Local Anesthesia Flashcards
name the 4 amides
give the fact for each and the other name it is called
- lidocaine / xylocaine –> safe, widely available
- mepivicaine /carbocaine —> least vasodilation
- bupivacaine / marcaine —> carpules not recommended in children - longest duration
- articaine (septocaine) –> shortest duration
* has one ester chain
where are amides metabolized
liver
which has least vasodilation
mepivicaine aka carbocaine
longest duration?
implication
bupivacaine (marcaine)
.5% bupivicaine w/ 1:200,000 epi
*so not recommended in children
which class ester vs amide is more likely to cause allergic and why
esters
*more toxic , more known allergies because of methylparaben
ester metabolism?
by plasma pseudocholinesterase
name 4 esters
- procaine
- cocaine
- tetracaine
- benzocaine
red carpule
lidocaine
2% with epi 1:100,000
gold 871 carpule
articaine 4% with epi 1:100,000
tan 466
Mepivicaine 3%
blue 300 carpule
Bupivicaine .5% with epi 1:200,000
landmarks for IAN
- pterygomandibular raphe (posterior border of mandible)
- coronoid notch (anterior border of mandible)
- occlusal plane of lower teeth
lingual nerve block vs IAN block ***
lingual nerve block anesthetizes the lingual soft tissues associated with all teeth in the quadrant and the anterior 2/3 of the hemi-tongue on the side of the block
The IAN ONLY anesthetizes the teeth and bone from central incisor to the third molar and the soft tissues from the central incisor to the BICUSPID ON THE BUCALL SIDE
the IAN does NOT innervate lingual soft tissues and so the block does not anesthetize any soft tissues
maximum recommended dosages of LA (for healthy) that are 7.0 mg/kg
max dose in mg?
articaine 4% 1:100,000 epi
articaine 4% 1:200,000 epi
(articaine / septocaine)
lidocaine 2% 1:100,000 epi
lidocaine 2%
1:50,000 epi
7.0 mg/kg OR
500 mg
articaine is determined by weight as well
maximum recommended dosages of LA (for healthy) that are 6.6 mg/kg
what is max dose of these in mg?
mepivacaine 2%
1:20,000
mepivacaine 3% without vasoconstrictor
6.6 mg/kg
OR
400 mg max
maximum recommended dosages of LA (for healthy) that are 8.8 mg/kg
max dose in mg?
prilocaine 4%
1:200,000 epi
prilocaine 4%
without vasoconstrictor
600 mg max dose
OR the 8.8 mg/kg
max number of carpules for healthy
bupivacaine 0.5%
1:200,000 epi?
max in mg?
10 cartridges
90 mg
max number of carpules for healthy of lido 2% 1:100?
lido 2% 1:50
lido 2% 1:100
11
lido 2% 1:50
5.5
basically half in 1:50 b/c the epi is more concentrated in this solution
max number of carpules for healthy of mepivicaine 2% 1:20,000?
mepivicaine 3% without vasoconstrictor?
mepivicaine 2% 1:20,000?
11
mepivicaine 3% without vasoconstrictor?
7
max number of carpules for healthy of prilocaine 4% 1:200,000 epi?
prilocaine 4%
without vasoconstrictor
8 carpules
lbs to kg conversion
divide by 2.2
or if in kg multiple by that
basic mechanism of LA
bind to receptor within the sodium channel and inhibit the influx of sodium during nerve conduction blocking activation and depolarization * within the sodium channel considered class D classification of local
CONDUCTION BLOCKADE
- no propagation of action potential or electrical depolarization
this is a NON depolarizing nerve block
affect of pKa
ONSET
- lower pka results in more rapid onset of action as more RN molecules are present to diffuse through the nerve sheath; thus the onset time is decreased
affect of lipid solubility
anesthetic POTENCY
- increased lipid solubility results in increased potency
affect of protein binding
DURATION
- increased protein binding allows anesthetic cations (RNH+) to be more firmly attached to proteins located at receptor sites’ thus the duration of action is increased
affect of vasodilatory activity
POTENCY AND DURATION
- greater vasodilatory activity results in increased blood flow to the area -resulting in rapid removal of anesthetic molecules from the injection site- thus anesthetic potency and duration would be decreased
list of moderateyl acting in terms of duration LA
mepivicaine
prilocaine
lidocaine
articaine
list o long acting in terms of duration LA
bupivicaine
articaine
% and color
4% articaine with 1:100,000 epi
gold
* shortest duration
less than 60 mins with infilatration
bupivicaine %
color
.5% bupivicaine 1:200,000 epi aka marcaine
blue
longest
not recommended in children
lidocaine %
epi concentrations
color
duration of action
2% lidocaine 1:100,000 epi (red)
2% lido 1:200,000 epi
about an hour
mepivicaine %
epi concentrations
color
duration
3% mepivicaine
tan
least vasodilation
which can be used with no vasoconstrictor
prilocaine
4% prilocaine
short duration though
drug that has been noted to be associated with methemoglobinemia
prilocaine
% prilocaine
4%
no vasoconstrictor
max dose is 8.0 mg/kg OR 600 mg
some say 8.8
technique difference when anesthetizing for IAN vs lingual
IAN - contact bone
Landmarks are the same: Pterygomandiular raphe, occlusal plain, coronoid notch however depth of injection is DIFFERENT
Lingual Nerve block – AFTER administration of the IAN block, the needle is withdraw 2/3 to ¾ of the way and the needle is aspirated a second time: Solution is deposited with the needle only 1/3 to ¼ advanced into the mucosa in area of Lingual Nerve
buccal nerve block?
mucosa of 2nd and 3rd lower molar
mental nerve and incisive nerve block
Mental foramen by apices of premolars
Incisive nerve block
For the actual block of the teeth , hold pressure for 2 mins after injection to force anesthetic into mental foramen
High rate of paresthesia
posterior superior alveolar block
max molars
16 mm depth (about half the length of the needle)
relatively high hematoma risk
local infilatrations mainly used for?
maxillary teeth on buccal or palatal
lower premolar, canine, incisor
buccal and lingual
mesiobuccal root of first molar innervated by?
infraorbital
infraorbital nerve innervates?
central to mesial buccal cusp of first max molar
max dose in mg for bupivicaine
1.3 mg/kg
.5% + 1:200,000 epi
which drugs max dose is 6.6 mg/kg
mepivicaine
