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SP18: Local Anesthesia > Final > Flashcards

Final Flashcards

1
Q

T/F: A second cartridge for an IAN/lingual and buccal injections is useful.

A

False

Reinjection after 5 minutes is useful

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2
Q

What are some secondary techniques to numbing the anterior mandible?

A
  1. Anterior infiltration
  2. Mental block
  3. PDL injection
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3
Q

T/F: Each cartridge contains 1.7 ml of solution.

A

True

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4
Q

T/F: Each 1% of LA is 10mg/ml.

A

True

1.7 ml solution of 2% lidocaine = 34 mg/cartridge

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5
Q

T/F: A 1:100,000 solution contains 0.01 mg/ml.

A

True

1.7 ml of 1:100,000 epi solution = .017mg of epinephrine

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6
Q

What is the adult and pediatric maximum dose of mepivacaine?

A

Adult - 400 mg

Child - 6.6 mg/kg

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7
Q

What is the adult and child max dose of 2% lidocaine (1:100,000)?

A

Adult - 500mg

Child - 7mg/kg

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8
Q

T/F: The maximum doses of articaine and lidocaine are the same.

A

True

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9
Q

What is different about most articaine local anesthetics vs lidocaine?

A

Lidocaine is a 2% solution while articaine is a 4% solution

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10
Q

T/F: Mepivacaine has a short acting time.

A

True

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11
Q

Which local anesthesia has the longer acting time?

A

0.5% Bupivacaine (1:200,000)

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12
Q

What is the adult and child maximum dose of bupivacaine?

A

Adult - 90mg

Child - 2mg/kg

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13
Q

How many cartridges of 2% lidocaine would it be safe to give an adult?

A

14 cartridges

2% solution = 20mg/ml
20mg/ml x 1.7ml/cartridge = 34 mg/cartridge

500 mg/34mg = 14 cartridges

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14
Q

What is the suggested maximum dose of epinephrine for a healthy adult? One with severe hypertension/cardiac disease?

A
  1. 2 mg - healthy

0. 04mg - unhealthy

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15
Q

What is the safe dose of epinephrine for a healthy 70 kg adult patient with 1:100,000 epinephrine solution?

A

11 cartridges

Maximum = 0.2mg = 20 ml in 1:100,000 solution

20ml/1.7ml cartridge = 11 cartridges

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16
Q

How many ml of a 1:100,000 epinephrine can an unhealthy adult have?

A

4ml = 2 cartridges

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17
Q

T/F: Articaine is safe to use for a mandibular block.

A

False

Possible for mandibular infiltration

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18
Q

What are three methods of intra-Osseous anesthesia?

A
  1. Periodontal ligament injection
  2. Intra-septal injection
  3. Intra-Osseous injection
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19
Q

Interligamentary injection is another term for _________.

A

PDL injection

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20
Q

What area is anesthetized during a PDL injection?

A

Bone, soft tissue, apical and pulpal tissues

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21
Q

T/F: A PDL injection should be given with the long axis of the tooth, with the bevel on the root.

A

True

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22
Q

What are two signs that you are in the right spot for a PDL injection?

A
  1. Resistance to deposition

2. Ischemia (blanching) of tissue

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23
Q

How much LA is deposited for a PDL injection?

A

0.2 ml (one stopper length) in 20 seconds

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24
Q

What are two contraindications for a PDL injections?

A
  1. Infection/inflammation at site

2. Presence of primary teeth

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25
Q

T/F: The PDL injection is used when you only have a partially successful IAN.

A

True

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26
Q

What can happen from excessive pressure on the cartridge?

A

Break the glass

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27
Q

Where is the target area for an intra-septal injection?

A

Center of interdental papilla equidistant from adjacent teeth

28
Q

What angle to you hold the needle at for an intra-septal injection?

A

45 degrees to long axis of tooth

90 degrees to the tissue

29
Q

How much anesthetic is given for an intra-septal injection?

A

0.2-0.4 ml

30
Q

T/F: Intra-Osseous injections are given into the inter proximal bone between two teeth.

31
Q

How long does it take for pulpal anesthesia to take place with intra-Osseous injections?

A

15-30 minutes

32
Q

T/F: Intra-Osseous injections involve drilling a whole into the bone.

33
Q

T/F: Palpitations are a more likely side effect of intra-Osseous injections.

34
Q

What teeth are indicated for an intra-pulpal injection?

A

Teeth ready for RCT

35
Q

T/F: Intra-pulpal injection technique uses pressure as part of the anesthesia technique.

36
Q

Articaine contains a _________ instead of a benzene ring like other amide LAs?

A

Thiophene ring

37
Q

T/F: Articaine contains an extra ester linkage.

38
Q

What is a downside about using a 4% solution instead of a 2% solution?

A

Higher chance of parasthesia

39
Q

T/F: Soft tissue testing is a good indicator of pulpal anesthesia.

A

False

Electric pulp test or Endo-Ice (cold refrigerant)

40
Q

Electronic pulp testing readings less than _______ resulted in pain during restorative procedures.

A

80

Reading must be 80 or above to indicate pulpal anesthesia

41
Q

T/F: Lip numbness is indicative of pulpal anesthesia.

42
Q

What is articaine useful for in anesthesia?

A

Mandibular infiltration

43
Q

T/F: There does seem to be more complications (parasthesia) with articaine.

44
Q

T/F: The Gow-Gates and Vazirani-Akinosi is superior to IA block.

45
Q

T/F: Two cartridges in an IA block are preferred due to better pulpal anesthesia.

A

False

Better soft tissue, no effect on pulp

46
Q

What is the effect of buffering anesthetic solutions?

A

Faster onset and less pain on injection - but probably not

47
Q

T/F: Injecting more slowly results in better anesthetic results.

48
Q

T/F: If a patient has profound lip numbness, but no pulpal anesthesia, you should repeat the block.

A

False

Move on to supplemental techniques

49
Q

Which injections are most vulnerable to needle breaking?

A

IA block and PSA

50
Q

How do you prevent needle breakage?

A

Don’t use short or 30 gauge needles, do not bend needle

51
Q

What should you do if there is a needle breakage?

A

Refer to OMFS

52
Q

What are the top 3 causes of parasthesia?

A
  1. Direct nerve injury
  2. Contaminated LA
  3. LA itself (articaine)
53
Q

How do you manage a patient with parasthesia?

A

Record the incident and watch for 2-3 weeks, if no improvement refer to OMFS

54
Q

How do you avoid facial nerve paralysis when giving IA block?

A

Ensure bone contact on medial side of ramus

55
Q

Multiple injections to the muscles can cause _________.

56
Q

If the patient has trismus for over 48 hours what should be suspected?

57
Q

T/F: Infection from local anesthesia is extremely rare.

58
Q

T/F: Local anesthetics exert a single action and are non-toxic.

A

False

No drug has these qualities

59
Q

What is biotransformation?

A

Esters hydrolyzed by pseudocholinesterase into PABA in plasma/liver

Amides bio-transformed by liver enzymes

60
Q

Which injection gives the highest percentage of positive aspirates?

A

IA block (12%)

61
Q

What are some signs of a LA overdose?

A

Talkativeness, slurred speech, metallic taste, twitching

62
Q

What is the first sign of moderate to high LA overdose?

A

Tonic-clonic seizure activity

63
Q

What is always the first step when an LA overdose is recognized?

A

Stop treatment

64
Q

T/F: O2 should be administered if a patient is suspected to have an LA overdose.

65
Q

T/F: Benadryl can be prescribed for a patient who has a skin reaction to LA.

66
Q

T/F: Epinephrine can be administered for a bronchial constriction or laryngeal edema reaction.

SP18: Local Anesthesia (2 decks)

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