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Spring 2018 > Local Test 2 > Flashcards

Local Test 2 Flashcards

1
Q

Intra-osseus anesthesia:
What?
3 examples

A

LA deposition into cancellous bone supporting tooth

PDL ligament injection
Intra-septal
Intra-osseus

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2
Q

Greatest benefit for PDL (ILI) injection

A

Mandible for localized area

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3
Q

Indications and contraindications for PDL

A

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
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4
Q

Side effects of PDL injection and how to avoid

A

Discomfort/sensitivity to biting for a few days

Inject slower/less

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5
Q

What gets anesthetized when doing an PDL

A

Bone
Soft tissue
Apical
Pulpal tissues

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6
Q

How much is injected in PDL

How long should it take

A

0.2 mL/20 sec

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7
Q

Intraseptal injections anesthetize what

A

Bone, soft tissue

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8
Q

Why would you do an intraseptal injection

A

Periodontally involved teeth

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9
Q

Intraseptal injection:
Where
How much over how long

A

Papilla, 45˚ to tooth (90˚ to tissue)

0.2-0.4 ml/20 sec

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10
Q

Intra-osseus injection:
What is anesthetized?
Complications

A

Bone, soft tissue, root structures

Fistula formation, perforation

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11
Q

Articaine formulation

A

Septicaine

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12
Q

Why is articaine more effective than lido

But also, it isn’t. And causes parathesia

A

Thiophene ring instead of benzene, increased lipid solubility

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13
Q

Each cartridge of LA contains how much

Each 1% of anything = _ mg/ml

A

1.7 ml

10mg/ml

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14
Q

1:100,000 solution contains _mg/ml

A

0.01mg/ml or 10mcg

1%          = 1/100        = 10mg/ml
0.001%  = 1/100,000 = 0.01mg/ml
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15
Q

Adult max safe dose of 2% lidocaine

A

500 mg

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16
Q

70 kilogram adult can have how many cartridges of 1:100,000 EPO?

Max amount of epi is 0.2mg

A

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

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17
Q

Healthy adult max epi

Unhealthy?

A
  1. 2

0. 04

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18
Q

Epi sensitive patient drug of choice?

Long term soft tissue anesthesia?

Difficulty achieving anesthesia

A

Mepivacaine 3% w/o vasoconstrictor

Bupivicaine 0.5% with 1:200,000 epi

Articaine 4% with 1:100,000 epi

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19
Q

Articaine can’t be used where

A

Mandibular blocks

20
Q

T/F Gow-Gates and Vazirani-Akinosi are superior to standard IA nerve block

A

FALSE

21
Q

_ IA block was more successful than a _ one

A

Slow (60s)

Rapid (15s)

22
Q

If patient has profound lip numbness but no pulpal anesthesia, do what

A

Supplemental injection NOT repeating IA

23
Q

Intraosseus anesthesia onset takes _

A

No time (immediate)

24
Q

T/F IO after IA works

A

TRUE

25
Q

How does an anesthetic reversal agent work

A

Vasodilation of vascular smooth muscle

26
Q

What needles should be used for IANB

A

Long and not 30-gauge

27
Q

Needle breaks, what do you do

A

Stop, refer to OMFS, document it

28
Q

3 things can cause prolonged anesthesia or parasthesia

A

Needle injury to nerve

Contaminated LA

LA itself (articaine)

29
Q

4 causes of trismus

A

Trauma to muscles (multiple needle punctures)
Contaminated solutions
Hemorrhage
Infection

30
Q

How to manage trismus

A 
Heat therapy
Warm saline rinses
Analgesics
Muscle relaxants
Physiotherapy
31
Q

If trismus lasts longer than 48 hours, consider _

A

Infection

32
Q

Management if hematoma starts

A 
Pressure
Document
Analgesics
Antibiotics
Ice
No heat for 4-6 hrs
33
Q

Infection causes

A

Needle contamination

Spreading infection by solution

34
Q

Idiosyncrasy:

A

Unexpected response to a drug

35
Q

Cause of overdose levels

A 
Total dose is too high
Absorption is too rapid
Intravascular injection
Bio-transformed too slow
Eliminated too slow
36
Q

How prevalent is atypical pseudocholinesterase

A

6-7% of patients

37
Q

Esters and amides are hydrolyzed/transformed where

A

Esters: liver and plasma

Amides: liver

38
Q

Better topical

A

Amide

39
Q

Minimal overdose

A 
Talkative
Stutter
Apprehension
Excitability
Metallic taste
Sweating
Higher BP/HR
40
Q

Moderate to high overdose symptoms

A

Tonic clinic seizure
CNS depression
depressed BP/HR/RR

41
Q

Blood level to have tonic-clonic seizure

A

> 7.5µg/ml

42
Q

If a patient has a severe rxn, do what

A 
Stop
Get help
Patient supine with feet up
Establish airway
O2
43
Q

3 things people can be allergic to in LA

A

Esters

Bisulfite or metabisulfite

44
Q

Max number of cartridges of 2% lido 1:100,000 a healthy adult can receive

A

14 because of lidocaine

But 11 since max dose of epi is less

45
Q

Max cartridges of mepivicaine

A

8

Spring 2018 (18 decks)

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