local ana in dent Flashcards
Define analgesia?
Absence of sensibility of pain, particularly the relief of pain without loss of consciousness
What do local anaesthetics do?
They eliminate sensations, especially pain, in one part of the body by the topical application or regional injection of a drug
What do local anaesthetics block?
They block entry of sodium ions into cells therefore blocks action potential
What are the 2 types of local anaesthetics?
- Amino esters– largely superseded (cocain, Procaine)
- Amino-amides: always have an i before the Caine bit: priolocain, lidocaine, mepivocaine, bupivacaine, articaine
What is the most common local anaesthetic we administer and what is the dosage we give?
Lidocaine 2% plain or with epinephrine 1:80,000
Describe Mepivacaine 3% plain 2% with epinephrine
It is plain and very short acting
Brand: scandonest
How are local anaesthetics metabolised excreted?
- Amino amides are metabolised by the liver| 2. Excreted via the kidneys
What advise do manufacturers say about the use of lidocaine?
manufacturers advise caution in patients with liver disease
Who should we avoid giving Felypressin?
Avoid in pregnancy
(Similar to oxytocin)
Who should we taken caution in giving Adrenalin / Epinephrine?
Care in ischaemic heart disease, hypertensives, unstable angina
What do Vasoconstrictors inc/ dec in local anaesthetics?
increase
-duration and depth of anaesthesia and reduce local blood flow
-increases length of action of local anaesthetic
Decrease
- lowers anaesthetic concentration in blood so decreases risk of toxicity
- decreases amount of bleeding at operation site
How can the operator reduce the chances of getting a needle stick injury?
Do not re-sheath or re-use| Use safety-plus system
How can patients have an allergy local cal anaesthetics?
Usually due to preservative| Was more common to ester-type (benzocaine, cocaine procaine).
Latex allergy may be triggered by rubber bung in cartridge. (Now more latex free but check packaging)
What are some symptoms of local anaesthetic allergy?
- Swelling2. Nausea malaise3. May lose consciousness4. Facial and laryngeal oedema
What are Psychogenic reactions a patient could have to LA?
Feeling faint
Fainting
Palpitations
Panic attack
What is a Vasovagal attack?
Fainting
What should you do if your patient faints?
- Lie them flat - head down
- Loosen tight clothing
- Call for help
- Give them a Glucose drink
If no improvement = - Check – airway, breathing, circulation
- Oxygen if necessary
- If not recovered in 2-3 minutes – assume not simple faint
Who should we take care with when administrating adrenaline?
Recent myocardial infarction or coronary artery bypass graft
Care in hypertension and heart problems (especially if unstable)
Care when using on patients tricyclic antidepressants, SSRIs, diuretics
What some adverse events that can occur when administering LA?
- Broken needle (Rare)
- Pain during or after
- Haematoma
- Trismus
- IV injection
- Blanching
- Facial paralysis
- Prolonged impaired sensation
- Soft tissue trauma
- Visual disturbances
How can we make LA less painful?
- explain, reassure, tailor treatment
- Use topical properly
- Room temperature cartridges
- Careful needle placement
- pressure w mirror handle, stretch tissues
- SLOW injection controlled delivery.