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2- Local Anaesthetic > LA for Children > Flashcards

LA for Children Flashcards

1
Q

What are the uses of LA in children?

A

Operative pain control
Hemorrhage control
Diagnostic tool

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2
Q

What is an example of physical LA?

A

(refrigeration anaesthesia)
By reducing the temperature
Ethyl chloride (rarely used as LA agent in children)

highly flammable

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3
Q

What are the types of topical/surface anaesthetics?

A
  • Intraoral topical agents
  • Topical anaesthetics for skin
  • Controlled release devices (patches)
  • Jet injectors
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4
Q

What are the two non-pharmalogical methods of LA?

A

TENS (Transcutaneous Electrical Nerve Stimulation)
Hypnosis

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5
Q

What are the 2 lidocaine solutions usually used?

A
  • Lidocaine 2% with 1:80000 epinephrine/adrenaline (amide) (Lignospan®, Xylocaine®)
  • Lidocaine 2% plain (amide) (shorter acting as no vasoconstricter)
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6
Q

What is the prilocaine solution usually used and when is it contraindicated (vascoconstrictor)?

A
  • Prilocaine (Citanest®) 3% with felypressin (also known as octapressin) 0.03IU/ml (amide)

octapressin can induce early labour (therefore do not use for pregnancy)

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7
Q

What is the articaine solution usually used?

A

Articaine 4% (Septanest®) with 1:100 000 adrenaline (amide)

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8
Q

What is lidocaine used for and what are the contraindications?

A

suitable for infiltration, block, and surface anesthesia

anti-arrhythmic drug

Heart block and no pace-maker. Allergy to LA (or to corn), hypotension, impaired liver function.

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9
Q

Which has a shorter half-life articaine or lidocaine?

A

articaine - 20 mins
lidcocaine - 1.5/2 hours

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10
Q

Which LAs have a benzene group and which have a thiophene?

A

prilocaine, lidocaine = benzene
thiophene = articaine (with additional ester group)

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11
Q

What is articaine used for?

A

*More effective for mandibular infiltrations than lignocaine
*Lignocaine and articaine are equally effective as blocks.

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12
Q

Why is lidocaine used for block?

A

4% articaine carries higher risk of non-surgical paraesthesia

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13
Q

What are the contraindications for articaine?

A

Avoid in sickle cell patients (and other haemoglobinopathies)

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14
Q

What is the effect of adrenaline?

A

Adrenaline binds to alpha-receptors in the peripheral vasculature causing vasocontriction. It also causes tachycardia , due to binding with Ɓ1-adrenergic receptors in the heart wall.

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15
Q

When is adrenaline contraindicated?

A

no need to avoid LA without adrenaline (which is less effective) unless BP> 200mmHg (systolic) and/or (diastolic) >115mmHg

have caution with patients on diuretics (“water tablet” used to decrease BP by flushing salt out of body)- use adrenaline free LA to avoid risk of reduction in potassium concentration)

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16
Q

What are 3 techniques of LA in children?

A

infiltration
intraligamentary
regional block

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17
Q

What are the 3 different needle sizes used for?

A

long - ID block
short - infiltration
ultra short - infiltration

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18
Q

What is the infiltration used for?

A
  • Anaesthesia in primary teeth
  • Anaesthesia in maxillary permanent teeth
  • Anaesthesia in mandibular permanent anterior teeth
  • Prior to intrapapillary and then intraligamental anaesthesia in posterior permanent teeth
  • Prior to intrapapillary and palatal/lingual anaesthesia
19
Q

How is lingual/palatal anaesthesia carried out?

A

Ultra short 90 degrees to surface Approach via anaesthetised buccal interdental papilla

20
Q

What is intraligamental LA used for?

(single tooth, injected into PDL)

A
  • to supplement infiltrations
  • may eliminate need for block
21
Q

How can intraligamental discomfort by reduced in a child?

A
  • Small buccal infiltration
  • Papillary injection
22
Q

What syringe in used for a intraligamental?

A

normal syinge with ultra short needle
custom made syringes

23
Q

How is intraligamental LA carried out?

needle and gauge

A
  • Interosseous via cancellous space via PDL
  • 0.2ml per root–beware excess dose
  • More successful with a vasoconstrictor
  • Ultra short 32 gauge needle
  • 30 degree to long axis of tooth in mesiobuccal gingival sulcus - advance until resistance
24
Q

What is the wand used for?

A

*Uses computerised flow of local anaesthetic
*Can be used as a method of intraligamental LA for single tooth anaesthesia
*Can also be used for infiltration and block anaesthesia.

25
Q

Where in the mandibular foremen in children?

A

below occlusal plane
lower than in adults

26
Q

Where is the location for a regional IAB and lingual nerve block?

A

Approach direct from primary molars of opposite side.

lateral to pterygo mandibular raphe and medial to ascending ramus

27
Q

How is a mental block carried out?

A

Advance needle in buccal sulcus toward region between apices of 1st and 2nd primary molars.

28
Q

What are advantages/disadvantages of a mental block?

A
  • Advantages
    – very good soft tissue anaesthesia
  • Disadvantages
    – Incisive nerve anaesthesia not as reliable as IDB
    – Incisors may get crossover supply across midline so need a labial infiltration adjacent to tooth as well as this block
29
Q

Where is the mental foremen in children?

A

more anterior in children than lateral in adults

30
Q

What block is hardly used?

A

maxillary

This is because the wide area of anesthesia resulting from maxillary nerve block (including the dural, temporal, and zygomatic regions; the mucosa of the maxillary sinus; and the maxillary teeth and their soft tissues) is often not needed

31
Q

What is used to block the nasopalatine and greater palatine nerves and how?

A

Greater palatine and nasopalatine blocks can be achieved by infiltrating LA through anaesthetised buccal papilla and ‘chasing’ the anaesthetic through to the palatal mucosa.

32
Q

What may cause allergy in LAs?

A
  • Metabisulphite (E223) preservative, antiseptic
  • Latex –rubber bung
  • Methyl parabens Preservative, (E218) found in blueberries.
33
Q

What can LA toxicity do?

A
  • CNS
    – Depressant leading to unconsciousness and respiratory arrest
  • Methaemoglobinaemia
    – condition where an abnormal amount of hemoglobin is oxidized to Fe3+ instead of Fe2+, reducing its ability to transport oxygen in the blood.
    – Caused by prilocaine, lidcaine articaine, benzocaine
34
Q

What is the safe dose of lidocaine, prilocaine, mepivicaine and articaine?

A

Lidocaine: 4.4 mg/kg
Prilocaine: 6 mg/kg
Articaine: 7 mg/kg

35
Q

What is the safe dose of lidocaine for a 20kg child?

2.2ml cartridge contains 44mg

A

– 2% soln in 2.2ml cartridge contains 44mg
– Max safe dose is 4.4mg/kg or 1/10th cart /kg

20kg x 4.4 = 88mg = 2 cartridges

36
Q

What is the safe dose of articaine for a 20kg child?

2.2mll cartridge contains 88mg

A
  • 4% soln in 2.2ml cartridge contains 88mg
  • Max safe dose is 7mg/kg
  • 88/7 cart/kg*
    20kg x 7 = 140mg= 1/5 short of 2 cartridges
37
Q

How can you prevent complications in LA?

A
  • Aspiration
  • Slow injection
  • Dose limitation
38
Q

What are the steps for treatment of toxicity?

A
  • Stop dental treatment
  • Provide basic life support
  • Call for medical assistance
  • Protect patient from injury
  • Monitor vital signs
39
Q

What are late localised complications?

A
  • Self inflicted trauma causing oral ulceration from chewing
  • Long lasting anaesthesia
  • Trismus
  • Infection
  • Developmental defects
40
Q

Where does pain occur?

A

– intraepithelial; subperiosteal;
– nerve trunk; intravascular

41
Q

Why for IDB be avoided in bleeding disorders?

A

can cause haematoma in retromolar and pterygoid area which is fatal and can go unnoticed

42
Q

Why should you take care with a patient with liver disease?

A

some LAs are metabolised in the liver therefore amide dose reduction

43
Q

Behaviour techniques in children?

A

Be empathetic
Positive reinforcement
Tell-show-do
Acclimatization
Desensitization
Voice control
Distraction
Role modeling

2- Local Anaesthetic (6 decks)

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