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Local Anaesthetic > Local Anaesthetic > Flashcards

Local Anaesthetic Flashcards

1
Q

What is the structure of a LA molecule

A

Aromatic region (Hydrophobic)
Ester or Amide bond
Basic amine side chains (hydrophillic)

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2
Q

What is a LA molecule presented as and why

A

Hydrochloride to render the amine base more soluble making the injection less painful

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3
Q

Why is the LA molecule partly dissociated

A

Its active in its ionised form but can only cross the membrane in it unionised form

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4
Q

What is the composition of a LA preparation

A 
LA base present as a hydrochloride
2-4% solution for dental use
Reducing agent
preservatives 
vasoconstrictor e.g. adrenaline
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5
Q

What are the 2 familys of LA

A

Esters and Amides

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6
Q

What are the most likely causes of an alergic reaction to LA

A

The rubber bung or preservatives in the LA

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7
Q

What are esters and amides broken down by

A

Esters- tissue esterases

Amides- liver amidases

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8
Q

What does a preperation of lignocaine consist of

A

2% lignocaine HCL or 2% lignocaine HCL + 1:80,000

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9
Q

What does a preperation of Prilocaine consist of

A

3% prilocaine HCL or 3% prilocaine + felypressin

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10
Q

What is the max dose of adrenaline

A

500ug

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11
Q

How much adrenaline does a cartridge contain

A

27.5ug

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12
Q

In the dental school what syringe is used

A

safety plus

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13
Q

What is the most fragile part of the needle

A

The hub

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14
Q

How do you asemble a syringe

A

1A- Colllect syringe handle and needle
1B- Collect selected LA cartridges (check batch no. and exp. date)

2A- Unpack everything
2B- record details for decontamination

3- Make up syringe handle, attach rubber bung so that the wider side faces towards the handle

4- Load cartridge of LA solution in the needle barrel, gold side in first

5- Connect syringe handle and LA needle with cartridge, should hear a click into place and then check for attachement

6- Prepare needle for use, pull back on safety sheath with needle away from you and sheath should click into place at connection between syringe and barrel. Make needle safe by re-sheathing with 1 click= safe but can be reused 2nd= needle locked

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15
Q

Why use LA

A

Undertake a range of dental procedures pain free

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16
Q

How do you prep a patient before LA

A

Check med history
Position in chair
Dry mucosa
Apply topical for 1-2mins

17
Q

What is the infiltration technique

A

LA solution deposited around terminal branches of nerve

18
Q

What is the block technique

A

LA solution deposited beside nerve trunk

19
Q

How would you achieve anaesthesia of dental pulp in the maxilla

A

Buccal Infiltration

20
Q

How would you achieve anaesthesia of buccal gingivae in the maxilla

A

Buccal Infiltration

21
Q

How would you achieve anaesthesia of palatal gingivae

A

Palatal injection

22
Q

How would you achieve anaesthesia of dental pulp in the mandible

A

Lower molars (and second premolar)- Inferior alveolar nerve block (IAN/IDB)

Lower premolars and canine-Mental (incisive) nerve block

Lower canine and incisors- Buccal/labial infiltration

23
Q

How would you achieve anaesthesia of buccal gingivae in the mandible

A

Lower molars and second premolar- (Long) Buccal infiltration

Lower first premolar and canine- Infiltration or long buccal or mental nerve block

Lower incisors and canines- Buccal/labial infiltration

24
Q

How would you achieve anaesthesia of lingual gingivae in the mandible

A

Secondary part of a IAN or lingual infiltration

25
Q

What is the best technique when injecting LA

A 
Strech mucosa
Puncture mucosa quickly
Position needle tip at target point
Bevel of needle towards bone
ASPIRATE 
Inject SLOWLY
26
Q

What is the method for a Buccal infiltration

A

Stretch Cheek
Puncture mucosa with correct bevel distal of the tooth
Advance needle till over apex of tooth
If contact bone withdraw slightly
Aspirate
Remove syringe from mouth
Slide sheath down to first click
Can replace cartridge if need further injections
Wait for 2 minutes for anaesthesia and test

27
Q

What is the method for a palatal infiltration

A

Short needle

Area of needle penetration is 5-10mm palatal to center of the crown

Apply presssure directly behind injection site with a cotton probe or mirror handle

Insert needle at 45degrees to injection site with bevel angled towards soft tissue

While maintaining pressure behind the injection site, advance the needle, and slowly deposit anesthetic solution as the soft tissue is penetrated

Advance the needle until contact is made with bone

Depth of penetration is usually no more than a few millimeters. The tissue is very firmly adherent to the underlying periosteum in this region, causing resistance to the deposition of local anesthetic

No more than 0.2–0.4 mL of anesthetic solution is necessary to provide adequate palatal anesthesia

Blanching of the tissue at the injection site immediately follows deposition of local anesthetic

28
Q

what LA injections can be perfromed as buccal infiltrations in mandible

A

Mental nerve block- between apices of lower premolars ( do not put in foramen)

Buccal injection- Lower buccal gingivae

29
Q

What is the method for Inferior Alveolar block

A

Long needle

Identify site so ask patient to open wide so can identify landmarks

Place thumb of nonworking hand intraorally at the coronoid notch and fingers extraorally at posterior border of ramus

inserted through the mucosa in the mandibular retro-molar region and lateral to the the pterygomandibular raphe 6-10mm above molar

Syringe lies over contra lateral 5-6

Advance to bony contact (1cm of needle visible)

If no bony contact reposition syringe distally and if too soon reposition mesially

When in correct position withdraw from bony contact slighlty

Aspirate and inject slowly (about 1.5ml)

30
Q

What is the onset time of Lidocaine

A

2-3mins

31
Q

What does a preperation of Articane consist of

A

Articane HCL 4% with adrenaline of either; 1:100,000 1:200,000 1:400,000

32
Q

What is the difference between Articane and Lidocaine

A

Articane is more potent by about 1.5x and has a more rapid onset

33
Q

What are the systemic complications of LA

A 
Psychogenic
Interactions with other drugs
Cross infections
Allergy
Collapase
Toxcicity
34
Q

What drugs can LA interact with

A

Tricyclics, B blockers, Non-potassium sparing diuretics

35
Q

What is the max dose (mg/kg) of Lignocaine

A

5mg/kg

36
Q

What is the max dose (mg/kg) of Articane

A

7mg/kg

37
Q

What is the max dose (mg/kg) of Prilocaine

A

8mg/kg

38
Q

With patients with cardiovascular disease what is the recomended number of cartridges

A

<3x2.2ml cartridges

39
Q

What are the local complications of LA

A

Failure to achieve anaesthesia
Prolonged anaesthesia(direct trauma from needle)
Pain after/during injection
Trismus(PROBABLY DAMAGE TO MEDIAL PTERYGOID)
Haematoma
Broken needle
Infection/ contamination
Facial paralysis (local into protid gland)
Intra-vascular injection

Local Anaesthetic (1 decks)

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