Local Anesthesia for Pediatric Pts Flashcards
________ is crucial to provide good care and have the child behave as well
Profound local anesthesia
all local anesthetics are what?
weak bases
which end of the LA is hydrophilic?
Amine end
which end of the LA is lipophilic?
aromatic
where are amides metabolized?
liver by P450 enzyme
are amides hypoallergenic?
yes but the true allergy are rare
when are esters applied?
in topical situations
where are esters metabolized?
pseudocholinesterase
are esters hypoallergenic?
no (they are hyperallergenic)
what is an example of an ester LA?
benzocaine
what and where does the acidic part of the LA do?
- in carpule
- keeps anesthetic on either the outside of the nerve sheath or the inside of the nerve sheath
what and where does the basic part of the LA do?
- once in the tissue
- allows the anesthetic to cross the lipid bilayer of the nerve sheath
how many mls of LA are in a cartridge?
-1.7ml
how many mg of lido are in 1 cartridge of 2% lido?
34mg
how many mg of articaine are in 1 cartridge of 4% articaine?
68mg
what is the max dose for lido?
- 4.4 mg/kg
- 2.0 mg/lb
what is the max dose for septocaine?
- 7.0 mg/kg
- 3.2 mg/lb
once inside the lipid bilayer, what happens to the LA?
converts back to acidic to block voltage gated Na+ channels, preventing depolarization
when infection is present, how does this affect the effectiveness of LA?
equillibrium shifts toward acidic form, delayeing onset and dec amount of anestheltic in the tissue
all LAs are ______
vasodilators
*reasons epi is in there (side effect is inc HR)
what is the effect of LA on the cardiovascular system?
- 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
what is the effect of LA on the central nervous system
- creates biphasic reaction
- overdose leads to dizziness, anxiety, confusion, twitching and seizures
- uncounciousness and possible respiratory arrest
how do you prevent an overdose?
- 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
how deep is topical anesthetic effective?
soft tissue 2-3 mm in depth
- onset in 30 secs
- toxic rxns unknown, local allergic rxns possible
how do you apply topical ?
- dry tissue
- do not have a massive glob
- direct contact for 1-2 minutes
- keep away from tongue.
where is the mandibular foramen in a child?
- slightly lower and more posterior in a child
- lower than the level of the occlusal plane
for kids, what is mandibular infiltration used for?
- primary FIRST molars, including pulpotomies
* NOT effective for pulp tx on 2nd molars!!!
for kids, is it better to use block or infiltration?
- both are equal in restorative procedures
* EXCEPT pulpotomies for second molars!!!
is articaine (septocaine) safe for kids?
yes
what type of LA should be avoided for blocks?
septocaine
what kids should you avoid giving septocaine to?
kids undre 4
should the assistant attempt to restrain the child for the shot?
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
why dont you use bezocaine on a kid under the age of 2?
hyperbilirubinemia
what position should the pediatric patient be in for injections?
supine
*mandible at 30 degree angle to the floor
what are some post op complications?
- drooling
- speech
- child upset
- soft tissue trauma
- hematoma
what percentage of kids get soft tissue trauma following mandibular nerve block?
13%
*if child is under 4, more soft tissue trauma from unilateral mandib block than from bilateral
rapidly restores normal sensation and function so patients can speak, smile, and drink normally in approx half the time
oraverse
how is oraverse administered/
with a standard dental syringe utilizing the same injection site and an identical administration technique that is used for LA
