Local Anesthesia for Pediatric Pts

Question 1

________ is crucial to provide good care and have the child behave as well

Answer 1

Profound local anesthesia

Question 2

all local anesthetics are what?

Answer 2

weak bases

Question 3

which end of the LA is hydrophilic?

Answer 3

Amine end

Question 4

which end of the LA is lipophilic?

Answer 4

aromatic

Question 5

where are amides metabolized?

Answer 5

liver by P450 enzyme

Question 6

are amides hypoallergenic?

Answer 6

yes but the true allergy are rare

Question 7

when are esters applied?

Answer 7

in topical situations

Question 8

where are esters metabolized?

Answer 8

pseudocholinesterase

Question 9

are esters hypoallergenic?

Answer 9

no (they are hyperallergenic)

Question 10

what is an example of an ester LA?

Answer 10

benzocaine

Question 11

what and where does the acidic part of the LA do?

Answer 11

• in carpule

- keeps anesthetic on either the outside of the nerve sheath or the inside of the nerve sheath

Question 12

what and where does the basic part of the LA do?

Answer 12

• once in the tissue

- allows the anesthetic to cross the lipid bilayer of the nerve sheath

Question 13

how many mls of LA are in a cartridge?

Answer 13

-1.7ml

Question 14

how many mg of lido are in 1 cartridge of 2% lido?

Answer 14

34mg

Question 15

how many mg of articaine are in 1 cartridge of 4% articaine?

Answer 15

68mg

Question 16

what is the max dose for lido?

Answer 16

• 4.4 mg/kg

- 2.0 mg/lb

Question 17

what is the max dose for septocaine?

Answer 17

• 7.0 mg/kg

- 3.2 mg/lb

Question 18

once inside the lipid bilayer, what happens to the LA?

Answer 18

converts back to acidic to block voltage gated Na+ channels, preventing depolarization

Question 19

when infection is present, how does this affect the effectiveness of LA?

Answer 19

equillibrium shifts toward acidic form, delayeing onset and dec amount of anestheltic in the tissue

Question 20

all LAs are ______

Answer 20

vasodilators

*reasons epi is in there (side effect is inc HR)

Question 21

what is the effect of LA on the cardiovascular system?

Answer 21

• creates biphasic reaction (excitation followed by depression)
• overdose leads to vasodilation with depression of the myocardium -> drop in BP
• bradycardia and cardiac arrest may happen

Question 22

what is the effect of LA on the central nervous system

Answer 22

• creates biphasic reaction
• overdose leads to dizziness, anxiety, confusion, twitching and seizures
• uncounciousness and possible respiratory arrest

Question 23

how do you prevent an overdose?

Answer 23

• always be aware of the weight of a child and the amount of anestetic that can be given
• never leave the child alone
• if symptoms happen, begin emergency management

Question 24

how deep is topical anesthetic effective?

Answer 24

soft tissue 2-3 mm in depth

• onset in 30 secs
• toxic rxns unknown, local allergic rxns possible

Question 25

how do you apply topical ?

Answer 25

- dry tissue - do not have a massive glob - direct contact for 1-2 minutes - keep away from tongue.

Question 26

where is the mandibular foramen in a child?

Answer 26

- slightly lower and more posterior in a child | - lower than the level of the occlusal plane

Question 27

for kids, what is mandibular infiltration used for?

Answer 27

- primary FIRST molars, including pulpotomies | * NOT effective for pulp tx on 2nd molars!!!

Question 28

for kids, is it better to use block or infiltration?

Answer 28

- both are equal in restorative procedures | * EXCEPT pulpotomies for second molars!!!

Question 29

is articaine (septocaine) safe for kids?

Answer 29

yes

Question 30

what type of LA should be avoided for blocks?

Answer 30

septocaine

Question 31

what kids should you avoid giving septocaine to?

Answer 31

kids undre 4

Question 32

should the assistant attempt to restrain the child for the shot?

Answer 32

no, if they touch them the kids will freak out. the assistant should put their arms above the childs to block if they do raise them

Question 33

why dont you use bezocaine on a kid under the age of 2?

Answer 33

hyperbilirubinemia

Question 34

what position should the pediatric patient be in for injections?

Answer 34

supine *mandible at 30 degree angle to the floor

Question 35

what are some post op complications?

Answer 35

- drooling - speech - child upset - soft tissue trauma - hematoma

Question 36

what percentage of kids get soft tissue trauma following mandibular nerve block?

Answer 36

13% *if child is under 4, more soft tissue trauma from unilateral mandib block than from bilateral

Question 37

rapidly restores normal sensation and function so patients can speak, smile, and drink normally in approx half the time

Answer 37

oraverse

Question 38

how is oraverse administered/

Answer 38

with a standard dental syringe utilizing the same injection site and an identical administration technique that is used for LA