LA in children Flashcards
types of LA forms
amides
esters
examples of amide LA
lidocaine
aptocaine
examples of esters
procaine
Benzocaine
how does aesthetic work
Chemical block between source of pain and brain
- Electrical signals pass as action potentials
- LA block the sodium channel, nerve signals cannot be transmitted
function of vasoconstrictor
- slows removal of anaesthetic from the nerve vicinity
- prolongs anaesthetic action
when to use LA in children
if the child is cooperative
procedure (removing mutliple or one filling)
effects of a painful experience, tolerance may change
contradictions of use for LA
infection at injection site(consider use of block, pH in area may reduce potency of LA)
contradictions of use for LA bleeding disorder
infiltration rather than block
block can cause sig haemorrhage
haematoma could develop
contradictions of use for LA lidocainr
known hypersensitivity acute porphyria (metabolic disorder, affects production of harm, accumulation an lead NS to attack causing damage to skin)
contradictions of use for LA adrenaline
cardiac arythmias
hyperthyroidisms
topical anaesthetic types/names
xylonor gel - 5% lidocaine
benzocaine gel - 20%
EMLA cream
La solutions that are used
2% lidocaine with 1;80,000 adrealine
3% prilocaine with felypressin
articaine
what is articaine good for
md infiltrations (good lipid solubility)
contraindications for LA
patients with allergies to meatbisulfties
- methemoglobinemia or haemoglobinpathies
- associated with convulstions, anti convulsant meds can be used
max doses of LA
1) Lidocaine
- 4.4mg per kg
2) prilocaine
- 6mg/kg
3) articaine
- 7mg/kg
- children 5mg/kg
4) bupivacaine
- 2mh/kg
calculating children weight if unknown
Bodyweight (KG) = (age+4) x2
- estimate body weight if unknown
- watch for smaller/larger children
calculating dose
Calculating dose
- weight 20kg
- max dose of lidocaine 4.4mg/kg
- max dose is therefore 4.4x20 gives 88mg
Mg in each cartridge
2% lidocaine =2g per 100g = 20 parts
per 1000ml = 20mg/ml
1 cartridge = 2.2ml=44mg
88mg/44mg gives 2 cartridge
10 years old at 30g, max 3 cartridges
generalised dosage
general
1 cartridge per 10kg body weight lidocaine
Articaine, lower max dose
- 1 cartridge every 12.5 kg
types of needles
1) infiltration
- 30 guage 2cm needle
2) block
- 27 guage 3 cm needle
- able to aspirate
3) intraligamental anaesthesia
- 30 guage
- 1cm needle
needle desensitisation
1) explain and teach relaxation
2) needle uncovered inside mouth
3) needle on gingiva
4) injection
max molar teeth permanent molar LA
- 1cm of bone covering roots of the permanent molars
- infiltration should be given above and distal to the BD root and the MB root
- Mesial and distal to the roots is more permeable
palatal analgesia for children
use inter papillary method instead
Before interpapillary, perform buccal infiltration
- penetrate buccal papilla to depth of 1-2mm
- syringe barrel parallel to occlusal plane and perpendicular to line of arch
- inject slow and gently advance
Interpapillary
- observe blanching of the palate, takes 20to 30 secs
- repeat with other papilla until blanching joins
- aesthetic of complete gingival cuff is achieved
- can progress to palatal infiltration
- also useful in mandible (over 5 years)
ID block technique
Mandibular foramen more distal and inferior
- level of lower occlusal place, approach rom 1stprimary molar on contralateral side
- 6-9 years old
- aspiration required
- long buccal injection
- block not on children younger than 6
infiltrate vs ID block
Rule of 10
- count number of tooth from midline and add age
- answer is the max age at which infiltration alone is likely to give anaesthetic
- 10 or more look for ID block
if (age of pt) + (tooth #) < 10 = infiltration
With articane, rule of 12
