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BDS2 CDS > LA symposium > Flashcards

LA symposium Flashcards

1
Q

how to differentiate LA induced facial palsy from stroke?

A

facial palsy is a lower motor neuron defect so complete facial paralysis on one side - CANNOT wrinkle forehead

stroke - can wrinkle forehead

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2
Q

max safe dosage of articaine, lidocaine and prilocaine

A

lidocaine => 4.4-5mg/kg

articaine => 7mg/kg

prilocaine => 6mg/kg

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3
Q

LA interacts with which other drugs?

A

Mono Amine Oxidase Inhibitors

tri-cyclics antidepressants

beta blockers

non potassium sparing diuretics

cocaine

halothane

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4
Q

what are the 3 most common LA

A

lidocaine 2% with 1:80000 adrenaline

articaine 4% with 1:100000 adre

prilocaine 3% with octapressin

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5
Q

lidocaine 2% with 1:80000 adrenaline is a ester or amide?

A

amide

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6
Q

articaine 4% is ester or amide

A

amide

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7
Q

amide vs ester

A

amide is more stable so it has longer half life

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8
Q

prilocaine 3% is ester or amide

A

amide

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9
Q

why cant u use prilocaine 3% on pregnant women

A

octapressin/felypressin can induce premature labour

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10
Q

septanest vs citanest

A

spetanest => articaine trade name

citanest => prilocaine trade name

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11
Q

what is used for blocks and what for infiltrations?

A

blocks -> lidocaine, prilocaine

infiltration -> articaine lidoacine prilocaine

**articaine usage in blocks is controversial, risk of paresthesia

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12
Q

systemic complications of LA

A

allergies
toxicity
stress
infections
interactions with other drugs

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13
Q

how many mg of LA in each cartridge of lidocaine and articaine?

A

lidocaine -> 44mg

articaine -> 88mg

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14
Q

local complications of LA

A

failure to achieve complete anesthesia due to poor technique or tissue pH (more acidic then harder)

prolonged anaesthesia

trismus

intravascular injection

facial paresis

facial palsy

broken needle

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15
Q

how to reduce toxic effects of LA?

A
  1. aspirating technique
  2. SLOW delivery, decreases chance of ovverload
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16
Q

does infection make it harder to achieve complete LA

A

yes

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17
Q

why would someone have prolonged anaesthesia?

A

direct trauma into nerve from needle

chemical trauma altered nerve structure

stronger LA might have higher risk

multiple injections with same needle, needle tip shape slightly changes

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18
Q

why is articaine 4% good for infiltrations?

A

it can penetrate and diffuse through cortical bone easily

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19
Q

how to treat trismus

A

muscle relaxant
anti inflammatory med

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20
Q

how to manage LA induced facial palsy in clinic

A

give eye patch until blink relfex returns

give reassurance

usally 2-3h

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21
Q

if you accidentally inject directly into a bv , what will you notice most likely?

A

adrenaline effects - palpitations, anxious, headache, sweating, pallour

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22
Q

what receptors that adrenaline binds to are we most interested in with LA?

A

alpha and beta 2

Mainly alpha 1 cause it causes vasoconstriction
these are the ones that control blood vessels

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23
Q

what is palatal anaesthesia chasing methos

A

give buccal infiltration first,

then inject into interdental papilla, slowly advancing the needle until the tissues on the palatal side blanches

finally inject from the palatal side, into the blanched side

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24
Q

what is intraligamental deliver of LA

A

sticking needle into the PDL space and make the LA liquid go into the cribriform plate into the cancellous bone. the LA will diffuse in the cancellous bone and find its way down to the apex of the tooth

requires HIGH pressure

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25
Q

what is intraosseous methos of LA

A

give a bit of LA

then drill through soft tissues and inject directly into bone

very effective

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26
Q

how to know if you are in the right place for intraligamental injection?

A

should feel resistance

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27
Q

why is palatal injection so painful?

A

tissues in the palatal region are tightly bound, the mucoperiosteum is tightly bound to the boe below

pain comes from the pressure of the LA being injected into the small space between the periosteum and bone

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28
Q

intraligamental injection is not affected by patient’s,,?

A

age
sex
needle gauge
syringe

29
Q

which LA type is most successful for intraligamental procedures?

A

best - llidocaine with 1:80000 adrenalilen

worst - lidocaine wihtout adrenaline

30
Q

what are the adv and disadv of topical jet injectors?

A

advantages
- no needles
- used on patients who cannot have deep injecions

disadv
- scary sound esp for kids
- taste is bad
- damage to soft tissues”!!!

31
Q

akinosi technique

A

closed mouth technique of IDB

32
Q

difference between akinosi, gow gates and IDB?

A

IDB is lower

gow gates and akinosi - much higher, aiming to hit the bone just below the condyle ie the neck of the condyle

^since they are higher, they block more of the nerve, includes the lingual, buccal nerves so more anaesthetized

33
Q

what is good about the wand delivery

A

constant controlled low pressure

34
Q

what topical agents are most commonly used (adults and children)

A

lidocaine 2% gel, 10% spray, 5% ointment

benzocaine 20% gel

35
Q

how deep does topical agents anaesthetise?

A

2-3mm depth of tissue

36
Q

what are the contraindications of lidocaine

A

heart block and no pacemaker

allergy to LA or corn

hypotension

impaired liver function

37
Q

what are the contraindications of articaine

A

avoid in sickle cell disease and other haemoglobinopathies

38
Q

effect of adrenaline?

A

More profound anaesthesia

Vasoconstriction keeps concentration of LA higher at site -> longer lasting

Haemorrhage control

39
Q

use of LA in children?

A

operative pain control
hemorrhage control
diagnostic tool

40
Q

when applying topical, the tissue needs to be?

A

dry + wait 2 min

41
Q

what non pharmalogical pain control methods are used on children?

A

hypnosis or

transcutaneous electrical nerve stimulation TENS

42
Q

half life of lidocaine

A

1.5h-2h

43
Q

half life of articaine

A

20min

44
Q

what are the effects of adrenaline?

A

binds to alpha receptors -> vasoconstriction

beta 1 receptors -> tachycardia

increaed BP overall

caution with patients on diuretics

45
Q

what length of needle for infiltration of children

A

ultra short purple
short blue

46
Q

when doing palatal anesthesia, what angle do you point the needle when advancing into the gingivae

A

90 deg using a ultra short needle

47
Q

when doing a intraligamental LA on childrenm what angle do you postion the needle

A

30 deg to the long axis of the tooth, mesiobuccal

48
Q

what needle lenght do you use for intraligamental in children

A

ultra short

49
Q

for IDB in children, what do you need to note that is different from adults

A

approach from primary molars instead of premolars

mandibular foramen is located LOWER and smaller

50
Q

difference in mental block between children and adult

A

mental foramen in children
- between 1 and 2 primary molars
- faces anteriorly
- 5mm above mandibular occlusal plane

mental foramen in adults
- below 2nd premolar
- faces laterally
- 1cm above mandibular occlusal plane

51
Q

how to treat LA toxicity

A

stop dental tx
provide BLS
call for assistance
protect patient from injury
monitor vital signs

52
Q

blue vs orange sharps box

A

orange - sharps without medicinal or empty cartridges

blue - sharps containing medicine like LA or botox

53
Q

when to avoid IDB

A

in bleeding disorders ask it can cause hematoma

54
Q

make child feel

A

safe
rapport
control
hand signals
ask them how theyre feeling
distract

55
Q

what does the health and safety regulations 2013 outline key points

A

safe use and disposal of sharps

training and education of staff

investigate and act in response to sharps injuries

avoid unnecessary use of sharps

56
Q

where should the sharps container be located in the clinic

A

on operators side

dispose when patient is still there

make sure box is located on waste height level surface

57
Q

which act states that patients have a right to decline medical history

A

equality act 2010

58
Q

should a patient’s medical history matter when you recieve a sharps injury?

A

by right no, if you follow all your SIPCEPs, treat all patients as high risk

59
Q

how to do first aid when you get a sharps injury

A

apply pressure allow bleed

wash with water and detergent

dry

put bandage

60
Q

should you be the one carying out risk assesment after you get a sharps injury

A

NO, ask someone else

61
Q

if patient does not consent to blood sample what do you do

A

nothing you can do.

just do your own follow ups and blood samples with PEP if required

62
Q

sharps inury procedure

A

stop you detnal work
inform patient
ensure sharp is closed and safe
carry out first aid
ask clinician for help
risk assesment
occupational health
consent
paper work
datix

63
Q

when do you call occupaitonal health?

A

after doing a risk assesment and seeing that they are high risk

64
Q

if student has gotten sharps injury from a high risk individua, what is the next few steps

A

immediate medical advice

PEP within the hour

counselling

medical treatment as advised by doctor

65
Q

Volume of LA to inject in children?

A

0.5ml - 1ml

Injected supra periosteal, as close as possible to the apices for a Buccal infiltration in children

66
Q

When to use IDB in children?

A
  • lingual nerve block is required
  • management of permanent molars
  • management of children molar incisor pattern hypomineralisation MIH
67
Q

In kids and adults, inject how high above the mandibular occlusal plane?

A

Kids -> 5mm
Adults -> 10mm

68
Q

Most common complication of LA

A

fainting from stress

69
Q

When to avoid LA? (children LA lecture)

A

Liver disease reduce injection
Allergy
Infection

*** for bleeding disorder avoid IDB

BDS2 CDS (15 decks)

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