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Module 3 Revision > Local Anaesthetic > Flashcards

Local Anaesthetic Flashcards

1
Q

What does a white handle on a syringe indicate?

A

It is single-use

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2
Q

What type of aspiration does an ultra safety plus twist syringe have?

A

Self-aspiration

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3
Q

Which direction should the finger grip be twisted when it is inserted into syringe barrel to lock it into place?

A

Clockwise

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4
Q

What is the purpose of the small protuberance at the bottom of the cartridge barrel?

A

It depresses the cartridge diaphragm throughout the injection procedure

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5
Q

In what instance would you slide the protective sheath down the barrel of syringe until you hear first click?

A

If you need to set the needle down or change cartridge

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6
Q

When you hear first click of protective sheath down barrel of syringe what does this mean?

A

It is in holding position

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7
Q

When you are finished with injection what should you immediately do?

A

Push protective sheath further until you hear a second click, this is in final position and is fully locked.

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8
Q

What direction should the finger holder of syringe be turned to be released from barrel?

A

Anti-clockwise

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9
Q

What are the three main components of dental local anaesthetic equipment (syringe)?

A
  1. Syringe barrel with needle
  2. LA cartridge
  3. Plunger/handle
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10
Q

What component of the syringe can be either single-use or come in a form that may be sterilised and reused?

A

Plunger/handle

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11
Q

What is the bevel?

A

The tip of the needle which is very sharp and appears asymmetric

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12
Q

What are the 3 types of needle/syringe used in dental LA?

A
  1. Ultrashort
  2. Short
  3. Long
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13
Q

What is the length and gauge of an ultrashort needle?

A

Length: 10mm
Gauge: 30

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14
Q

Define gauge in relation to LA

A

The size of the hole in needle

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15
Q

If the gauge becomes higher, what would happen to the size of hole in the needle?

A

It would decrease

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16
Q

How many types of ‘short’ needle can you have and what is the difference between them?

A

Two types. The length is the same, however the gauge differs

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17
Q

What are the two different gauges of small needle?

A

Blue = 30
Orange = 27

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18
Q

What is the length of a small needle?

A

25mm

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19
Q

What is the length and gauge of a long needle?

A

Length: 35mm
Gauge: 27

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20
Q

What LA is generally used in Dundee dental hospital? (Trade name)

A

Lignospan special

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21
Q

What volume of solution does one cartridge of lignospan specail contain?

A

2.2ml

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22
Q

What does the 2.2ml solution found in one cartridge of lignospan special contain?

A

44 mg lidocaine hydrochloride
27.5 micro grams adrenaline

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23
Q

What does adrenaline act as?

A

A vasoconstrictor

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24
Q

Apart from LA and vasoconstrictor, what else is contained within one cartridge of lignospan special?

A
  • stabiliser/ preservative
  • isotonic carrier medium
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25
Q

On disposal, what components of a syringe would be put into the sharps bin?

A

Cartridge
Barrel and needle

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26
Q

What component of a syringe would be disposed of in the clinical waste bin?

A

Fingergrip/ handle

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27
Q

What aids the prevention of intra-vascular injection?

A

Aspiration

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28
Q

What could be the two main consequences of intra vascular injection?

A
  • inadequate/failure of anaesthesia
  • increased risk of systemic side effects
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29
Q

Lowering pressure on the cartridge achieves what?

A

Aspiration ( if in vessel, blood will flow back)

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30
Q

Define anaesthesia

A

Loss of sensation

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31
Q

Define analgesia

A

Loss of pain sensation

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32
Q

Loss of sensation in a localised area of the body, involving no loss of consciousness is a result of?

A

Local anaesthetic

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33
Q

What was found to increase the duration of anaesthesia in 1901?

A

Adrenaline

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34
Q

What can induce haemostasis?

A

Adrenaline

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35
Q

Define haemostasis

A

Cessation of bleeding

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36
Q

LA is used for pain control in what scenarios?

A
  • during procedures
  • post-operatively
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37
Q

Give some examples of dental procedures where LA may be used

A

Scaling, extraction, endodontics

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38
Q

What are the four different types of LA techniques ?

A
  1. Topical
  2. Infiltration
  3. Regional (block)
  4. Supplementary techniques
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39
Q

Anaesthesia of surface tissues is achieved by application of what?

A

Topical anaesthesia

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40
Q

Anaesthesia of the root apex of a tooth is achieved through what technique?

A

Infiltration

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41
Q

Anaesthesia of a nerve trunk is achieved through what technique?

A

Regional (block)

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42
Q

What type of anaesthetic is used in very minor oral surgery, abscess incisions, or on the palate for impressions?

A

Topical anaesthesia

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43
Q

What determines the effectiveness of infiltration anaesthesia?

A

The permeability of bone, through which the solution must pass

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44
Q

If there is dense bone, will this result in less or more effective anaesthesia?

A

Less effective

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45
Q

If there is thin and porous bone, will this result in less or more effective anaesthesia ?

A

More effective

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46
Q

what length of needle is typically used for infiltrations?

A

25mm (short needle)

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47
Q

What is key to remember about speed when injection?

A

Always inject SLOWLY

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48
Q

What tooth causes the most complications for infiltration anaesthesia?

A

Maxillary 6’s

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49
Q

Why do maxillary 6’s cause such a complication for infiltration procedures?

A
  • thick bone at zygomatic process, where upper 6 lays.
  • divergent palatal root on upper 6 is difficult to reach
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50
Q

What type of anaesthesia will not work on very dense outer cortical bone ( i.e. surrounding lower molars)?

A

Lidocaine infiltration

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51
Q

Infiltration with another LA is believed to work on very dense outer cortical bone. What is this anaesthetic?

A

Articaine

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52
Q

Intraligamentary and intraosseous are two forms of what?

A

Supplementary technique

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53
Q

How would you perform an intraligamentary supplemental technique?

A

Inject down PDL

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54
Q

Is an intraligamentary technique high or low pressure?

A

High

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55
Q

How would you perform an intraosseous supplementary technique?

A

Drill hole into bone, inject through hole in bone.

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56
Q

Where is articaine metabolised?

A

In the plasma and liver

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57
Q

How are LA’s classified by structure?

A

They are amide or ester

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58
Q

Give examples of amide LA’s

A
  • lidocaine, prilocaine, articaine etc.
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59
Q

Give an example of an ester LA

A

Benzocaine

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60
Q

What LA is mostly amide in structure but also has ester links?

A

Articiane

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61
Q

What is the impact of an LA with a low pKa?

A

PKa reflects solubility. An anaesthetic can exist on either a charged or uncharged form, the more uncharged, the easier it will pass through lipid membrane. The lower the pKa ( more uncharged) , the faster the onset of anaesthetic.

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62
Q

How does pH impact LA performance?

A

Low pH gives more charge which has a negative/lowered effect on LA performance

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63
Q

Name an LA with a high protein binding

A

Articaine

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64
Q

Name the least vasodilatory LA

A

Mepivocaine

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65
Q

Where are most LA’s metabolised?

A

Liver and plasma

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66
Q

What LA is metabolised in the lungs?

A

Prilocaine

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67
Q

What is the effect of LA drugs on the heart?

A

They act as vasodilators, therefore calm down an overexcitable heart

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68
Q

Why is a vasoconstrictor commonly used alongside LA agent?

A

Prolongs length of anaesthesia

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69
Q

What is the most potent vasoconstrictor used in dentistry?

A

Adrenaline

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70
Q

Name two vasoconstrictors that can be used alongside LA agent

A

Adrenaline
Phelypressin

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71
Q

Which component of the LA cartridge requires a preservative/ stabiliser? And why?

A

Adrenaline
As it oxidises quickly

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72
Q

What is the affect of a vasoconstrictor in systemic uptake of anaesthetic?

A

Slows it down

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73
Q

What is the max dose of lidocaine + adrenaline that can be given to an 85KG healthy adult male?

A

300mg ( 6.8 cartridges)

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74
Q

What LA preparation could be given to a patient who cannot accept adrenaline?

A

Mepivocaine and prilocaine

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75
Q

Why does articaine have a low systemic toxicity?

A

It is broken down in plasma and liver so does not remain in high levels in the blood

76
Q

What determines the efficacy of an infiltration LA?

A

Bone density

77
Q

State the boundaries of the pterygomandibular space

A

Lateral= mandible
Medial= medial pterygoid
Anterior = buccinator
Posterior = parotid gland
Superior= lateral pterygoid

78
Q

What nerves need to be anaesthetised to extract a lower molar tooth?

A
  • inferior alveolar nerve
  • long buccal nerve
  • lingual nerve
79
Q

What tissues are supplied by the incisive nerve?

A

Anterior teeth (incisors and canines)

80
Q

What LA technique is used predominantly for maxillary anaesthesia?

A

Infiltrations

81
Q

What are the four important nerves that branch for CN V2 regarding delivery of maxillary LA?

A
  • posterior superior alveolar nerve
  • middle superior alveolar nerve
  • anterior superior alveolar nerve
  • infraorbital nerve
82
Q

Where does anaesthesia of the anterior superior alveolar nerve block sensation to?

A

The maxillary incisors and canine (bilaterally)

83
Q

Where does anaesthesia of the middle superior alveolar nerve block sensation to?

A

The maxillary pre-molars and mesio-buccal root of 1st molar (bilaterally)

84
Q

Where does anaesthesia of the posterior superior alveolar nerve block sensation to?

A

Maxillary molars (bilaterally)

85
Q

Where does anaesthesia of the incisive branch of the nasopalatine nerve block sensation to?

A

The palatal gingivae of anterior teeth and the anterior part of palate ( from insicors to canines)

86
Q

What part of the gingiva does the infraorbital nerve innervate?

A

High up in the labial sulcus

87
Q

To achieve anaesthesia of the 2nd upper premolar through buccal infiltration, what nerve ending would you aim to block?

A

Middle superior alveolar nerve

88
Q

What are the two main LA techniques used for maxillary anaesthesia?

A

Infiltrations and regional blocks

89
Q

This LA technique is easy, safe, has low risk of intra vascular administration and low risk of nerve injury. What is being described?

A

Infiltration technique

90
Q

What is the main downfall of infiltration technique?

A

It requires local diffusion for effectiveness, this can be tricky to achieve at times.

91
Q

This LA technique can be difficult and has a higher risk of intra vascular administration and nerve injury than another commonly used technique.

A

Regional block

92
Q

What does infiltration anaesthesia set out to achieve?

A

Diffusion of LA solution close to, to in the target tissue ( root apex)

93
Q

What type of needle would you use for an infiltration?

A

25mm (blue-cap short needle)

94
Q

What type of bone does infiltration work best with?

A

Thin porous bone ( e.g. maxillary anterior teeth)

95
Q

In what area of the dentition can infiltrations prove difficult to achieve?

A

Around the maxillary first molar. This is due to its palatal divergent root as well as the thicker lateral bone due to the zygomatic process.

96
Q

What type of bone will lidocaine infiltrations not work on?

A

Very dense outer cortical bone

97
Q

What LA solution would work on infiltration of dense outer cortical bone? And why?

A

Articaine as it has higher diffusivity rate than lidocaine

98
Q

What LA solution is most commonly used for infiltrations?

99
Q

How would you apply topical anaesthesia?

A
  1. Identify injection site
  2. Dry with 3 in 1
  3. Apply gel using cotton wool or gauze
  4. Leave cotton wool/gauze in place for 3-5 mins
  5. Deliver injection or perform procedure
100
Q

When giving an infiltration, what must the tissue be?

101
Q

What angle must the syringe be to the bone when giving infiltration?

A

45 degrees

102
Q

At what point would you inject solution when giving an infiltration?

A

When bone has been contacted and aspiration has occurred

103
Q

At what speed should you inject LA solution?

104
Q

What is aspiration?

A

Technique used to reduce the risk of intra vascular injection

105
Q

What would indicate that an injection has gone into a vessel?

A

If blood appears in the cartridge after aspiration

106
Q

How long should it take to administer 1ml of LA solution ( half a cartridge)?

107
Q

Why are palatal infiltrations often uncomfortable/painful?

A

Because the periosteum is lifted from the bone during injection

108
Q

In what situation would you most likely require palatal infiltrations?

A

For tooth extractions

109
Q

What maxillary nerves are commonly anaesthetised using regional block technique?

A

Greater palatine nerve or the incisive nerve

110
Q

What needle would be used for maxillary regional blocks?

A

25mm ( blue-cap short needle)

111
Q

How would you locate the incisive branch of the nasopalatine nerve for a regional block?

A

Would be found in line with canines (horizontally) and in line with the interproximal space between central incisors ( vertically)

112
Q

What location would you find the greater palatine nerve when giving a regional block?

A

In line with the interproximal space between the upper 2nd and 3rd molars

113
Q

Which LA technique would be required if an upper canine required a restoration?

A

Labial infiltration for pulpal anaesthesia

114
Q

Which LA technique would be required for extraction if upper canine?

A

Labial and palatal infiltration

115
Q

Which LA technique would be required to restore an upper 7?

A

Buccal infiltration

116
Q

Which LA technique would be required for the extraction of an upper 7?

A

Buccal and palatal infiltration

117
Q

Which LA technique would be required to restore all upper premolars and molars?

A

A range of buccal infiltrations
(possibly a palatal infiltration for upper 6 divergent root)

118
Q

Which LA technique would be required for extraction of upper all premolars and molars?

A

A greater palatine nerve block

119
Q

Which LA technique would be required to restore both upper central incisors?

A

Two labial infiltrations

120
Q

Which LA technique would be required for extraction of both upper central incisors?

A

Labial infiltration and a nasopalatine nerve block

121
Q

What are the main nerves associated with the CN V3 for mandibular anaesthesia?

A
  • inferior alveolar nerve
  • lingual nerve
  • long buccal nerve
  • mental nerve
  • incisive nerve
122
Q

The lingual nerve enters the mandible. True or false?

A

False. It does not enter the mandible.

123
Q

What area of the mouth does the mental nerve innervate?

A

The lower lip and surrounding soft tissues

124
Q

What teeth does the inferior alveolar nerve innervate?

A

All molars and premolars of the mandible

125
Q

What teeth does the incisive nerve innervate?

A

All incisors and canines of the mandible

126
Q

What type of nerve block can anaesthetise a while side of the mandible?

A

Inferior alveolar nerve block

127
Q

What needle is required for an inferior alveolar nerve block?

A

35mm long needle ( yellow-cap)

128
Q

What is the common technique used for inferior alveolar nerve block?

A

The direct technique (halstead approach)

129
Q

Where does the inferior alveolar nerve enter the mandible?

A

Through the mandibular foramen

130
Q

What structure sits medial to the buccinator muscle and is of importance when it comes to IANB injections?

A

Pterygomandibular raphe

131
Q

Which part of the inferior alveolar nerve is targeted when giving a block?

A

The part of the nerve that is exposed before it enters the mandible

132
Q

What could happen if anaesthetic is deposited too far posteriorly during an IAN block?

A

It could penetrate the facial nerve causing drooping of the muscles of facial expression

133
Q

What is the sign of mental nerve anaesthesia?

A

When the lower lip becomes numb

134
Q

What is the medial border of the pterygomandibular space?

A

Medial pterygoid muscle

135
Q

What is the lateral border of the pterygomandibular space?

A

Ramus of the mandible

136
Q

What is the posterior border of the pterygomandibular space?

A

Parotid gland and facial nerve (CN VII)

137
Q

What is the anterior border of the pterygomanibular space?

A

Buccinator

138
Q

What is the superior border of the pterygomanibular space?

A

Lateral pterygoid muscle

139
Q

What LA solution cannot be used for block anaesthesia in the mandible? And why?

A

Articiane, as it can have a negative impact on nerve trunks

140
Q

When giving an IAN block, where would you place your supporting thumb?

A

In the coronoid notch of the anterior border of the ramus

141
Q

What are the three boundaries of the injection point for an IAN block?

A
  1. Thumb in coronoid notch
    2.Pterygomandibular raphe
  2. Vertical height halfway up thumbnail
142
Q

When should you stop inserting the needle in an IANB?

A

When you hit bone ( approx 2.5cm)

143
Q

What should the injection Angela of the syringe be for an IAN block?

A

The syringe should come across the mouth, the barrel should be sat over the premolars of the opposite side of the mouth

144
Q

When would you known an IAN block was successful?

A

When the patients lower lip has gone numb

145
Q

What is the difference between a lingual nerve block and IAN block?

A

Lingual nerve block is much more (1-1.5cm) superficial

146
Q

Where does the long buccal nerve branch across and why is this important to know?

A

Branches across the coronoid notch, important for long buccal nerve block

147
Q

Where would you administer a mental nerve block and with what needle?

A

Administer inferior to the interproximal space between premolars. Use a short needle (25cm)

148
Q

In what scenario would you split the dose of LA between a labial and lingual infiltration?

A

For restoration or extraction of a mandibular incisor

149
Q

In the mandible, what LA solution is preferred for infiltrations?

150
Q

Why should you never do a bilateral IAN block?

A

The patients mouth would be completely numb

151
Q

What are the three types of supplemental technique?

A
  • intra-osseous ( direct + intraligamentary + periodontal)
  • intra- papillary
  • Akinosi injection
152
Q

Technique where needle is inserted into hole in the cortical bone

A

Direct intraosseous technique

153
Q

What is the high pressure technique which administers low volumes of LA down the PDL?

A

Intraligamentary

154
Q

What is the likely mode of action of the intraligamentary technique?

A

Spread of LA solution out of PDL to cancellous bone

155
Q

What are the two main advantages of intra-papillary supplementary technique?

A
  • allows for comfortable palatal anaesthesia
  • useful for child treatment
156
Q

What should you observe at the papilla while giving intra-papillary LA?

A

Blanching ( turns white)

157
Q

What supplementary technique does not involve injection, but involves squirting topical LA into periodontal pocket?

A

Intra-periodontal pocket technique

158
Q

What LA preparations cam be given plain? ( without vasoconstrictor)

A
  • Mepivacaine
  • prilocaine
159
Q

What determines whether an anaesthetic is amide or ester?

A

The structure of it’s intermediate chain

160
Q

What are examples of ester anaesthetics?

A
  • procaine
    -benzocaine
161
Q

What are examples of amide anaesthetics?

A
  • lidocaine
  • prilocaine
  • mepivacaine
  • bupivacaine
  • articaine
162
Q

Which LA preparation is classed as an amide but also has an ester link?

163
Q

All LA used by injection are what? Amides or esters.

164
Q

What is the specific receptor theory for how anaesthetic travels through membrane to access Na+ channels?

A
  • LA binds to channels, inactivating them.
165
Q

A drug will travel through a membrane faster if its… charged or uncharged?

166
Q

What are the two factors that determine whether a drug us charged or uncharged?

A
  1. PKa of drug
  2. pH of environment
167
Q

Is LA more charged or uncharged if pKa of LA is low?

168
Q

What two drugs have lower pKa values, allowing them to work quicker?

A

Lidocaine and articaine

169
Q

What is the working time of lidocaine and articiane?

170
Q

If the environments pH is low, will the LA be more uncharged or charged?

171
Q

Which nerve fibres are easiest to block through LA?

172
Q

which nerve fibres are hardest to block through LA?

A

A-alpha fibres

173
Q

What is articiane unique selling point?

A

High diffusivity

174
Q

Where is articiane metabolised and why?

A

Plasma, due to its ester component

175
Q

What component of LA extends its duration?

A

Vasoconstrictor

176
Q

What is the role of preservatives in LA?

A

To prevent adrenaline from oxidising

177
Q

What is the antagonist used to halt vasoconstriction and anaesthetic, causes LA to wear off?

A

Phentolamine

178
Q

What vasoconstrictor should not be given to pregnant women? And why?

A

Felypressin, as it has oxytocin effect so may induce early labour

179
Q

What is the max doses of lidocaine that can be used on a normal healthy adult?

180
Q

What is the max doses of mepivaciane that can be used on a normal healthy adult?

181
Q

What is the max doses of prilocaine/ felypressin that can be used on a normal healthy adult?

182
Q

What LA should be avoided if patient has a heart condition?

A

Lidocaine/ adrenaline

183
Q

What structural component of articiane allows for its high diffusivity?

A

Thiopene ring

184
Q

When should you not use articiane on a patient?

A

If they are a new mum who is breastfeeding

185
Q

What is parasthesia?

A

Physical trauma to nerve trunk

186
Q

What LA should not be used in an IANB due to risk of parasthesia?

Module 3 Revision (20 decks)

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