Local Test 2 Flashcards
Intra-osseus anesthesia:
What?
3 examples
LA deposition into cancellous bone supporting tooth
PDL ligament injection
Intra-septal
Intra-osseus
Greatest benefit for PDL (ILI) injection
Mandible for localized area
Indications and contraindications for PDL
I:
- 1/2 teeth anesthesia
- Isolated teeth in both mand quadrants need it (avoid full IA block)
- Children (avoid IA)
- Risky IA block (hemophilia)
C:
- infection or severe inflammation
- presence of primary teeth
Side effects of PDL injection and how to avoid
Discomfort/sensitivity to biting for a few days
Inject slower/less
What gets anesthetized when doing an PDL
Bone
Soft tissue
Apical
Pulpal tissues
How much is injected in PDL
How long should it take
0.2 mL/20 sec
Intraseptal injections anesthetize what
Bone, soft tissue
Why would you do an intraseptal injection
Periodontally involved teeth
Intraseptal injection:
Where
How much over how long
Papilla, 45˚ to tooth (90˚ to tissue)
0.2-0.4 ml/20 sec
Intra-osseus injection:
What is anesthetized?
Complications
Bone, soft tissue, root structures
Fistula formation, perforation
Articaine formulation
Septicaine
Why is articaine more effective than lido
But also, it isn’t. And causes parathesia
Thiophene ring instead of benzene, increased lipid solubility
Each cartridge of LA contains how much
Each 1% of anything = _ mg/ml
1.7 ml
10mg/ml
1:100,000 solution contains _mg/ml
0.01mg/ml or 10mcg
1% = 1/100 = 10mg/ml 0.001% = 1/100,000 = 0.01mg/ml
Adult max safe dose of 2% lidocaine
500 mg
70 kilogram adult can have how many cartridges of 1:100,000 EPO?
Max amount of epi is 0.2mg
1: 100,000 is 0.01 mg/ml
0. 2mg max/0.01 mg/ml LA = 20ml total of LA can take
20ml/1.7ml per cartridge = 11 cartridges
Healthy adult max epi
Unhealthy?
- 2
0. 04
Epi sensitive patient drug of choice?
Long term soft tissue anesthesia?
Difficulty achieving anesthesia
Mepivacaine 3% w/o vasoconstrictor
Bupivicaine 0.5% with 1:200,000 epi
Articaine 4% with 1:100,000 epi
Articaine can’t be used where
Mandibular blocks
T/F Gow-Gates and Vazirani-Akinosi are superior to standard IA nerve block
FALSE
_ IA block was more successful than a _ one
Slow (60s)
Rapid (15s)
If patient has profound lip numbness but no pulpal anesthesia, do what
Supplemental injection NOT repeating IA
Intraosseus anesthesia onset takes _
No time (immediate)
T/F IO after IA works
TRUE
How does an anesthetic reversal agent work
Vasodilation of vascular smooth muscle
What needles should be used for IANB
Long and not 30-gauge
Needle breaks, what do you do
Stop, refer to OMFS, document it
3 things can cause prolonged anesthesia or parasthesia
Needle injury to nerve
Contaminated LA
LA itself (articaine)
4 causes of trismus
Trauma to muscles (multiple needle punctures)
Contaminated solutions
Hemorrhage
Infection
How to manage trismus
Heat therapy Warm saline rinses Analgesics Muscle relaxants Physiotherapy
If trismus lasts longer than 48 hours, consider _
Infection
Management if hematoma starts
Pressure Document Analgesics Antibiotics Ice No heat for 4-6 hrs
Infection causes
Needle contamination
Spreading infection by solution
Idiosyncrasy:
Unexpected response to a drug
Cause of overdose levels
Total dose is too high Absorption is too rapid Intravascular injection Bio-transformed too slow Eliminated too slow
How prevalent is atypical pseudocholinesterase
6-7% of patients
Esters and amides are hydrolyzed/transformed where
Esters: liver and plasma
Amides: liver
Better topical
Amide
Minimal overdose
Talkative Stutter Apprehension Excitability Metallic taste Sweating Higher BP/HR
Moderate to high overdose symptoms
Tonic clinic seizure
CNS depression
depressed BP/HR/RR
Blood level to have tonic-clonic seizure
> 7.5µg/ml
If a patient has a severe rxn, do what
Stop Get help Patient supine with feet up Establish airway O2
3 things people can be allergic to in LA
Esters
Bisulfite or metabisulfite
Max number of cartridges of 2% lido 1:100,000 a healthy adult can receive
14 because of lidocaine
But 11 since max dose of epi is less
Max cartridges of mepivicaine
8
