LA in Children Flashcards
why is LA used in children?
- operative pain control
- haemorrhage control
- diagnostic tool
what is meant by surface anaesthesia?
anaesthesia of the surface tissues (e.g skin or mucous membranes)
what are the uses of surface anaesthesia?
- to reduce pain of LA injection
- to reduce discomfort of venipuncture
- for superficial soft tissue manipulation
what are the two types of surface anaesthesia?
- physical
- pharmacological
what is physical surface anaesthesia?
- ‘refrigeration anaesthesia’
- reduces the temperature
what is meant by pharmacological anaesthesia?
topical anaesthesia
how deep do topical anaesthesias work?
2-3mm depth of tissue
what is the typical technique for applying topical anaesthesia?
- dry area
- apply over limited area (cotton wool)
- apply for 2 mins
what are some commonly used intraoral topical anaesthetics?
- lidocaine
- benzocaine
when is intra-oral topical anaesthesia used?
- pre-injection
- rubber dam clamp
- placing matrix band
- scaling
what are some means of non-pharmacological pain control?
- TENS (transcutaneous electrical nerve stimulation
- Hypnosis
what does a TENS machine do?
blocks large myelinated nerve fibres and closes the gate to central transmission of smaller unmyelinated pain fibres
what is hypnosis?
an altered state of mine such that suggestions are accepted more readily and acted upon more powerfully
what are some common LA solutions?
- lidocaine 2% with 1:80000 adrenaline
- lidocaine 2% plain
- prilocaine 3% with felypressin
- articaine 4% with 1:100000 adrenaline
- mepivicaine 3% plain
what is the usual half life of lidocaine?
1.5-2hrs
what type of LA is lidocaine appropriate for?
- infiltration
- block
- surface anaesthesia
what is the purpose of adding adrenaline/epinephrine to LA solutions?
- adrenaline vasoconstricts arteries
- reducing bleeding
- delays the resorption of anaesthesia
- doubles the duration of anaesthesia
in what case would the use of Lidocaine not be advised?
- patients with heart block & no pace maker
- allergy to LA
- hypotension
- impaired liver function
what is the half life of articaine?
20 mins
why is the risk of systemic toxicity lower with articaine compared to other LAs?
it is hydrolysed by blood quicker
what type of infiltration is Articaine more effective compared to lidocaine?
mandibular infiltrations
in what cases should Articaine be avoided as a local anaesthetic?
- sickle cell patients
- haemoglobinpathies
what needle sizes (and their use) are used in LA for children?
- ultra-short (infiltration)
- short (infiltration)
- long (ID block)
when performing an intraligamental injection, what needle is used in children?
ultra short 32 gauge needle
what is important to remember about the mandibular foramen in children compared to adults?
the mandibular foramen is LOWER in children than in adults
if high levels of LA reach the cardiovascular system, what might occur?
circulatory collapse
if large amounts of LA reach the CNS what might occur?
unconsciousness and respiratory arrest
what is the maximum safe dose for Lidocaine 2% (plain/epinephrine)?
4.4mg/kg
what is the maximum safe dose for Prilocaine 4% plain / Prilocaine 3% w felypressin?
6.0mg/kg
what is the maximum safe dose for Mepivicaine 3% plain / 2% w epinephrine?
4.4mg/kg
what is the maximum safe does for Articaine 4% with epinephrine?
7.0mg/kg
what would a dentist do if they suspected LA overdose in a child?
- stop dental treatment
- provide BLS
- call for medical assistance
- protect patient from injury
- monitor vital signs
what are some LA complications that can occur post-procedure?
- self-inflicted trauma (ulceration)
- long lasting anaesthesia
- trismus
- infection
why is it important to avoid IDB anaesthesia in patients with bleeding disorders?
can cause haematoma in the retromolar and pterygoid area (LIFE THREATENING if unnoticed)
in terms of behaviour management, what is an important aspect that the dentist should AVOID?
- bribing
- coaxing
- shouting
etc.
what behaviour management techniques are used in the clinic when administering LA to a child?
- positive reinforcement
- tell, show, do
- distraction
- voice control
