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Local Anesthesia > Local Anesthesia > Flashcards

Local Anesthesia Flashcards

1
Q

Which nerves are anesthetized with a Gow-Gates injection?

A
  • Auriculotemporal
  • Inferior alveolar
  • Buccal
  • Mental
  • Incisif
  • Lingual
  • Mylohyoid
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2
Q

Which structures/tissues are anesthetized following a Gow-Gates injection?

A

Ipsilateral teeth up to the midline, buccal and lingual tissues, anterior two thirds of the tongue, floor of the month, skin over the zygoma, posterior aspect of the cheek and temporal region.

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3
Q

Which structure secretes epinephrine?

A

Adrenal medulla

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4
Q

Describe epinephrine action?

A

Sympathomimetic

Acts on adrenergic receptors alpha and beta
A1: vasoconstrictor (primary receptor in oral mucosa)
B1: vasopressor (contractibility) and increase heart rate
B2: vasodilatation in skeletal muscle (very little in oral mucosa)

Reduce pulpal blood flow (Kim)
Can induce BP drop and increase HR (5-10 min)

When given with LA, reduces peak plasma and control hemorrhage.

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5
Q

Name condition for which epinephrine is absolutely contraindicated.

A 
Heart diseases:
- unstable angina
- recent myocardial infarction
- recent coronary artery bypass surgery 
- refractory arrhythmias
- untreated and uncontrolled severe hypertension 
- untreated and uncontrolled congestive heart failure 
Uncontrolled hyperthyroidism 
Uncontrolled diabetes 
Intolerance to sulfites 
Steroid-dependent asthma 
Pheocromocytoma

Perusse 1992

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6
Q

Hyperthyroidism symptoms

A 
Tachycardia
Goiter
Palpitation
Nervousness
Tremor
Increase of the BP
heat intolerance

Perusse 1992

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7
Q

How much epi in one cartridge of 4% lidocaine 1:100 000?

A

0.018 mg

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8
Q

How much epi given IM for an anaphylactic choc?

A

0.3-0.5 mg

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9
Q

Diabetic patient: what to consider for local anesthesia/hemorrhage control?

A

If diabetes isn’t well controlled, epi is contraindicated because epi is a hyperglycemic hormone.

If the diabetes is well controlled (with insulin, hypoglycemic medication or diet): dose of epi needed as small as possible

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10
Q

Asthmatic patient: what to consider before local anesthesia?

A

If severe asthma, corticosteroid dependent: avoid epinephrine because higher risk of sulfite sensitivity. 8.4% vs 0.8% (asthmatic non corticosteroid dependent pts) (Bush).

Consequence: severe asthmatic reaction

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11
Q

Name relative contraindications of epinephrine.

A

Patient taking tricyclic antidepressants
Patient taking phenothiazine compounds (anti-psychotic)
Patient taking monoamine oxidase inhibitors
Patient taking nonselective beta-blockers
Cocaine abusers

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12
Q

Describe the mechanism of action of lidocaine.

A

Lidocaine blocks fast voltage-gated sodium channel in the cell membrane of post synaptic neurons, preventing depolarization and inhibiting the generation and propagation or nerve impulses.

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13
Q

True/false

Lidocaine has anti-inflammatory and immunomodulating properties.

A

True

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14
Q

How lidocaine is eliminated?

A

Metabolized in the liver and excreted by the kidneys in urine (10% as an unchanged drug and 90% as metabolites)

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15
Q

What is the maximal dosage of the different L.A?

A

Lido 2% 1:50 00 or 1:100 00
7.0mg/kg
500mg/kg

Lido 2% plain
4.4mg/kg
Max 300 mg
36 mg/cartridge

Mepivacaine 3%
6.6 mg/kg
Max 300 mg
54 mg/cartridge

Articaine 4% 1:100 000
7.0 mg/kg
Max 500 mg
72 mg/cartridge

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16
Q

Describe CNS and CVS symptoms of L.A toxicity/overdose.

A

CNS - initially excitation, after drowsiness, seizure, disorientation, loss of consciousness

CVS - decreases cardiac output, hypotension, cardiac arrest

17
Q

Which L.A is more susceptible to cause methemoglobinemia?

A

Prilocaine

Lack of oxygen in RBC

18
Q

What the best L.A to use for a patient with severe liver dysfunction?

A

Procaine

An ester metabolisms by serum esterases so toxicity in those with liver is not a problem.

19
Q

Symptoms of a vasoconstrictor overdose.

A 
Anxiety
Headache 
Palpitation dizziness 
Nausea 
Stomach ache 
Restlessness
Tremor
Anginal pain
Hypertension 
Tachycardia
20
Q

5 reasons of anesthetic failure.

A

1- Lower pH of inflamed tissue reduces the amount of base form of anesthetic.

2- unsuccessful technique

3- Inflamed nerves have altered resting potential and decreased excitability threshold

4- TTX (tetrodotoxines produce by bacterias) resistant sodium channel

4- apprehensive patient have decrease pain threshold

21
Q

What is the concentration of epi in mg/ml for L.A with 1:200 000, 1:100 000 ant 1:50 000 epi?

A

1: 200 000 = 0.005mg/ml
1: 100 000= 0.010mg/ml
1: 50 000= 0.02mg/ml

22
Q

Which teeth are anesthetized with an anterior superior nerve block?

A
  • Max central inc
  • Max lateral inc
  • Canine
  • when MSA absent: first and second max pre-molar and MB root of the max first molar
23
Q

What are done landmarks to adequately perform an anterior superior nerve block?

A

First max pm aligned with infra-orbital foramen

Half long needle in

24
Q

Which teeth are anesthetized with a middle alveolar nerve block?

A
  • Max second molar
  • Max first molar
  • Mb root first molar (if not inerved by PSA or ASA
25
Q

What is the main landmark for a middle alveolar nerve block?

A

Vestibule second pre-molar

26
Q

Which injections are associated with trismus?

A

PSA nerve block

IANB

27
Q

Give 2 risks associated with a posterior alveolar nerve block.

A
  1. Hematoma formation from injection of L.A in the pterygoid plexus of veins
  2. Accidental puncture of the maxillary artery

To avoid those risks: aspiration and adequate landmarks

28
Q

Which teeth are anaesthetized with a PSA nerve block?

A

third, second and first max molars despite MB root of the first molar

29
Q

What is the Finder and Moore rule (2002)?

A

1 cartridge of L.A for every 25 pounds of the patient weight.

30
Q

Name 5 possible complication of L.A.

A
  1. Cardiovascular effects: tachycardia, increase of the heart rate and BP (adrenergic receptors)
  2. Systemic effect: Initially excitatory phase (ms contraction, grand mal convulsion, tremor), followed by a depressive phase (sedation, hypotension, respiratory arrest)
  3. Peripheral nerve paresthesia: 5X more w/ articaine than lido after IANB
  4. L.A. or Latex allergy: very rare, maybe because of the latex stopper
  5. Sulphite allergy: Sulfites are added for epic stability (to avoir molecule breakdown). Asthmatics 5% more frequent.
31
Q

2 principal causes of trismus?

A

1- insertion of the needle in the pterygoid plexus
2- laceration/puncture of a small vein

This can cause a larger hematoma in the infra temporal fossa

Multiple injections increase the chance of bleeding from muscles or blood tissue damage

Trauma to muscles or blood vessels in the infra temporal space is the most common etiology factor in trismus

Infection of the latter hematoma further contributes to hypomobility

32
Q

Maximum dose epi for cardiac people?

A

0,04 mg

Malamed

33
Q

Best L.A for pregnant pt?

A

Lido and prilocaine

FDA B

34
Q

According to each ASA categories, what is the Max dose of epinephrine?

A

ASA 1- 0.2 mg

ASA 2 - 0.1 mg

ASA 3 - 0.04 mg

35
Q

Through which structures the needle goes through for an IANB?

A

a. Soft tissue
b. Posterior aspect of the buccinator
c. Lateral to the medial pterygoid muscle, lingual of lingual nerve
d. Through the lateral pterygoid
e. Injection of L.A. in the pterygomandibular space

Local Anesthesia (1 decks)

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