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LA Flashcards

1
Q

Define local anaesthesia

A

Loss of sensation in circumscribed area of the body caused by depression of excitation in nerve endings or inhibition of conduction process in peripheral nerves

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2
Q

Why must you give LA with GA

A

GA no alagesic effect, without LA, must give more GA to put patient into even deeper sedation

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3
Q

Larger needle gauge = greater or smaller diameter?

A

Smaller diameter

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4
Q

If you see blood when you aspirate, is it good technique

A

Yes, because you DID aspirate

Means that blood vessel is near target

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5
Q

What is the soft tissue target when trying to numb buccal nerve

A

Buccal soft tissue adjacent to 3rd mandibular molar just above occlusal plane

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6
Q

Relationship of lingual nerve to IDN

A

Lingual nerve is medial to IDN

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7
Q

What are the important branches of the maxillary nerve

A

Nasopalatine, greater palatine, lesser palatine nerve

Anterior, middle, posterior superior alveolar nerve

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8
Q

What do the greater palatine nerves supply

A

Mucosa of the hard palate

Palatal gingiva of maxillary alveolar process

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9
Q

What do lesser palatine nerves supply

A

Soft palate

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10
Q

What does the posterior superior alveolar nerve supply

A

Maxillary molars and buccal gingiv

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11
Q

What do anterior superior alveolar nerves supply

A

Maxillary canines and incisors

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12
Q

Anterior division of mandibular nerve is sensory or motor

A

Motor, except long buccal nerve which is sensory

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13
Q

Posterior division of mandibular nerve is sensory or motor

A

All sensory except nerve to mylohyoid

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14
Q

Articaine is an amide or ester. What is it often used for

A

Amide. Used in perio. Diffuses through bone better

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15
Q

Name 4 amide LAs

A 
Articaine
Bupivacaine
Lidocaine
Mepivacaine
Prilocaine
Etidocaine
Dibucaine
Ropivacaine
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16
Q

Name examples of esters

A

Benzocaine, procaine

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17
Q

What is the mode of action of LA

A

Bind to specific sites of channel protein, stabilise inactivated conformation of sodium channel

Block influx of sodium ions into neuron, reduce depolarisation, block conduction of impulses

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18
Q

3 functions of vasoconstrictors

A

Increase length and depth of action

Reduce toxicity (because delay absorption into blood stream)

Haemostatic effect

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19
Q

Contraindications for use of LA with adrenaline

A

Unstable angina

Recent myocardial infarction

Recent coronary artery bypass surgery

Untreated/uncontrolled severe hypertension

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20
Q

Orange LA carpule has or does not have vasoconstrictor

A

Has vasoconstrictor

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21
Q

What colour LA carpule to be used in pregnant patients

A

Green ie no vasoconstrictor

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22
Q

Maximum dose of adrenaline for healthy patient and for patient with significant cardiovascular history

A

Healthy patient: 0.2mg

Cardiovascular: 0.04mg

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23
Q

How many carpules of 2 lidocaine with 1:100 000 epi maximum for patient with significant cardiovascular history?

A

1 carpule = 1.8cc
1:100 000 = 1mg/100ml
1 carpule contains 1.8 x 0.01 = 0.018mg epinephrine
0.04÷0.018=2.22

24
Q

What is the maximum dose of LA that can be given

25
Maximum number of carpules that can be given to a 23kg patient with significant cardiovascular history. Carpule contains 2% lidocaine with 1:250 000 epinephrine
2% = 2g/dL = 20mg/ml 1.8x20=36mg Max dose of lidocaine 7mg/kg. 7x23÷36=4.47 1:250 000= 1mg/250ml = 0.004mg/ml Each carpule 1.8cc 0.04 ÷ (0.004x1.8) = 5.55 Max 4.4 carpules
26
Maximum dose of lidocaine with vasoconstrictor
7mg/kg, max 500mg
27
Max dose of lidocaine without vasoconstrictor
4.4mg/kg
28
Maximum dose of mepivacaine
6.6mg/kg max 400mg
29
Maximum dose of bupivacaine
1..3mg/kg max 90mg
30
Why is it very important to aspirate bupivacaine
It is the most cardiotoxic
31
What is the diameter of the short needle
30 gauge
32
EMLA cream formed from 2.5% lidocaine and 2.5% prilocaine penetrates skin at what speed
5mm in one hour
33
Where is local infiltration for tooth deposited
Near or at the apex of the tooth. Diffuse through bone to affect periapical nerves and nerves supplying PDL, adjacent bone, soft tissue
34
Root length is usually ___ crown height
Twice
35
Tissue should be ___ when administering LA infiltration
Taut
36
Palatal LA infiltration give about __cm away from the tooth, ___ to bone
1cm from the tooth | Perpendicular to bone
37
In IDN block, what is needle tip aiming for
Just above the mandibular foramen just behind the lingula, where IDN inserts into mandibular canal
38
Why is lingual nerve anaesthesised during IDN block
Lingual nerve is just anterior and medial to IDN
39
In IDN block, the needle is inserted into
Pterygotemporal depression a the height of greatest depth of coronoid notch
40
Pterygomandibular raphe is lateral or medial to pterygotemporal depression
Medial
41
How deep does needle for IDN go
20-25mm
42
What needle should be used for IDN block
25 gauge long needle
43
Barrel of syringe rests on ____ during IDN block
Contralateral premolar
44
How to give buccal nerve block
Injection given immediately after idn block, insert at mucobuccal fold distal to last molar
45
What does Gow gates mand block anaesthetise
``` Pulpal anaesthesia Buccal soft tissue and bone Anterior 2/3 of tongue Floor of mouth Periosteum Lingual soft tissue ```
46
What does vazirani akinosi mandibular nerve block block (closed mouth)
``` Pulpal anaesthesia Buccal soft tissue Bone anterior to mental foramen ie 2nd premolar onwards Anterior 2/3 of tongue Floor of mouth Lingual soft tissues ```
47
How is gow gates block administered
Needle tip just below mesiolingual cusp of maxillary 2nd molar, just distal to the 2nd molar
48
How is closed mouth technique administered
Lingual aspect of ramus adjacent to mucogingival junction of last maxillary molar
49
What does incisive nerve block anaesthetise
In the quadrant: 2PM, canine, 2 incisors Buccal soft tissue Bone anterior to mental foramen Skin of lower lip and Chin
50
What needle to use for incisive nerve block
27 gauge short
51
Relationship of long buccal nerve to last molar
Lateral and behind
52
How long is the long needle
41mm
53
Relationship of the buccinator to the raphe
Buccinator is lateral to the raphe
54
Is the needle beveled
No
55
Greater palatine block will anaesthetise
Only the upper mucosa
56
What do you anaesthetise for maxillary molar
Posterior superior alveolar | Greater palatine?
57
What do you anaesthetise for mandibular molar
Inferior alveolar nerve Lingual nerve Long buccal nerve

Oms (24 decks)

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