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ICS > Local Anaesthesia 2 > Flashcards

Local Anaesthesia 2 Flashcards

1
Q

why are vasoconstrictors used

A 
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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2
Q

what are the types of vasocnostrtors

A

sympathomimetic amines

synthetic polypeptide

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3
Q

what is the sympathomimetic amine

A

adrenaline

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4
Q

what is the synthetic polypeptide

A

felypresin

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5
Q

what does adrenaline act on

A

alpha 2 receptors

adrenoreceptors

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6
Q

what si the usual concentration used of adrenaline in LA

A

1:80,000 = 12.5 micrograms/ml

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7
Q

what si the adrenaline in a cartridge

A
  1. 2ml cartridge

27. 5 micrograms

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8
Q

what does adrenaline require for shelf life

A

preservative

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9
Q

what are the systemic effects of adrenaline

A

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

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10
Q

how much felypressin is usually used

A

0.03 IU/ml = 0.54 micrograms/ml

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11
Q

what si felypressins relationship to vasopressin

A

analogous

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12
Q

what does felypressin work on

A

venous side

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13
Q

what is the potency of felypressin like in comparison to adrenaline

A

vasoconstrictive potency is about half

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14
Q

what is the haemostats ability of felypressn like compared to adrenaline

A

poor

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15
Q

what is the mild effect of felypressin considering pregnancy

A

ocytocic effect

induce labour

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16
Q

what des felypressin risk of interferon with

A

interferign with placental circulation and uterine tone

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17
Q

what is the max dose recommended for healthy adult

A

lidocaine 2%
adrenaline 1:80,000
500mg

lidocaine 2% plain
300mg

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18
Q

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

A

slows down systemic uptake of drug

but vasoconstrictor effect can be variable

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19
Q

what is lidocaine and adrenaline aka

A

utilycaine

lignospan special

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20
Q

what is lidocaine anaesthetic

A

lidocaine hydrochloride

2% = 20mg/ml

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21
Q

what is the vasoconstrictor used in lidocaine

A

adrenaline

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

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22
Q

what si the preservative used in lidocaine

A

sodium or potassium metabisulphite

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23
Q

what is the max dose of lidocaine

A

4.4mg/kg (300mg)

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24
Q

what is another way of working out max does

A

based on pt weight

tenth cartridge per kg for healthy pt

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25
Q

using weight what is max lidocaine for healthy pt

A

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

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26
Q

what is mepivicaine aka

A

scandonest 3% plain

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27
Q

what is mepiviacaine

A

mepivicaine hydrochloride

3% = 30 mg/ml

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28
Q

what is mepivicaines vasoaons

A

none

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29
Q

what is the preservative in mepivicaine

A

none

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30
Q

what is the max dose of anaesthetic

A

4.4mg/kg

300mg

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31
Q

what is imp about mepivicaine

A

least vasodilatory

reasonable duration when used plain

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32
Q

what si prilocaine and felypressing aka

A

citanest 3% with octapressin

33
Q

what sis th prilocaine LA called

A

prilociane hydrochlorde

3% = 30mg/ml

34
Q

what is the vasoaons used in prilocaine

A

felypressin

0.03 IU/ml = 0.54 micrograms/ml

35
Q

what is the preservative used in prilocaine

A

not required

36
Q

what is the max anaesthetic dose

A

6mg/kg

37
Q

what is lidocaine/adrenaline used for

A

used for most injections

38
Q

when do u not use lidocaine/adrenaline

A

unstable angina
severe cardiac dysrhythmia
allergy to any components

39
Q

when do u use prilocaine/octapresisn

A

avoiding adrenaline
latex allergy
prevrtaive allergy

40
Q

when do not use prilocaine

A

avoid in pregnancy

41
Q

when use mempivicaine

A

alternative to prilocaine

42
Q

when use articaine

A

USP - diffusibility, esp thor bone

potential alternative to inf alv blocks

43
Q

when to reduce dose

A

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

44
Q

what drugs did adrenaline contraindicate

A

tricyclic antidepressants

mono-amine oxidase inhibitors

45
Q

how do u prevent adrenaline contraindicating a drug

A

reduce dose or use alternative

46
Q

what is articaine

A

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

47
Q

what is articaine increases lipid solubility

A

thiopene ring

48
Q

what si the vol of spetanest

A

1:100,000

49
Q

what is the vol of barticaine

A

1”100,000

50
Q

what is the conc of articaine to be used

A

4% = 40mg/ml

88mg

51
Q

what is the vasoconstrictor in articaine and how much of it

A

adrenaline
1:100,000
10 micrograms/ml

52
Q

what is the preservative used in articaine

A

sodium metabisulphite

53
Q

what si the max dose of articaine

A

7mg/kg

300mg

54
Q

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

A

children <4 years

55
Q

what does the plasma contain for LA metab

A

plasma esterases

56
Q

what does the liver contain for LA metab

A

hepatic enzymes

57
Q

what is most elimination of LA done via

A

kidneys

58
Q

what does rapid breakdown show

A

low system toxicity

59
Q

what are some short lasting LA

A

lidocaine
prilocaine
mepivicaine

60
Q

what criteria is used if another LA is needed

A

efficacy
USP
safe
evidence

61
Q

what si efficacy

A

is it as good as others

62
Q

what is USP

A

does it have a unique selling point

63
Q

what makes a USP

A

ability to diffuse through bone

anaesthesia of lower post teeth by infiltration

64
Q

what are the LA’s used for mandibular infiltration

A

randomised crossover double bind trial

4% articiane vs 2% lidocaine

65
Q

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

A

articiane 64.5%

lidocaine 38.7%

66
Q

what LA is more effective on the mandibular infiltration

A

more effective at anaesthetising lower molars by infiltration

67
Q

what is the randomised controlled trial for manidnblar infiltraiosn

A

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

68
Q

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

A

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

69
Q

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

A

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

70
Q

what is paraesthesia

A

altered sensation

71
Q

what causes paraesthsia

A

physical trauma to nerve trunk

72
Q

does articaine cause paraestheisa

A

not likely due to articaine

lowest neurotoxicity when compared to other drugs at same conc

73
Q

what is articaine efficacy like

A

appears to be as good a lidocaine and prilocain

74
Q

what is USP of articaine

A

more profound anaesthesia
lower molars by infiltration
inc scirnetifc evidence

75
Q

what is the safety of articiane

A

low toxicity due to rapid metabolism

higher incidence to lidocaine

76
Q

what does IAB success depend largely upon

A

accuracy injection
anatomy
speed of injection
not diffusibility through bone

77
Q

what is avoided when IAB

A

artiaine

78
Q

consider using articiane by infiltration when

A

failed IAB’s
supplementing IABS
to avoid IAB’s

ICS (3 decks)

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