LA Symposium Flashcards by Alex MacKinnon

Define a nerve block anaesthesia and what it is used to anaesthetise

Anaesthetic deposited beside nerve trunk

Used to produce soft tissue anaesthesia
Used where bone is too thick to allow infiltration (mandible)

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What LA type would you use to anaesthetise dental pulp in maxilla?

Buccal infiltration

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What LA type would you use to anaesthetise buccal gingivae in maxilla?

Buccal infiltration

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What LA type would you use to anaesthetise palatal gingivae in maxilla?

Palatal injection

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What LA type would you use to anaesthetise dental pulp in lower molars (and second premolar)?

Inferior alveolar nerve block (IAN/IDB)

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What LA type would you use to anaesthetise the pulp of lower premolars and canine?

Mental (incisive) nerve block

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What LA type would you use to anaesthetise the pulp of lower canine and incisors?

Buccal/labial infiltration

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What LA type would you use to anaesthetise buccal gingivae in lower molars and second premolar?

(Long) buccal infiltration

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What LA type would you use to anaesthetise buccal gingivae in lower first premolar and canine?

IAN block or mental block

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What LA type would you use to anaesthetise buccal gingivae in lower incisors and canines?

Buccal/labial infiltration

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What LA type would you use to anaesthetise lingual gingivae in mandible?

IAN block, if given

Lingual infiltration

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What tissues need to be anaesthetised for a restoration?

Pulp

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What tissues need to be anaesthetised for an extraction?

Pulp and gingivae

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What are the 2 types of needles used for LA in adults and give their lengths

Short- 25mm

Long- 35mm

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Name 4 steps taken to prep patient for LA injection

Check medical history

Position in chair (dictated by type of treatment)

Dry mucosa

Apply topical (pea size on cotton wool)

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What are the 5 steps in injection technique?

Stretch mucosa

Puncture quickly- use distraction

Position needle tip at target point

Aspirate

Inject slowly- no less than 30 seconds

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What is the role of the bevel?

To provide a cutting surface, that offers little resistance to mucosa as the needle penetrates and withdraws from tissue

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Name the 4 important landmarks when giving IAN

Coronoid notch on mandibular ramus
Posterior border of mandible
Pterygomandibular raphe
Lower premolar teeth on opposite side

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Where is the site of anaesthetic deposition for IANs

In the region of the mandibular foramen

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How much of needle should be visible during IAN when bony contact is made?

1cm

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What 3 effects does LA have on CVS?

Myocardial depression
- decreased excitability
- decreased force of attraction
Vasodilation (arterioles)
Inhibition of sympathetic system

What are 2 adverse effects of LAs

Overdosage (toxic)

Allergy (rare)

Name 3 ways overdosage can be avoided

Limiting volume
Aspirating
Slow injection

What 4 effects does adrenaline have on heart, and what receptors involved?

Increased HR
Increased force
Increased CO
Increased excitability

β1 receptors

What 3 effects does adrenaline have on blood vessels and what receptors are involved?

Coronary dilation Skin contraction-- α receptors Muscle dilation-- β2 receptors

What effect does adrenaline have on BP?

Increased systolic Decreases diastolic Overall- little effect

Name 7 symptoms of adrenaline overdose

``` Fear/anxiety Trembling Weakness Dizziness Pallor/sweating Palpitations Headache ```

What is the cause of fainting?

Lack of oxygenated blood to brain

Name 6 clinical features of fainting

``` Light headiness Pallor Beads of sweat Bradycardia (slow pulse) Nausea Pupil dilation ```

Name 4 ways to manage fainting

Lay flat and raise legs Loosen neck clothing Improve room ventilation Sweet drink

Define trismus

Inability to open mouth fully

Cause of trismus

Probably damage to medial pterygoid Injection too low, too forceful

Cause of facial palsy

Local into parotid gland- infection too far posteriorly

How would you diagnose palsy?

Test branches of facial nerve

3 clinical features of IV injection

Skin blanching Visual disturbance Aural disturbance

Define surface anaesthesia

Anaesthesia of the surface tissues I.e. Skin, mucous membranes

3 uses of surface anaesthesia

Decrease pain of LA injection Decrease discomfort of venipuncture For superficial soft tissue manipulation

2 types of surface anaesthesia

Physical (refrigeration anaesthesia) Pharmacological (topical)

4 types of topical anaesthetic application

Intraoral topical agents Topical anaesthesias for skin Controlled release devices Jet injectors

What are 2 advantages and 4 disadvantages of topical jet injectors?

Adv- allows anaesthesia upto 1cm sole means achieving LA Dis- could cause soft tissue damage if careless Frightening sight and sound Taste of solution Expensive

What are 4 contradictions for using lidocaine?

Heartblock and no pacemaker Allergy to LA Hypotension Impaired liver function

2 uses of intraligamentary LA

Supplement infiltration | May eliminate need for block

What volume of LA is used for intraligamentary LAs

0.2ml per root

How is intraligamentary LA given?

30° to long axis of tooth in mesio buccal gingival sulcus

How would you give a mental block in child?

Advance needle in buccal sulcus towards region between apices of first and second primary molars

One advantage and disadvantage of mental block in kid

Adv- v good soft tissue anaesthesia Dis- not as reliable as ID

5 steps to deal with treatment of toxicity

``` Stop treatment Provide BLS Call for medical assistance Protect patient from injury Monitor vital signs ```

6 late localised complications of LA

``` Self-inflicted trauma Oral ulceration Trismus Long lasting anaesthesia Infection Developmental defects ```

What is Gow gates technique?

Open mouth technique Patient lying flat Aim for neck of condylar process

What is the Akinosi technique?

Closed mouth technique

Define an infiltration anaesthetic and what it's used for

LA solution deposited around terminal branches of nerves Used to anaesthetise soft tissues Used to produce pulpal anaesthesia where alveolar bone is thin (maxilla, lower anterior teeth)