LA symposium Flashcards
how to differentiate LA induced facial palsy from stroke?
facial palsy is a lower motor neuron defect so complete facial paralysis on one side - CANNOT wrinkle forehead
stroke - can wrinkle forehead
max safe dosage of articaine, lidocaine and prilocaine
lidocaine => 4.4-5mg/kg
articaine => 7mg/kg
prilocaine => 6mg/kg
LA interacts with which other drugs?
Mono Amine Oxidase Inhibitors
tri-cyclics antidepressants
beta blockers
non potassium sparing diuretics
cocaine
halothane
what are the 3 most common LA
lidocaine 2% with 1:80000 adrenaline
articaine 4% with 1:100000 adre
prilocaine 3% with octapressin
lidocaine 2% with 1:80000 adrenaline is a ester or amide?
amide
articaine 4% is ester or amide
amide
amide vs ester
amide is more stable so it has longer half life
prilocaine 3% is ester or amide
amide
why cant u use prilocaine 3% on pregnant women
octapressin/felypressin can induce premature labour
septanest vs citanest
spetanest => articaine trade name
citanest => prilocaine trade name
what is used for blocks and what for infiltrations?
blocks -> lidocaine, prilocaine
infiltration -> articaine lidoacine prilocaine
**articaine usage in blocks is controversial, risk of paresthesia
systemic complications of LA
allergies
toxicity
stress
infections
interactions with other drugs
how many mg of LA in each cartridge of lidocaine and articaine?
lidocaine -> 44mg
articaine -> 88mg
local complications of LA
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
how to reduce toxic effects of LA?
- aspirating technique
- SLOW delivery, decreases chance of ovverload
does infection make it harder to achieve complete LA
yes
why would someone have prolonged anaesthesia?
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
why is articaine 4% good for infiltrations?
it can penetrate and diffuse through cortical bone easily
how to treat trismus
muscle relaxant
anti inflammatory med
how to manage LA induced facial palsy in clinic
give eye patch until blink relfex returns
give reassurance
usally 2-3h
if you accidentally inject directly into a bv , what will you notice most likely?
adrenaline effects - palpitations, anxious, headache, sweating, pallour
what receptors that adrenaline binds to are we most interested in with LA?
alpha and beta 2
Mainly alpha 1 cause it causes vasoconstriction
these are the ones that control blood vessels
what is palatal anaesthesia chasing methos
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
what is intraligamental deliver of LA
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
what is intraosseous methos of LA
give a bit of LA
then drill through soft tissues and inject directly into bone
very effective
how to know if you are in the right place for intraligamental injection?
should feel resistance
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
intraligamental injection is not affected by patient’s,,?
age
sex
needle gauge
syringe
which LA type is most successful for intraligamental procedures?
best - llidocaine with 1:80000 adrenalilen
worst - lidocaine wihtout adrenaline
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”!!!
akinosi technique
closed mouth technique of IDB
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
what is good about the wand delivery
constant controlled low pressure
what topical agents are most commonly used (adults and children)
lidocaine 2% gel, 10% spray, 5% ointment
benzocaine 20% gel
how deep does topical agents anaesthetise?
2-3mm depth of tissue
what are the contraindications of lidocaine
heart block and no pacemaker
allergy to LA or corn
hypotension
impaired liver function
what are the contraindications of articaine
avoid in sickle cell disease and other haemoglobinopathies
effect of adrenaline?
More profound anaesthesia
Vasoconstriction keeps concentration of LA higher at site -> longer lasting
Haemorrhage control
use of LA in children?
operative pain control
hemorrhage control
diagnostic tool
when applying topical, the tissue needs to be?
dry + wait 2 min
what non pharmalogical pain control methods are used on children?
hypnosis or
transcutaneous electrical nerve stimulation TENS
half life of lidocaine
1.5h-2h
half life of articaine
20min
what are the effects of adrenaline?
binds to alpha receptors -> vasoconstriction
beta 1 receptors -> tachycardia
increaed BP overall
caution with patients on diuretics
what length of needle for infiltration of children
ultra short purple
short blue
when doing palatal anesthesia, what angle do you point the needle when advancing into the gingivae
90 deg using a ultra short needle
when doing a intraligamental LA on childrenm what angle do you postion the needle
30 deg to the long axis of the tooth, mesiobuccal
what needle lenght do you use for intraligamental in children
ultra short
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
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
how to treat LA toxicity
stop dental tx
provide BLS
call for assistance
protect patient from injury
monitor vital signs
blue vs orange sharps box
orange - sharps without medicinal or empty cartridges
blue - sharps containing medicine like LA or botox
when to avoid IDB
in bleeding disorders ask it can cause hematoma
make child feel
safe
rapport
control
hand signals
ask them how theyre feeling
distract
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
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
which act states that patients have a right to decline medical history
equality act 2010
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
how to do first aid when you get a sharps injury
apply pressure allow bleed
wash with water and detergent
dry
put bandage
should you be the one carying out risk assesment after you get a sharps injury
NO, ask someone else
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
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
when do you call occupaitonal health?
after doing a risk assesment and seeing that they are high risk
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
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
When to use IDB in children?
- lingual nerve block is required
- management of permanent molars
- management of children molar incisor pattern hypomineralisation MIH
In kids and adults, inject how high above the mandibular occlusal plane?
Kids -> 5mm
Adults -> 10mm
Most common complication of LA
fainting from stress
When to avoid LA? (children LA lecture)
Liver disease reduce injection
Allergy
Infection
*** for bleeding disorder avoid IDB
