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Spring 2018 > Local Anesthesia 1 > Flashcards

Local Anesthesia 1 Flashcards

1
Q

Nerve type classification

A, B, C and subtypes

A

A: large, myelinated
Alpha, beta, gamma = motor, proprioception
Delta = sensory

B: preganglionic autonomic (otherwise same as Aδ)

C: small, unmyelinated

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2
Q

Sodium channel activation gate:

Inactivation gate?

A

Act: m
Inact: h

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3
Q

Steps in impulse propagation

A

Na influx causes rapid depolarization

Na channels close, K permeability increases

Polarity restored

Wave of depolarization

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4
Q

_ is responsible for depolarization

A

Na channel inactivation

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5
Q

Distance b/t nodes is proportional to _+

A

Diameter

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6
Q

How does local anesthetic act on nerves

A

Blocks influence of stimulation on Na permeability

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7
Q

Specific receptor vs. membrane interaction theories

A

SR: anesthetic receptor in channel, from intracellular side

MI: agent molecules associated with hydrophobic membrane

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8
Q

_ is the common ester LA. Almost all other injectables are _

A

Procaine

Amides

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9
Q

Q is the _ constant

pKa is the _ constant

A

Aqueous distribution constant - ability to penetrate hydrophobic tissue

Dissociation constant - proportion of ionized to unionized molecules

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10
Q

Susceptibility to blockade
From most to least affected

DWCSTPP

A 
Dull pain
Warmth
Cold
Sharp pain
Touch
Pressure
Proprioception
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11
Q

5 things in an anesthetic compound, common examples

A 
Local anesthetic
Vasoconstrictor
Antioxidant (w VC) - Na metabisulfite
Preservative - methylparaben
PH adjusting agents - HCl,NaOH
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12
Q

Typical pH of anesthetic compound

A

4-6, especially with vasoconstrictor

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13
Q

Vascular uptake (systemic distribution) depends on what 3 things

A

Vascularity of area
Vasodilation of agents
Quantity

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14
Q

More lipophilic = _ % bound

A

Higher

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15
Q

Conditions that increase plasma binding (5)

Conditions that decrease plasma binding

A

MI, cancer, trauma, surgery, chronic pain

Pregnancy, oral contraceptive, estrogen, acidosis, increasing dose

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16
Q

How long does it take the following to uptake unbound drug:

Lungs
Brain, heart, liver, kidneys
Muscle
Fat

A

Lungs - 1 min
BHLK - 5 min
Muscle - 15 min
Fat - 1-2 hrs

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17
Q

_ breaks down ester anesthetics

A

Psudocholinesterase

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18
Q

CNS effects of lidocaine in low, moderate, mod/high, high conc.

A

Low: anticonvulsant, relaxation, analgesia

Mod: euphoria, drowsiness, slurred speech

Mod/High: disorientation, tremor, unconsciousness, seizures

High: coma, Resp arrest

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19
Q

High conc of anesthetic decrease what in the heart

A 
Conduction velocity
Automaticity
Myocardial contractility
Cardiac output
Blood pressure
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20
Q

More _ an anesthetic is, the greater proportion of cardiovascular to CNS effects

A

Lipophilic

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21
Q 
Adrenergic receptors:
α1
α2
β1
β2
A

α1: increases BP
α2: inhibits NE release
β1: Increases HR
β2: Decreases BP

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22
Q

Plain LA are _ by nature

A

Vasodilator

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23
Q

3 reasons for vasoconstrictors in LA

A
  1. Hemostasis
  2. Lower toxicity by lowering CV absorption
  3. Increased duration
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24
Q

3 modes of action of VC

A

Direct - act on adrenergic receptors
Indirect - use NE release
Mixed - both

25
Q

1:1000 conc. Means what

A

1gm of solute in 1000 ml of solvent

1,000 mg in 1,000 ml

26
Q

How much epinephrine is in each of the following:

1: 50,000 1.7 ml cartridge
1: 100,000 1.7 ml c
1: 200,000 1.7 ml c

A
  1. 034 mg
  2. 017 mg
  3. 0085 mg
27
Q

Maximum epinephrine dose per appointment for healthy person?

Pt. With cardiovascular disease?

A

Healthy: 0.2 mg
Diseased: 0.04 mg or 2 cartridges of 1:100,000 epinephrine

28
Q

Antioxidant Most used with epinephrine

A

Sodium bisulfite

29
Q

4 things that determine which vasoconstrictor to use

A

Length of dental procedure
Hemostasis requirements
Post-op pain control requirement
Medical status

30
Q

An alpha blocker would cause what two effects

A

Hypotension and tachycardia

31
Q

Non-selective β blocker would cause _

A

Increased blood pressure and bradycardia

32
Q

If a patient is taking TCAs, what can epinephrine do? Why?

A

Produce exaggerated effects

TCAs block reuptake of NE and E

33
Q

Epinephrine is metabolized by what two enzymes

A

MAO

COMT

34
Q

5 contraindications to using VCs

A 
ASA IV
Acute MI
Angina at rest (unstable angina)
Cardiac dysrhythmias
Uncontrolled hyperthyroidism
35
Q

Avoid _ in patients with methemoglobinemia

A

Prilocaine

36
Q

Local infiltration vs nerve block

A

LI: Tx in same area in which local an was deposited

NB: an. Deposited close to main nerve trunk, away from tx

37
Q

What 6 factors determine selection of LA technique

A
  1. Area (bone differences)
  2. Procedure(s) performed
  3. Duration and profoundness needed
  4. Age
  5. Hemostasis
  6. Presence of infection
38
Q

PSA and MSA innervate which teeth

A

MSA= premolars and MB root of first molar

PSA= molars except MB root of first molar

39
Q

Which nerves innervate palatal mucoperiosteum

A

Anterior teeth: nasopalatine nerve

Premolars and molars: greater palatine

40
Q 
Supra-periosteal injection:
Used for what
Where
Needle
Contraindications
A

Pulpal anesthesia in maxillary teeth

Outside maxilla at level of root apex

25 or 27 gauge needle

CI for large areas

41
Q

PSA block:
Injection site
Angulation

A

Height of MB fold over second molar

Up, in and back all at 45˚ angle

42
Q

MSA block:

Point of insertion

A

Height of Mucobuccal fold above max 2nd premolar

43
Q

Infraorbital block:
Which nerves are anesthetized
Point of infiltration
Depth and orientation of needle:

A

ASA, MSA, infraorbital nerve

Over max 1st premolar

Needle touches roof of foramen and bevel is towards foramen

44
Q

Palatal anesthesia requires _

A

Topical and pressure anesthesia

45
Q 
Greater palatine nerve block:
Which teeth
Point of insertion
Pressure where:
Depth
A

PM and molars
Anterior to GP foramen
Pressure at junction of alveolar process and HP
5mm

46
Q

Incisive nerve block:
Needle insertion:
Depth

A

Lateral to incisive papilla

5mm

47
Q 
V2 nerve block high tuberosity technique:
Where
Depth
Amount
Risk
A

Same as PSA
30mm
Deposit 1.8 ml
Risk of hematoma formation

48
Q

V2 greater palatine approach
Where
Problems

A

Up through greater palatine foramen

Close to eye, can have vision problems

49
Q 
Volume of LA injected:
infiltration:
PSA
MSA
ASA IO
Palatal infiltration
Greater palatine
Nasopalatine
V2 nerve block
A 
I: 0.6 
PSA: 0.9-1.7
MSA: 0.9-1.2
ASA: 0.9-1.2
Palatal inf: 0.2-0.3
GP: 0.45-0.6
NP: 0.45
V2: all of it
50
Q

IAN supplies:

A

Teeth to midline (24/25 cross over)
Body of mandible
Buccal mucoperiosteum, mucous membrane ant. To mand 1st molar

51
Q

LB nerve supplies

A

Buccal mucoperiosteum of mandibular molars

52
Q

Lingual nerve supplies

A

Ant. 2/3 of tongue and floor of mouth

Lingual mucoperiosteum

53
Q

IAN block:
Height:
Depth:
Angle

A

Height:

Index finger in coronoid notch
6-10 mm above occlusal plane
Finger on coronoid
Lateral to pterygomandibular raphe

Tip located slightly superior to mandibular foramen

Depth:
To the BONE (20-25 mm, 2/3 to 3/4 of long needle)

From opposite premolar region

54
Q

Lingual nerve block

A

From IAN, withdraw 5mm and inject 0.3 ml

55
Q

Accessory mandibular innervation (mylohyoid nerve) block location

A

Lingual surface of tooth posterior to tooth in question

56
Q

Long buccal n. Block:
Insertion
Angle
Depth

A

Mucous membrane distal and buccal to most distal molar in arch

Parallel and lateral to occlusal plane

Bone contact, 2-4 mm

57
Q

Mental nerve block:
Affected tissue:
Needle insertion:

A

Muc membranes ant to mental foramen and skin of lower lip and chin

MB b/t apices of 1/2 premolars

58
Q

Gow-Gates V3 block:
Insertion:
Target area
Depth

A

Distal to max 2nd molar

Target: lateral side of condylar neck, just below lat. pter muscle insertion

To BONE

59
Q

vazirani ankinosi V3 block (closed mouth)
Who?
Why
Insertion

A

Pt with trismus

Relieve muscle spasm (V3 innervates muscles of mastication

Medial border of ramus at height of MGJ next to max 3rd molar

Spring 2018 (18 decks)

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