longer than normal
Hypo-responders: don’t stay numb as long as expected because the body metabolizes it too quickly
What the 2 types of injections we will be giving?
Nerve block & infiltraions
Which injection type has the longer duration?
Nerve block
If you use less volume of local anesthetic you ________ duration
Decrease
The percentage listed on a carpule of local anesthetic indicates what?
The amount of local anesthetic in mg per ml of anesthetic solution (CONCENTRATION)
List the concentrations for the following local anesthetics
4% Articaine .5% Bupivacaine 2% Lidocaine 2% Mepivicaine 3% Mepicivaine 4% Prilocaine
4% Articaine ---> 40 mg/ml .5% Bupivacaine ---> 5 mg/ml 2% Lidocaine ---> 20 mg/ml 2% Mepivicaine ---> 20 mg/ml 3% Mepicivaine ---> 30 mg/ml 4% Prilocaine ---> 40 mg/ml
There are _______ per carp of local anesthetic
1.8 ml
How do you determine how much of the drug you’re giving per carp of local anesthetic?
Determine concentration of the drug X 1.8 ml X number of carps given = Amount of drug given
Determine the concentration of the local anesthetic agent in 2% solution of Lidocaine?
2% Lidocaine = 20 mg/ml
If 2 cartridges of 2% Lidocaine are administered to your patient, what quantity of Lidocaine was given?
- Find concentration
2% —> 20 mg/ml - Multiply by 1.8 ml to find amount for carp
20 mg/ml X 1.8 ml = 36 mg of Lidocaine per carp - Multiply amount per carp by the number of carps used
36 mg X 2 carps = 72 mg of Lidocaine
ANSWER = 72 mg
If 2 cartridges of 3% Mepivicaine plain are administered to your patient, what quantity of Mepivicaine was given?
3% —> 30 mg/ml
30 mg/ml X 1.8 ml = 54 mg per carp
54 mg X 2 carps = 108 mg of Mepivicaine
ANSWER = 108 mg
What are the maximum recommended doses (MRD) per lb for the 5 local anesthetics used in North America?
Articaine = 3.2 mg/lb Bupivacaine = .9 mg/lb Lidocaine = 3.2 mg/lb Mepivacaine = 3.0 mg/lb Prilocaine = 4.0 mg/lb
What are the absolute MRD for the 5 local anesthetics used in North America?
Articaine = n/a Bupivacaine = 90 mg Lidocaine = 500 mg Mepivacaine = 400 mg Prilocaine = 600 mg
Calculate MRD in milligrams for 120 lb healthy adult or 3% Mepivacaine
- What is the MRD per lb for Mepivacaine
3. 0 - Multiply MRD per lb by the weight of the patient
3. 0 mg/lb X 120 lbs = 360 mg
ANSWER = 360 mg
Calculate the MRD in cartridges for a 120 lb healthy patient using 3% Carbocaine
- What is the MRD per lb for Carbocaine
3.0 - Multiply MRD per lb by the weight of the patietn
3.0 X 120 = 360 mg - Take the amount of local anesthetic per mg and divide it by the concentration of local anesthetic per carp
360 mg / (30X1.8) = 6.6 carps
ANSWER = 6.6 carps
