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Oms > LA > Flashcards

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

A

7mg/kg

25
Q

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

A

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
Q

Maximum dose of lidocaine with vasoconstrictor

A

7mg/kg, max 500mg

27
Q

Max dose of lidocaine without vasoconstrictor

A

4.4mg/kg

28
Q

Maximum dose of mepivacaine

A

6.6mg/kg max 400mg

29
Q

Maximum dose of bupivacaine

A

1..3mg/kg max 90mg

30
Q

Why is it very important to aspirate bupivacaine

A

It is the most cardiotoxic

31
Q

What is the diameter of the short needle

A

30 gauge

32
Q

EMLA cream formed from 2.5% lidocaine and 2.5% prilocaine penetrates skin at what speed

A

5mm in one hour

33
Q

Where is local infiltration for tooth deposited

A

Near or at the apex of the tooth. Diffuse through bone to affect periapical nerves and nerves supplying PDL, adjacent bone, soft tissue

34
Q

Root length is usually ___ crown height

A

Twice

35
Q

Tissue should be ___ when administering LA infiltration

A

Taut

36
Q

Palatal LA infiltration give about __cm away from the tooth, ___ to bone

A

1cm from the tooth

Perpendicular to bone

37
Q

In IDN block, what is needle tip aiming for

A

Just above the mandibular foramen just behind the lingula, where IDN inserts into mandibular canal

38
Q

Why is lingual nerve anaesthesised during IDN block

A

Lingual nerve is just anterior and medial to IDN

39
Q

In IDN block, the needle is inserted into

A

Pterygotemporal depression a the height of greatest depth of coronoid notch

40
Q

Pterygomandibular raphe is lateral or medial to pterygotemporal depression

A

Medial

41
Q

How deep does needle for IDN go

A

20-25mm

42
Q

What needle should be used for IDN block

A

25 gauge long needle

43
Q

Barrel of syringe rests on ____ during IDN block

A

Contralateral premolar

44
Q

How to give buccal nerve block

A

Injection given immediately after idn block, insert at mucobuccal fold distal to last molar

45
Q

What does Gow gates mand block anaesthetise

A 
Pulpal anaesthesia 
Buccal soft tissue and bone 
Anterior 2/3 of tongue
Floor of mouth
Periosteum 
Lingual soft tissue
46
Q

What does vazirani akinosi mandibular nerve block block (closed mouth)

A 
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
Q

How is gow gates block administered

A

Needle tip just below mesiolingual cusp of maxillary 2nd molar, just distal to the 2nd molar

48
Q

How is closed mouth technique administered

A

Lingual aspect of ramus adjacent to mucogingival junction of last maxillary molar

49
Q

What does incisive nerve block anaesthetise

A

In the quadrant: 2PM, canine, 2 incisors
Buccal soft tissue
Bone anterior to mental foramen
Skin of lower lip and Chin

50
Q

What needle to use for incisive nerve block

A

27 gauge short

51
Q

Relationship of long buccal nerve to last molar

A

Lateral and behind

52
Q

How long is the long needle

A

41mm

53
Q

Relationship of the buccinator to the raphe

A

Buccinator is lateral to the raphe

54
Q

Is the needle beveled

A

No

55
Q

Greater palatine block will anaesthetise

A

Only the upper mucosa

56
Q

What do you anaesthetise for maxillary molar

A

Posterior superior alveolar

Greater palatine?

57
Q

What do you anaesthetise for mandibular molar

A

Inferior alveolar nerve
Lingual nerve
Long buccal nerve

Oms (24 decks)

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