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YR3 ORS > LA > Flashcards

LA Flashcards

1
Q

Why do we use LA?

A
  • Pain control
  • Control bleeding
  • Symptom relief for those with facial pain
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2
Q

How does LA work within a nerve cell?

A

Unionised LA are lipid soluble so can diffuse across the lipid cell membrane.
Once inside the nerve cell, the LA molecule comes ionised due to the pH within the cell being lower and then block the sodium channels.

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3
Q

Why might LA affect cells differently?

A 
Type of sodium channel
Myelination or not 
Size of nerve 
Length of each nerve 
Depth of nerve fibre
Distribution of Na+ and K+ channels of each nerve 
Inflamed nerve
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4
Q

What is the structure of an LA molecule?

A

Hydrophobic aromatic ring

Hydrophilic amine group

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5
Q

What are the two types of LA and where are they metabolised?

A

Amides - metabolised by the liver

Esters - metabolised by plasma cholinesterases

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6
Q

What is the only type of LA which is an ester?

A

Benzocaine (used in topical)

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7
Q

What affects the speed of action of the LA?

A
  • Tissue pH
  • pKa of anesthesia
  • Diffusion distance to nerve
  • Concentration of LA
  • Lipid solubility
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8
Q

Why do we add a reducing agent to LA?

A

Prevent degradation of the vasoconstrictor by reducing the amount of oxygen there is to react with adrenaline

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9
Q

Why may some patients need to use prilocaine with felypressin?

A
  • Patients with heart conditions

- Patients who are allergic to other LA types

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10
Q

Why is articaine more effective than lidocaine?

A

It is double the concentration

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11
Q

Where is articaine metabolised?

Who is this good for?

A

Metabolised by plasma esterases in surrounding cells (even tho it is an amine).

Good for those with liver disease where the dose needs to be reduced.

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12
Q

Why do we not use articaine for a block?

A

Higher concentration so said to increase the risk of nerve damage.

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13
Q

What do we use an extra short needle for?

A

Intra-ligamentary injection

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14
Q

What nerves does the mandibular nerve go into?

A

Lingual
Buccal
Inferior alveolar

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15
Q

What nerve supplies the maxilla palatal gingiva?

A

Nasopalatine

Anterior palatine

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16
Q

What supplies the buccal gingiva of the maxillary arch?

A

Buccal nerve 3-8 and infraorbital nerve 3-1

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17
Q

What technique of LA uses a supra periosteal injection?

A

Infiltration

18
Q

Should we bevel our needle towards or away from bone? Why?

A

Towards - reduce trauma to soft tissue and discomfort for patient

19
Q

What do we need to make sure we have done before injecting with a buccal infiltration?

A

Hit bone and then retract before injecting

20
Q

When we do an maxillary extraction, how much of the cartrige do we give buccally and how much apaltally?

A

3/4 buccal and 1/4 palatally

21
Q

Why do we give the palatal infection between the midline raphe and the attached mucosa?

A

Most fleshy part so is the most comfortable

22
Q

Why do we give interpapillary injections?

A

To avoid palatal injections (advance needle towards the palate)

23
Q

When do we give an intraligamentary injection?

A
  • When the tooth has periodontal infection
24
Q

Why do we stretch the mucosa before injecting?

A

Less [painful to penetrate with needle

25
Q

What LA do we use for extraction of a mandibular second molar?

A

ID block and long buccal block

26
Q

What are the main complications of LA?

A
  • Failed LA
  • Trismus
  • Prolonged anaesthesia
  • Pain on injection
  • Needle breakage
  • Infection
  • Soft tissue injury
27
Q

Why does an abscess affect LA effectiveness?

A
  • Reduced pH of tissue = less dissociation of LA molecules once injected
  • Less ionised LA molecules to block to Na+ channels
  • Increase in blood supply during infection to the area causing wash out of the anaesthetic
28
Q

Why it is hard to anaesthetise a tooth with irreversible pulpitis?

A
  • Hyperalgesic pulp (increased pain)
29
Q

What technique can cause prolonged anaesthesia?

A
  • Inferior alveolar nerve block
30
Q

What is the difference between prolonged and persistent anesthesia?

A

Prolonged anaesthesia = lasts days to months

Persistent anaesthesia = permanent nerve damage resulting in change in sensation to area (numb, tingling or burning)

31
Q

What are some systemic complications of LA?

A
  • Intravascular injection
  • Allergy
  • Toxicity
  • Vasovagal
32
Q

What teeth does buccal infiltration work in mandibular teeth?

A

up the second premolar

33
Q

If we do an intra papillary injection, what other injection can we avoid?

A

Palatal injection

34
Q

What question can we ask a patient to see if an ID block has worked?

A

Is your lip and chin numb?

35
Q

How do we know if we have our needle in a nerve?

A

Patient will feel sharp electric shock

36
Q

What can we inject into which will give the patient a facial palsy?

A

Parotid gland (facial nerve running through)

37
Q

What LA do we give for a lower third molar extraction?

A

ID block & buccal nerve block

38
Q

When do we need to use block anaesthesia?

A
  • When anesthesia is required over a larger area
  • Where bone is porous and LA cannot diffuse in
  • If there is an abscess near sight of infection inhibiting a buccal infiltration
39
Q

What two nerves does a mental nerve anathetise?

A
  • Mental nerve

- Incisive nerve

40
Q

What soft tissue does a buccal nerve block anaethetise?

A

Buccal soft tissues distal to second premolar

YR3 ORS (12 decks)

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