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Peds 2 > Local Anesthesia for Pediatric Pts > Flashcards

Local Anesthesia for Pediatric Pts Flashcards

1
Q

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

A

Profound local anesthesia

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2
Q

all local anesthetics are what?

A

weak bases

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3
Q

which end of the LA is hydrophilic?

A

Amine end

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4
Q

which end of the LA is lipophilic?

A

aromatic

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5
Q

where are amides metabolized?

A

liver by P450 enzyme

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6
Q

are amides hypoallergenic?

A

yes but the true allergy are rare

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7
Q

when are esters applied?

A

in topical situations

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8
Q

where are esters metabolized?

A

pseudocholinesterase

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9
Q

are esters hypoallergenic?

A

no (they are hyperallergenic)

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10
Q

what is an example of an ester LA?

A

benzocaine

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11
Q

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

A
  • in carpule

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

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12
Q

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

A
  • once in the tissue

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

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13
Q

how many mls of LA are in a cartridge?

A

-1.7ml

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14
Q

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

A

34mg

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15
Q

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

A

68mg

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16
Q

what is the max dose for lido?

A
  • 4.4 mg/kg

- 2.0 mg/lb

17
Q

what is the max dose for septocaine?

A
  • 7.0 mg/kg

- 3.2 mg/lb

18
Q

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

A

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

19
Q

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

A

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

20
Q

all LAs are ______

A

vasodilators

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

21
Q

what is the effect of LA on the cardiovascular system?

A
  • 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
22
Q

what is the effect of LA on the central nervous system

A
  • creates biphasic reaction
  • overdose leads to dizziness, anxiety, confusion, twitching and seizures
  • uncounciousness and possible respiratory arrest
23
Q

how do you prevent an overdose?

A
  • 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
24
Q

how deep is topical anesthetic effective?

A

soft tissue 2-3 mm in depth

  • onset in 30 secs
  • toxic rxns unknown, local allergic rxns possible
25
Q

how do you apply topical ?

A
  • dry tissue
  • do not have a massive glob
  • direct contact for 1-2 minutes
  • keep away from tongue.
26
Q

where is the mandibular foramen in a child?

A
  • slightly lower and more posterior in a child

- lower than the level of the occlusal plane

27
Q

for kids, what is mandibular infiltration used for?

A
  • primary FIRST molars, including pulpotomies

* NOT effective for pulp tx on 2nd molars!!!

28
Q

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

A
  • both are equal in restorative procedures

* EXCEPT pulpotomies for second molars!!!

29
Q

is articaine (septocaine) safe for kids?

A

yes

30
Q

what type of LA should be avoided for blocks?

A

septocaine

31
Q

what kids should you avoid giving septocaine to?

A

kids undre 4

32
Q

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

A

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

33
Q

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

A

hyperbilirubinemia

34
Q

what position should the pediatric patient be in for injections?

A

supine

*mandible at 30 degree angle to the floor

35
Q

what are some post op complications?

A
  • drooling
  • speech
  • child upset
  • soft tissue trauma
  • hematoma
36
Q

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

A

13%

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

37
Q

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

A

oraverse

38
Q

how is oraverse administered/

A

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

Peds 2 (9 decks)

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