Local Anaesthesia 2 Flashcards by Charlotte Smith

why are vasoconstrictors used

increase speed of onset
counteract vasodilatory effects of LA agent
extend duration LA 
improve depth LA
lower blood levels of LA
reduce haemorrhage

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what are the types of vasocnostrtors

sympathomimetic amines

synthetic polypeptide

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what is the sympathomimetic amine

adrenaline

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what is the synthetic polypeptide

felypresin

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what does adrenaline act on

alpha 2 receptors

adrenoreceptors

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what si the usual concentration used of adrenaline in LA

1:80,000 = 12.5 micrograms/ml

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what si the adrenaline in a cartridge

2ml cartridge

27. 5 micrograms

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what does adrenaline require for shelf life

preservative

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what are the systemic effects of adrenaline

direct raises rate and force of contraction - CO
may inc BP
vasoaons

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how much felypressin is usually used

0.03 IU/ml = 0.54 micrograms/ml

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what si felypressins relationship to vasopressin

analogous

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what does felypressin work on

venous side

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what is the potency of felypressin like in comparison to adrenaline

vasoconstrictive potency is about half

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what is the haemostats ability of felypressn like compared to adrenaline

poor

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what is the mild effect of felypressin considering pregnancy

ocytocic effect

induce labour

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what des felypressin risk of interferon with

interferign with placental circulation and uterine tone

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what is the max dose recommended for healthy adult

lidocaine 2%
adrenaline 1:80,000
500mg

lidocaine 2% plain
300mg

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why si there a higher maximum dose when a vasoconsritor is used

slows down systemic uptake of drug

but vasoconstrictor effect can be variable

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what is lidocaine and adrenaline aka

utilycaine

lignospan special

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what is lidocaine anaesthetic

lidocaine hydrochloride

2% = 20mg/ml

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what is the vasoconstrictor used in lidocaine

adrenaline

1: 80,000
12. 5 micro grams/ml

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what si the preservative used in lidocaine

sodium or potassium metabisulphite

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what is the max dose of lidocaine

4.4mg/kg (300mg)

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what is another way of working out max does

based on pt weight

tenth cartridge per kg for healthy pt

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using weight what is max lidocaine for healthy pt

70kg man = 7/10 cartridge 1/10 = 4.4mg dose = 308mg

what is mepivicaine aka

scandonest 3% plain

what is mepiviacaine

mepivicaine hydrochloride | 3% = 30 mg/ml

what is mepivicaines vasoaons

none

what is the preservative in mepivicaine

none

what is the max dose of anaesthetic

4.4mg/kg | 300mg

what is imp about mepivicaine

least vasodilatory | reasonable duration when used plain

what si prilocaine and felypressing aka

citanest 3% with octapressin

what sis th prilocaine LA called

prilociane hydrochlorde | 3% = 30mg/ml

what is the vasoaons used in prilocaine

felypressin | 0.03 IU/ml = 0.54 micrograms/ml

what is the preservative used in prilocaine

not required

what is the max anaesthetic dose

6mg/kg

what is lidocaine/adrenaline used for

used for most injections

when do u not use lidocaine/adrenaline

unstable angina severe cardiac dysrhythmia allergy to any components

when do u use prilocaine/octapresisn

avoiding adrenaline latex allergy prevrtaive allergy

when do not use prilocaine

avoid in pregnancy

when use mempivicaine

alternative to prilocaine

when use articaine

USP - diffusibility, esp thor bone | potential alternative to inf alv blocks

when to reduce dose

liver disease - impaired metabolism beta blockers calcium channel blockers drug abuse

what drugs did adrenaline contraindicate

tricyclic antidepressants | mono-amine oxidase inhibitors

how do u prevent adrenaline contraindicating a drug

reduce dose or use alternative

what is articaine

3- propylamino-2-carbomethoxy-4-methylthiopene hydrochloride AMIDE with ESTER

what is articaine increases lipid solubility

thiopene ring

what si the vol of spetanest

1:100,000

what is the vol of barticaine

1"100,000

what is the conc of articaine to be used

4% = 40mg/ml | 88mg

what is the vasoconstrictor in articaine and how much of it

adrenaline 1:100,000 10 micrograms/ml

what is the preservative used in articaine

sodium metabisulphite

what si the max dose of articaine

7mg/kg | 300mg

what is group of people is articiane not to be used on

children <4 years

what does the plasma contain for LA metab

plasma esterases

what does the liver contain for LA metab

hepatic enzymes

what is most elimination of LA done via

kidneys

what does rapid breakdown show

low system toxicity

what are some short lasting LA

lidocaine prilocaine mepivicaine

what criteria is used if another LA is needed

efficacy USP safe evidence

what si efficacy

is it as good as others

what is USP

does it have a unique selling point

what makes a USP

ability to diffuse through bone | anaesthesia of lower post teeth by infiltration

what are the LA's used for mandibular infiltration

randomised crossover double bind trial | 4% articiane vs 2% lidocaine

what si the success of the LA's used in mandibular infiltration

articiane 64.5% | lidocaine 38.7%

what LA is more effective on the mandibular infiltration

more effective at anaesthetising lower molars by infiltration

what is the randomised controlled trial for manidnblar infiltraiosn

4% artisane buccal + lingual infiltration vs 2% lidocaine by IAB

what is comparable about LA in randomised controlled trial for manidnblar infiltraiosn

efficacy 4% artisane by infiltration comparable to 2% lidocaine by IAB

what are some safety considerations that can take place in LA use

rapid metab (plasma esterases, liver amid eases) lower adrenaline conc higher anaesthetic conc 4%

what is paraesthesia

altered sensation

what causes paraesthsia

physical trauma to nerve trunk

does articaine cause paraestheisa

not likely due to articaine | lowest neurotoxicity when compared to other drugs at same conc

what is articaine efficacy like

appears to be as good a lidocaine and prilocain

what is USP of articaine

more profound anaesthesia lower molars by infiltration inc scirnetifc evidence

what is the safety of articiane

low toxicity due to rapid metabolism | higher incidence to lidocaine

what does IAB success depend largely upon

accuracy injection anatomy speed of injection not diffusibility through bone

what is avoided when IAB

artiaine

consider using articiane by infiltration when

failed IAB's supplementing IABS to avoid IAB's