LA in Children Flashcards

1
Q

why is LA used in children?

A
  • operative pain control
  • haemorrhage control
  • diagnostic tool
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2
Q

what is meant by surface anaesthesia?

A

anaesthesia of the surface tissues (e.g skin or mucous membranes)

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3
Q

what are the uses of surface anaesthesia?

A
  • to reduce pain of LA injection
  • to reduce discomfort of venipuncture
  • for superficial soft tissue manipulation
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4
Q

what are the two types of surface anaesthesia?

A
  • physical

- pharmacological

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5
Q

what is physical surface anaesthesia?

A
  • ‘refrigeration anaesthesia’

- reduces the temperature

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6
Q

what is meant by pharmacological anaesthesia?

A

topical anaesthesia

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7
Q

how deep do topical anaesthesias work?

A

2-3mm depth of tissue

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8
Q

what is the typical technique for applying topical anaesthesia?

A
  • dry area
  • apply over limited area (cotton wool)
  • apply for 2 mins
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9
Q

what are some commonly used intraoral topical anaesthetics?

A
  • lidocaine

- benzocaine

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10
Q

when is intra-oral topical anaesthesia used?

A
  • pre-injection
  • rubber dam clamp
  • placing matrix band
  • scaling
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11
Q

what are some means of non-pharmacological pain control?

A
  • TENS (transcutaneous electrical nerve stimulation

- Hypnosis

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12
Q

what does a TENS machine do?

A

blocks large myelinated nerve fibres and closes the gate to central transmission of smaller unmyelinated pain fibres

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13
Q

what is hypnosis?

A

an altered state of mine such that suggestions are accepted more readily and acted upon more powerfully

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14
Q

what are some common LA solutions?

A
  • lidocaine 2% with 1:80000 adrenaline
  • lidocaine 2% plain
  • prilocaine 3% with felypressin
  • articaine 4% with 1:100000 adrenaline
  • mepivicaine 3% plain
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15
Q

what is the usual half life of lidocaine?

A

1.5-2hrs

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16
Q

what type of LA is lidocaine appropriate for?

A
  • infiltration
  • block
  • surface anaesthesia
17
Q

what is the purpose of adding adrenaline/epinephrine to LA solutions?

A
  • adrenaline vasoconstricts arteries
  • reducing bleeding
  • delays the resorption of anaesthesia
  • doubles the duration of anaesthesia
18
Q

in what case would the use of Lidocaine not be advised?

A
  • patients with heart block & no pace maker
  • allergy to LA
  • hypotension
  • impaired liver function
19
Q

what is the half life of articaine?

20
Q

why is the risk of systemic toxicity lower with articaine compared to other LAs?

A

it is hydrolysed by blood quicker

21
Q

what type of infiltration is Articaine more effective compared to lidocaine?

A

mandibular infiltrations

22
Q

in what cases should Articaine be avoided as a local anaesthetic?

A
  • sickle cell patients

- haemoglobinpathies

23
Q

what needle sizes (and their use) are used in LA for children?

A
  • ultra-short (infiltration)
  • short (infiltration)
  • long (ID block)
24
Q

when performing an intraligamental injection, what needle is used in children?

A

ultra short 32 gauge needle

25
what is important to remember about the mandibular foramen in children compared to adults?
the mandibular foramen is LOWER in children than in adults
26
if high levels of LA reach the cardiovascular system, what might occur?
circulatory collapse
27
if large amounts of LA reach the CNS what might occur?
unconsciousness and respiratory arrest
28
what is the maximum safe dose for Lidocaine 2% (plain/epinephrine)?
4.4mg/kg
29
what is the maximum safe dose for Prilocaine 4% plain / Prilocaine 3% w felypressin?
6.0mg/kg
30
what is the maximum safe dose for Mepivicaine 3% plain / 2% w epinephrine?
4.4mg/kg
31
what is the maximum safe does for Articaine 4% with epinephrine?
7.0mg/kg
32
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
33
what are some LA complications that can occur post-procedure?
- self-inflicted trauma (ulceration) - long lasting anaesthesia - trismus - infection
34
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)
35
in terms of behaviour management, what is an important aspect that the dentist should AVOID?
- bribing - coaxing - shouting etc.
36
what behaviour management techniques are used in the clinic when administering LA to a child?
- positive reinforcement - tell, show, do - distraction - voice control