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BDS Finals > Local Anaesthetic > Flashcards

Local Anaesthetic Flashcards

1
Q

Types of LA

A

Ester
Amide

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2
Q

Vasoconstrictor options (3)

A
  1. Adrenaline
  2. Felypressin
  3. None
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3
Q

Preservatives (2)

A

Bisulphite
Propylparaben

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4
Q

Who should felypressin not be used on

A

Pregnant individuals
Labour could be induced

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5
Q

Where is anaesthetic deposited in infiltration (2)

A

Around terminal branches of nerves
Bone must be thin to allow infiltration

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6
Q

Where is anaesthetic deposited in blocks (2)

A

Beside the nerve trunk
Used where bone too thick to allow infiltration

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7
Q

How to anaesthetise palatal gingivae

A

Palatal injection

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8
Q

What teeth pulp does an IDB anaesthetise

A

Lower molars and second premolar

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9
Q

How to anaesthetise pulp of lower premolars and canine

A

Mental (incisive) nerve block

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10
Q

How to anaesthetise pulp of lower canine and incisors

A

Buccal/labial infiltration

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11
Q

How to anaesthetise buccal gingivae of lower molars and second premolar

A

Long buccal infiltration
Not going to get everything with IDB

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12
Q

How to anaesthetise buccal gingivae of lower first premolar and canine

A

Infiltration OR
long buccal OR
Mental nerve block

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13
Q

How to anaesthetise buccal gingivae of lower incisors and canines

A

Buccal/Labial infiltration

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14
Q

How to anaesthetise lingual gingivae in mandible

A

Secondary part of IDB
Lingual infiltration

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15
Q

Citanest - vasoconstrictor (2)

A

Does not contain adrenaline
Can come with no vasoconstrictor

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16
Q

What will make topical anaesthetic more effective

A

Dry mucosa

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17
Q

General injection technique (5)

A
  1. Stretch mucosa
  2. Puncture quickly
  3. Aspirate
  4. Inject slowly
  5. Ensure correct bevel of needle
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18
Q

Bevel of needle

A

Thinnest part of needle enters mucosa first

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19
Q

Infiltration bevel

A

Bevel away from bone so as not to penetrate periosteum

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20
Q

Limitations of infiltration (2)

A

Infection
Dense bone

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21
Q

Buccal Infiltration technique (5)

A
  1. Stretch cheek
  2. Puncture mucosa with correct bevel
  3. Advance needle until over apex of tooth
  4. If contact bone, withdraw slightly
  5. 45 degree angle to bone
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22
Q

Can needles be placed in the orange bin

A

Yes, if empty

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23
Q

Where should a mental block be administered

A

Between apices of lower premolars

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24
Q

Landmarks for IDB (4)

A
  1. Coronoid notch of mandibular ramus
  2. Posterior border of mandible
  3. Pterygomandibular raphe
  4. Lower premolar teeth of the opposite side
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25
Q

What is in the area of the site for IDB deposition

A

Mandibular foramen

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26
Q

How much of the needle should be in tissue for an IDB

A

3/4

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27
Q

Injection technique for IDB (5)

A
  1. Thumb at anterior notch
  2. Needle entry junction of buccal pad of fat and pterygomandibular raphe
  3. Syringe lies over contralateral 5/6
  4. Advance to bony contact then retract 1mm
  5. 1cm of needle visible
28
Q

Bony contact too soon for IDB

A

Reposition syringe barrel mesially

29
Q

Secondary part of IDB

A

For lingual anaesthesia withdraw while injecting last 1/3 of solution

30
Q

How does LA stop nerve conduction

A

Blocking voltage gated Na channels

31
Q

LA in myelinated axons

A

Multiple nodes of ranvier must be blocked or the current could be strong enough to flow past one blocked node

32
Q

Types of Ester anaesthetic (3)

A
  1. Benzocaine
  2. Procaine
  3. Cocaine
33
Q

Amide anaesthetics (4)

A
  1. Lignocaine
  2. Prilocaine
  3. Articaine
  4. Bupivicaine
34
Q

Felypressin (3)

A

Vasoconstrictor
Synthetic vasopressin
Also called octapressin

35
Q

Adrenaline effect on cardiac output

A

Increases

36
Q

Adrenaline effect on mean arterial BP

A

Little or no effect

37
Q

Noradrenaline effect on mean arterial BP

A

Increases
Can result in a decrease as body compensates

38
Q

Where are amide anaesthetics broken down

A

In the liver by liver amidases

39
Q

Where are ester anaesthetics broken down

A

In the tissue by tissue esterases

40
Q

Concentration of adrenaline in lidocaine

A

1:80,000

41
Q

Maximum dose of lidocaine

A

5mg per kg body weight

42
Q

Maximum adrenaline dose

A

500 micrograms

43
Q

How much adrenaline does a cartridge of lidocaine contain

A

27.5 micrograms

44
Q

Complications of LA - Local (9)

A
  1. Prolonged anaesthesia
  2. Trismus
  3. Haematoma
  4. Intra-vascular injection
  5. Facial paresis
  6. Broken needle
  7. Infection
  8. Soft tissue damage
  9. Contamination
45
Q

Complications of LA - Systemic (6)

A
  1. Psychogenic
  2. Interaction with other drugs
  3. Cross infection
  4. Allergy
  5. Collapse
  6. Toxicity
46
Q

Potential drug interactions with LA (5)

A
  1. MAOI
  2. Tri-cyclics
  3. Beta blockers
  4. Non-potassium sparing diuretics
  5. Cocaine
47
Q

If a patient faints during LA

A

Differentiate between just fainting or toxicity and fainting

48
Q

What block will anaesthetise all upper teeth on one side

A

Posterior superior alveolar nerve block

49
Q

Cause of trismus after IDB (2)

A

Damage to medial pterygoid
Injection too low or too rapid

50
Q

Facial palsy vs palsy after stroke

A

True facial palsy will affect the forehead as well whereas palsy after a stroke may only affect either the upper or lower half of the face

51
Q

Facial palsy after IDB cause

A

LA into parotid gland
Injection too far posteriorly

52
Q

Onset of facial palsy after IDB

A

Within minutes

53
Q

Onset of truisms after IDB

A

Within hours

54
Q

Management of trismus after IDB (3)

A
  1. Reassurance
  2. Muscle relaxant?
  3. Anti-inflammatory
55
Q

Management of facial palsy after IDB (2)

A

Reassurance
Cover eye with pad until blink reflex returns

56
Q

When should sharps be disposed of

A

When the patient is still in the dental chair

57
Q

Sharps - ARC

A

Are you injured?
Remove your gloves
Check the area carefully

58
Q

Chasing injection

A

Start with buccal infiltration, then papilla between 4 and 5 which will numb some of palate. Then palate which has been anaesthetised

59
Q

Intraligamental anaesthesia (3)

A
  1. Not recommended free hand for restorative work
  2. Peripress syringe
  3. If easy to inject, probably in the wrong place
60
Q

Peripress syringe

A

Produce more pressure

61
Q

Intraosseus injection (3)

A
  1. Stabident perforator
  2. Done if cheek, tongue and lip are all numb but tooth is not (pulp hyperaemic)
  3. Inject directly into cancellous bone
62
Q

Stabident perforator (2)

A

Cuts hole through mucosa into cancellous bone
Attaches to slow speed

63
Q

Topical Jet Injector (3)

A
  1. Can cause burns in mucosa
  2. Basically a compressed air pistol
  3. Expensive
64
Q

Advanced La techniques

A

Gow Gates
Akinosi Technique

65
Q

Gow Gates (2)

A
  1. Needle goes in very high
  2. Aim for neck of condylar process
66
Q

Akinosi Technique (2)

A
  1. Closed mouth technique
  2. Sometimes used as stepping stone to infiltration
67
Q

Constituents of LA (5)

A
  1. Base
  2. Reducing agent
  3. Preservatives
  4. Fungicide
  5. +/- vasoconstrictor

BDS Finals (23 decks)

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