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2nd year > Local anaesthetic 2 > Flashcards

Local anaesthetic 2 Flashcards

1
Q

What is Felypressin and why do we use it?

A

Brand name octapressin. A vasoconstrictor. It is an alternative to adrenaline (chosen for hypertensive patients)

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2
Q

Compare infiltrations to Blocks

A

Blocks inject the trunk of the nerve.

Infiltrations inject at the terminal branches of the nerves.

Blocks use a 35mm needle(yellow cap).

Infiltrations use a 25mm needle(blue cap).

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3
Q

How does Bone density affect infiltrations?

A

Dense bone prevents infiltration from working. The bone is too thick for the LA to penetrate (e.g posterior mandible)

4% articaine can be used to provide an infiltration on the mandible.

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4
Q

When would you choose a nerve block over an infiltration?

A

When you are working on many teeth (infiltrations can only numb 1 or 2 teeth)

Or on dense bone

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5
Q

What LA technique would you use to anaesthetise the Dental pulp of the maxilla?

A

Buccal infiltration

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6
Q

What LA technique would you use to anaesthetise the Buccal gingivae of the maxilla?

A

Buccal infiltration

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7
Q

What LA technique would you use to anaesthetise the palatal gingivae of the maxilla?

A

Palatal infiltration

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8
Q

How would you anaesthetise a lower molar or second premolar

A

Pulp- inferior alveolar nerve block

Gingivae- Buccal infiltration

Lingual- Lingual infiltration

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9
Q

How would you anaesthetise a lower premolar or canine

A

Pulp- Mental nerve block

Gingivae- mental nerve block

Lingual- lingual infiltration

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10
Q

How would you anaesthetise the lower canines and incisors.

A

Pulp - buccal/ labial infiltration

Gingivae- buccal/ labial infiltration

Lingual- lingual infiltration

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11
Q

You are restoring a tooth, what tissue(s) should be anaesthetised

A

dental pulp

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12
Q

You are extracting a tooth, What tissue(s) should be anaesthetised?

A

Pulp and gingivae

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13
Q

You are scaling a tooth, What tissue(s) should be anaesthetised?

A

gingivae or Pulp and gingivae (if doing root surface debridement)

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14
Q

Compare clicking the barrel closed once and clicking the barrel closed twice.

A

1 click- closed for safety- can still be re-opened

2 click- closed permanently- cannot be re-opened and goes to sharps.

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15
Q

Why do we record the batch number of the LA cartridge ?

A

For tracking purposes.

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16
Q

Why do we dry the patient’s mucosa before administering topical A?

A

As a wet mucosa would dilute the Topical anaesthetic

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17
Q

Blood is present in the cartridge after aspiration. How do you respond?

A

Do not inject the LA. Change cartridge and reposition the needle.

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18
Q

Why do we inject the LA slowly?

A

As injecting it quickly would force the LA in and upregulate the pain response.

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19
Q

Why is the needle beveled?

A

To provide a cutting surface that offers little resistance when penetrating and withdrawing the needle.

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20
Q

Where is the needle positioned for a buccal infiltration?

A

At the apex of the tooth on the distal side.

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21
Q

Where is the needle positioned for a mental block?

A

Between the apices of the lower premolars (but not in the mental foramen)

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22
Q

Where is the needle positioned for a posterior superior alveolar nerve block?

A

Mesial buccal fold of the 2nd maxillary molar

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23
Q

Where is the needle positioned for the middle superior alveolar nerve block?

A

Mesial buccal fold of the 2nd maxillary premolar

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24
Q

Where is the needle positioned for the anterior superior alveolar nerve block?

A

Mesial buccal fold of the maxillary first premolar (Infra orbital foramen).

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25
Q

What needle is used in an inferior alveolar nerve block?

A

35mm

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26
Q

Why is the tissue tightened before adminstering LA?

A

To make the tissue easier to penetrate

27
Q

What are the landmarks for an Inferior alveolar nerve block?

A

thumb- coronoid notch

Finger- posterior border of the mandible shown by the pterygomandibular raphe.

28
Q

Discuss the vertical and horizontal positioning of an IAN?

A

vertical 6-10mm above the teeth

Horizontal- 3/4 of the way between the thumb and the pterygomandibular raphe

29
Q

How do you know that the needle is in the correct position?

A

You contact the bone when 3/4 of the needle has disappeared

30
Q

1/4 of the needle has disappeared before bone contact how do we fix this?

A

needle is too anterior (reposition mesially)

31
Q

All of the needle has disappeared and there is no bone contact. How do we fix this?

A

needle is too posterior (re-position distally)

32
Q

Compare the main types of LA used?

A

Mepivicaine -3 % - works for a shorter period of time. (no vasoconstrictor)

Lignocaine- 2%

Articaine- 4% (proccessed in the plasma)

Prilcaine=-3%

33
Q

What anaesthetic would be selected as the ‘Go to’ drug.

A

Lignocaine- gives good level of LA without the risks of 4% articaine.

34
Q

What are the systemic complications of LA?

A

Psychogenic/stress

  • drug interactions
  • allergy
  • induced pregnancy (due to felypressin)

Collapsing

Toxicity

35
Q

What are the clinical features of anxiety?

A
  • pallour
  • beads of sweat
  • shaking
36
Q

How do we manage a patient who is anxious?

A

lay patient flat and lift their legs

Loosen neck clothing

Improve ventillation

Give them sugar (may be due to lack of food)

37
Q

What drugs interact with LA adrenaline?

A
  • antidepressants M.A.I.Os and tricyclates
  • Beta blockers
  • Non pottasium sparing diuretics
  • Coccaine
38
Q

Give the max safe dosage, Mgs in a cartridge and max cartridges for Mepivicaine

A

max safe dosage- 3mg/kg cartridge- 66 max cartridges- 6

39
Q

Give the max safe dosage, Mgs in a cartridge and max cartridges for Lignocaine

A

max safe dosage- 5mg/kg cartridge- 44 max cartridges- 7

40
Q

Give the max safe dosage, Mgs in a cartridge and max cartridges for Articaine

A

max safe dosage- 7mg/kg cartridge- 88 max cartridges- 5

41
Q

Give the max safe dosage, Mgs in a cartridge and max cartridges for Prilocaine

A

max safe dosage- 8mg/kg cartridge- 66 max cartridges- 8

42
Q

How does adrenaline affect the heart?

A

Increases heart rate

increases heart force

increases heart output

Increases heart excitability

43
Q

Discuss the dangerous of adrenaline

A
  • Worries of increasing blood pressure in patients with cardiac disease
  • Hyperthyroidism
  • Phaeochromocytoma (extra adrenaline causes hypotension.
  • Patients on diuretics (increased adrenaline decreases K+ conc in plasma. This is already low in patients on thiazide diuretics.
44
Q

What causes prolonged anaesthesia?

A

Direct trauma from the needle

Multiple passes with the same needle

Injecting the LA into the nerve

45
Q

What is trismus? Give its presentation cause and management

A

Muscle spasm

Presentation: Patient unable to open mouth

Cause: Injection to medial pterygoid

Management: Reassurance Muscle relaxants e.g. Diazepam

46
Q

Give the presentation/ cause diagnosis and management of facial palsy?

A

Presentation: Full paralysis

Cause: injection into parotid gland

Diagonsis: test the facial nerve

Management : Reassurance Cover with eye patch until blinking reflex returns

47
Q

What is an alternative technique for palatal anaesthesia?

A

The chasing technique. (You numb an area which then blanches. You then inject that area) Eventually this numbs the palate.

48
Q

When would you use intra-osseus anaesthesia?

A

When the LA is not working for the dental pulp but works for everything else. So you drill a hole in the already numb alveolar bone and inject the LA directly.

49
Q

How does the akinosi technique help treating patients with trismus?

A

The trismus may be caused by the excessive pain. So by killing the pain- it enables the patient to open their mouth allowing the usual LA technique.

50
Q

compare the wand to a hand syringe?

A

A wand administers the local anaesthetic at a lower constant pressure.

51
Q

When do you use a nasopalatine block?

A

When anaesthetising upper maxillary anterior teeth.

52
Q

Compare Articaine to lignocaine?

A

Articaine is processed in the plasma and has a lower risk of systemic toxicity (The drug is hydrolysed quicker in blood)

Lignocaine- This is the drug of choice. It is also anti-arrhythmic so should not be used if the patient has heart block or a pacemaker.

53
Q

Compare the two options for surface anaesthesia?

A

Physical e.g. ethyl chloride (which reduces the temperature of the skin to give local anaesthetic)

Pharmacological e.g. benzocaine (topical anaesthetic )

54
Q

Compare EMLA cream to Ametop gel?

A

EMLA cream is an euteric mixture of prilocaine and lidocaine that is placed for 45 minutes.

Ametop gel is a tetracaine 4% gel and this has a faster onset

55
Q

Compare the depth of tissue of an intra-oral topical agent to that of the wand?

A

An intra-oral topical agent can anaesthetise tissue 2-3mm deep.

A wand can anaesthetise tissue 1cm deep. (much deepr)

56
Q

What is transcutaneous electrical nerve stimulation?

A

Where probes on either side of the area needing numbed block large myelinated nerve fibres. This also closes the gate to the central transmission of unmyelinated nerve fibres.

57
Q

Compare the mental foramen of an adult to a child.

A

A child’s foramen faces anteriorly (to the front)

An adults foramen faces posteriorly (to the back)

58
Q

How do we treat toxicity.

A
  1. Stop dental treatment.
  2. Provide basic life support.
  3. Call for medical assistance
  4. Protect patient from injury.
  5. monitor vital signs.
59
Q

What is the most common complication of LA for children?

A

Self inflicted trauma and ulceration.

60
Q

Where is the needle positioned for a lingual infiltration?

A

In the reflected mucosa below the tooth in question.

61
Q

What is a hyperaemic pulp and how do we deal with it?

A

This is a tooth that won’t go numb after our LA injections.

To treat this we use:

Intrapulpal or intraligamentary injections

62
Q

Compare intra-pulpal and intra-ligamentary injections

A

Intrapulpal- you inject LA directly into the root and you need access to the canals for this- useful if you are struggling with anaesthesia pre-root canal.

Intra-ligamentary - The needle is inserted into the PDL space and injected so it goes into the alveolar bone.

63
Q

What are the difficulties with giving a patient intraligamentary LA?

A
  • It is painful
  • It is difficult to ensure you are in the PDL space
  • Small risk of injecting the IDN
  • LA only lasts a short period of time.

2nd year (63 decks)

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