fundamentals of local anesthesia

Question 1

needles

Answer 1

1) blue 20 mm
- short is 20-25 mm
- infiltrations and localized
- palatal
2) yellow 32 mm
long is 29-42 mm
- mandibular blocks

Question 2

if you touch bone

Answer 2

1) probably switch the needle because it can be blunted

Question 3

comparing needles

Answer 3

1) smaller gauges are wider and shorter
2) deflects less
3) best aspiration

red 25 mm => yellow 27 mm => blue 30 mm

Question 4

communicate

Answer 4

1) we give injections / anesthesia
2) we don’t give shots
3) small pinch
- but not painful. brutal, hurts really bad

Question 5

non verbal communication

Answer 5

1) placement of syringe prior to injection
2) palpating landmarks prior to placing topical
3) background preparation noise

Question 6

comfort for the operator

Answer 6

1) watch ergonomics and fulcrum
2) no inappropriate elbow
3) fingerless retraction
4) best to use protective goggles
5) if using loupes do not look through magnification

Question 7

applying topical

Answer 7

1) benzocaine
2) no massage bc it will cause salivation

Question 8

painelss injections

Answer 8

1) make sure tissue is TAUT
2) establish finger rest, fulcrum
3) once through penetration site, get to deposition site and slowly inject
- 0.45 ml per 15 seconds
4) do not insert to the full length of the hub
5) strongly consider use of instrument retraction technique

Question 9

during injection

Answer 9

1) watch for non verbal cues from patient

Question 10

time to breathe

Answer 10

1) slowly remove the needle using same route as entering
2) may notice slight bleeding
3) tissue may appear a little swollen
4) onset of injection is 3-5 mins or 5-10 for block

Question 11

confirm anesthesia

Answer 11

1) EPT
2) ice test with endo ice

Question 12

before procedure

Answer 12

1) ask patient if they feel numb or have sensation on their lip or tongue
2) subjective tingling sensation to midline does not indicate profound anesthesia

Question 13

clean up

Answer 13

1) disassemble capped needle and cartridge needle and cartridge from syringe
2) sharps container

Question 14

document

Answer 14

1) if its not written in the note, it did not happen
2) type of anesthetic, amount, vasoconstrictor?, etc

Question 15

anesthetics

Answer 15

1.8 mL
1) plain with vasoconstrictor
- amides, lipid soluble
- lidocaine HCl, etc.
- epinephrine, norepinephrine, levonordefrine
- FDA recommended max dosages

Question 16

know the chart of different anesthetics and max doses

Answer 16

:(
everything is weight based dosing