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LA symposium Flashcards

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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
what is intraosseous methos of LA
give a bit of LA then drill through soft tissues and inject directly into bone very effective
26
how to know if you are in the right place for intraligamental injection?
should feel resistance
27
why is palatal injection so painful?
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
28
intraligamental injection is not affected by patient's,,?
age sex needle gauge syringe
29
which LA type is most successful for intraligamental procedures?
best - llidocaine with 1:80000 adrenalilen worst - lidocaine wihtout adrenaline
30
what are the adv and disadv of topical jet injectors?
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
akinosi technique
closed mouth technique of IDB
32
difference between akinosi, gow gates and IDB?
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
what is good about the wand delivery
constant controlled low pressure
34
what topical agents are most commonly used (adults and children)
lidocaine 2% gel, 10% spray, 5% ointment benzocaine 20% gel
35
how deep does topical agents anaesthetise?
2-3mm depth of tissue
36
what are the contraindications of lidocaine
heart block and no pacemaker allergy to LA or corn hypotension impaired liver function
37
what are the contraindications of articaine
avoid in sickle cell disease and other haemoglobinopathies
38
effect of adrenaline?
More profound anaesthesia Vasoconstriction keeps concentration of LA higher at site -> longer lasting Haemorrhage control
39
use of LA in children?
operative pain control hemorrhage control diagnostic tool
40
when applying topical, the tissue needs to be?
dry + wait 2 min
41
what non pharmalogical pain control methods are used on children?
hypnosis or transcutaneous electrical nerve stimulation TENS
42
half life of lidocaine
1.5h-2h
43
half life of articaine
20min
44
what are the effects of adrenaline?
binds to alpha receptors -> vasoconstriction beta 1 receptors -> tachycardia increaed BP overall caution with patients on diuretics
45
what length of needle for infiltration of children
ultra short purple short blue
46
when doing palatal anesthesia, what angle do you point the needle when advancing into the gingivae
90 deg using a ultra short needle
47
when doing a intraligamental LA on childrenm what angle do you postion the needle
30 deg to the long axis of the tooth, mesiobuccal
48
what needle lenght do you use for intraligamental in children
ultra short
49
for IDB in children, what do you need to note that is different from adults
approach from primary molars instead of premolars mandibular foramen is located LOWER and smaller
50
difference in mental block between children and adult
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
how to treat LA toxicity
stop dental tx provide BLS call for assistance protect patient from injury monitor vital signs
52
blue vs orange sharps box
orange - sharps without medicinal or empty cartridges blue - sharps containing medicine like LA or botox
53
when to avoid IDB
in bleeding disorders ask it can cause hematoma
54
make child feel
safe rapport control hand signals ask them how theyre feeling distract
55
what does the health and safety regulations 2013 outline key points
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
where should the sharps container be located in the clinic
on operators side dispose when patient is still there make sure box is located on waste height level surface
57
which act states that patients have a right to decline medical history
equality act 2010
58
should a patient's medical history matter when you recieve a sharps injury?
by right no, if you follow all your SIPCEPs, treat all patients as high risk
59
how to do first aid when you get a sharps injury
apply pressure allow bleed wash with water and detergent dry put bandage
60
should you be the one carying out risk assesment after you get a sharps injury
NO, ask someone else
61
if patient does not consent to blood sample what do you do
nothing you can do. just do your own follow ups and blood samples with PEP if required
62
sharps inury procedure
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
when do you call occupaitonal health?
after doing a risk assesment and seeing that they are high risk
64
if student has gotten sharps injury from a high risk individua, what is the next few steps
immediate medical advice PEP within the hour counselling medical treatment as advised by doctor
65
Volume of LA to inject in children?
0.5ml - 1ml Injected supra periosteal, as close as possible to the apices for a Buccal infiltration in children
66
When to use IDB in children?
- lingual nerve block is required - management of permanent molars - management of children molar incisor pattern hypomineralisation MIH
67
In kids and adults, inject how high above the mandibular occlusal plane?
Kids -> 5mm Adults -> 10mm
68
Most common complication of LA
fainting from stress
69
When to avoid LA? (children LA lecture)
Liver disease reduce injection Allergy Infection *** for bleeding disorder avoid IDB

BDS2 CDS (15 decks)

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