Local anesthesia administration Flashcards
T/F
All local anesthetics are weak acids
False
All local anesthetics are weak bases
Amides are metabolized where? What is their allergenicity?
In the liver by P450
Hypoallergenic
Example of an amide anesthetic
Lidocaine
Esters are metabolized where? What is their allergenicity?
in the bloodstream by pseudocholinesterase
Hyperallergenic
Example of an ester anesthetic
Benzocaine
What are the two forms of local anesthetic and where are they typically found?
Acidic- in carpule, and once intracellular
Basic- in tissue, and while crossing lipid bilayer
How does an infection affect the effectiveness of LA?
Equilibrium shifts toward acidic form
This will delay onset and decrease amt of anesthetic in the tissue
T/F
All local anesthetics are vasodilators
True
What addition to the LA helps to delay the absorption of the LA into the bloodstream, prolonging the effective time?
Epinephrine
Which type of LA should not be used in PEDO?
Prilocaine
Methemoglobinemia
What is the max dose and duration with epi for lidocaine?
4.4 mg/kg
120-240min
What is the max dose and duration with epi for articaine?
7.0mg/kg
140-270min
What are the typical signs of overdose in a pedo patient?
Excitation followed by depression (biphasic rxn)
Vasodilation with depression of myocardium
–> drop in blood pressure
Bradycardia/cardiac arrest may result
Dizzyness, anxiety, confusion, muscle twitching and seizures, unconsciousness and possible respiratory arrest may occur
What is the maximum total dosage in mg for lidocaine for the heaviest patient according to the AAPD?
300mg
What is the maximum total dosage in mg for articaine for the heaviest patient according to the AAPD?
500mg
What is the depth of effectiveness for topical anesthetic?
2-3mm
What is the procedure for topical anesthetic application?
Dry tissue
Use a thin coating
Direct contact for 1-2min
Keep away from tongue
What are the appropriate gauges for needles used in dental LA administration?
23-30 gauge
Blood can be aspirated through all of these
What is the minimum age a child must be to receive articaine?
4y.o.
What is the difference in position of the mandibular foramen in children as compared to adults?
Slightly lower and more posterior in a child
Pulpal involvement of which primary molars will require an IAN block?
2nd primary molars
What is the best way to achieve palatal anesthesia in a pediatric patient?
Start buccal, wait 2-3 min
Consider interpapillary, waith 2-3min
Apply sucularly or incisively if necessary
What are the main postoperative complications of IAN blocks?
Drooling Speech Child upset Soft tissue trauma Hematoma
What percentage of children experience postoperative tissue trauma following mandibular block anesthesia?
13%
Is a rubber dam required?
According to AAE it is considered standard of care for any and all endodontic procedures
