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REVISION BDS > Overview of LA Techniques p200 > Flashcards

Overview of LA Techniques p200 Flashcards

1
Q

infiltration

A

local anaesthestic deposited round the termonal branches of nerves

used for soft tissues to the area adminstered (benefits of vasoconstrictor)

produce pulpal anaesthesia if alveolar bone is relatively thin

(maxilla and lower anteriors)

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2
Q

block

A

anaesthestic deposited beside the nerve trunk

abolishes sensation distal to site

used to produce

  • soft tissue anaesthesia
  • produce pulpal anaesthesia to teeth where bone is too thick to allow infiltration techniques to work successfully
    • mandible
  • anaesthesia to multiple tissues using single injection
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3
Q

general injection technique

A
  • stretch mucosa
  • puncture mucosa quickly > use distraction (wriggle toes)
  • position needle tip at target point
  • aspirate
  • inject slowly (no less than 30 secs)
  • bevel of needle should be towards you so it doesn’t occlude when it hits bone
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4
Q

Maxillary anaesthesia types

A

buccal infiltration

palatal infitration

intraligamentary injection

infraorbital nerve block

ant, middle and post superior alveolar nerve block

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5
Q

buccal infiltration anaesthetises

A

dental pulp and buccal gingivae

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6
Q

buccal infiltration technique

A

Patient sitting up and at 45* angle
Dentist infront and to the side which they are anaesthetising
Draw imaginary line along muco-buccal fold and one up long axis of tooth

Aim to anaesthetise just above the apex (DISTAL TO IT)
1. Stretch Cheek
2. Puncture mucosa with correct bevel of needle
3. Advance needle until over the apex of the tooth
4. If contact bone withdraw slightly
Aspirate -> if negative, inject slowly
-> if positive, reposition and repeat

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7
Q

uses of buccal infiltration

A

mental block

between apices of lower premolars

buccal injection, lower buccal gingivae

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8
Q

anterior superior alveolar nerve block affects

A

teeth 1,2, 3

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9
Q

middle superior alveolar nerve block affects

A

teeth 4, 5, and mesio-buccal of root of 6

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10
Q

posterior superior alveolar nerve block affects

A

all of 6 (bar MB root), 7 and 8

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11
Q

what nerve may some people not have

A

middle superior alveolar nerve

so ant 1-4 and post 5-8

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12
Q

palatal infiltration anaesthesises

A

palatal mucoperiosteum not pulp

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13
Q

2 nerves that can be affected in palatal infiltrations

A

nasopalatine nerve

greater anterior palatine nerve

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14
Q

nasopalatine nerve innervates

A

mucoperiosteum of teeth 1, 2, 3 (ant 1/3)

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15
Q

greater anterior palatine nerve innervates

A

mucoperiosteum of teeth 4, 5, 6, 7 and 8 (post 2/3)

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16
Q

how to do a palatal infiltration

A

Midway between the gingival margin of the tooth and the median palatine raphe (e.g midline of palate)

Along the long axis of tooth

Hit vault of palatine bone within 2mm of insertion
* injection for the maxillary third molar should be at palatal root of maxillary second molar to avoid anaesthesia of lesser palatine nerves which supply the soft palate = gagging

For Nasopalatine inject at incisive papilla

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17
Q

issue with palatal infiltration

A

often painful

use CHASING technique

Labial or Buccal first (give time to work) through interdental papilla

  • Use mirror to check for blanching of palatal mucosa at the respective area

Anaesthetise the blanched area
Use short needle!!
Can use topical beforehand

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18
Q

LA characteristic

A

bad taste

no flavour added to reduce allergy risk

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19
Q

intraligamentary injection anaesthetises

A

PDL

i.e. if pulp and periodontal nerve of tooth being worked on

down long axis of tooth

can use intraosseous anaesthesia with stabident

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20
Q

increased age means

A

increased maxillary and mandibular bone density

so poorer diffusion of anaesthetic

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21
Q

inferior alveolar nerve block anaesthesis

A
  • all teeth in quadrant
  • most of tongue on respective side
  • labial/buccal mucosa until 2nd premolar

buccal molar mucosa is unaesthetised

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22
Q

anatomy of IAN

A 
M= Masseter
R = ramus
AV = inferior alveolar vein
IAA = inferior alveolar artery
SML = spheno mandibular ligament
MP = medial pterygoid muscle
LN = lingual nerve
B = buccinator
PMR = pterygomandibular raphe
SCM = superior constrictor muscle
P = parotid gland
TT = tendon of temporalis
L = lingula.
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23
Q

IAN needle passes through

A

Buccinator muscle and into the pterygomandibular
space where it is directed to an area of bone just superior to the
Lingula

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24
Q

neurovascular bundle for IAN

A

The Inf Alv N. Inf Alv Vein, and Inf Alv Artery are wrapped together by a fibrous sheath in a neurovascular bundle, which occupies a spooned-out depression on the medial surface of the ramus

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25
Q

lingual nerve location realtive to IAN

A

superior and medial

26
Q

amount of LA used for IDB

A

2/3 cartridge

leave last 1/3 for lingual nerve - deposit on retration (1-2mm)

27
Q

technique for IDB

A
  • Thumb placed at anterior notch, fingers concavity of ramus outside mouth
  • Needle entry junction of buccal pad of fat/Pterygomandibular raphe
  • Syringe lies over contra lateral 5-6
  • Advanced to bony contact (1cm of needle visible)
    • If no bony contact reposition syringe distally
  • Roughly 2/3 up nail of thumb horizontally (if thumb in coronoid notch)
28
Q

buccal nerve block anaestheses

A

buccal mucosa of lower 6, 7, 8

(not number by IDB)

29
Q

buccal nerve block technique

A
  • Injection distal and buccal to last molar near anterior border of ramus of mandible
  • At level of occlusal plane
  • Must be done when operating on any of those teeth
30
Q

mental nerve block anaesthetises

A

pulpal anaesthesia for mandibular teeth anterior to the mental foramen

  • pre-molars, canine, lateral and central incisor

buccal mucous membrane anterior to the mental foramen

skin of lower lip and chin

31
Q

mental nerve block technique

A

Inject at mucobuccal fold at mental foramen located between the apices of the two premolars/canine and deposit into the foramen

Down long axis of teeth

32
Q

incisive nerve block anaesthetises

A
  • buccal soft tissue
  • similar to mental nerve block
33
Q

use of incisive nerve block

A

soft tissue biopsy

34
Q

maxillary nerve

A
35
Q

mandibular nerve

A
36
Q

complications and contraindications to LA classes

A

psychogenic causes

drug interactions

allergies

toxicity

pregnancy

37
Q

pscychogenic complications of LA

A
  • fainting
  • bradycardia
  • vagal event
38
Q

pscychogenic complications of LA caused by

A

lack of oxygenated blood to brain

39
Q

clincial features of psychogenic complications of LA

A
  • lightheadedness
  • pallor
  • beads of sweat on face
  • bradycardia
  • pupil dilation
  • nausea
40
Q

management of psychogic complications from LA

A
  • lie flat and raise legs
  • loosen neck clothing (improve room for ventilation)
  • sweet drink?
41
Q

possible drug interactions with LA

A
  • monoamine-oxidase inhibitors (antidepressants)
  • tricyclics
  • Beta blockers
  • non-potassium sparing diuretics
  • cocaine
42
Q

MAOI interaction with LA

A

most adrenaline metabolised bu catechol-A-Methyl transferase system

if on MAOI it retains adreanline (i.e. not metabolised)

43
Q

tricyclics interaction with LA

A

hypertension due to uptake of adrenaline at symptomatic nerve terminals (limit pt to 2 cartridges)

44
Q

Beta blockers interaction with LA

A

Beta2 adrengic receptors blocked = increase in vasodilation

45
Q

non-potassium sparing diuretics interaction with LA

A

can cause Hyperkalemia due to adrenalines Potassium lowering action = potentioal arrythmia/muscle weakness

46
Q

cocaine interaction with LA

A

increased adrenergic activity - Catecholamines (adrenaline) bind to receptors and increase symp activity

47
Q

allergies to LA

A

true allergies are v rare (usually due to latex bung)

sometimes methylparaben preservative in LA

48
Q

clincal signs of LA toxicity

A
  • convulsions
  • loss of conciousness
  • respiratory depression
  • circulatory collapse
49
Q

pregnancy and LA

A

felypression (octapressin) has the theoretical potential to induce labour

(acts like oxytocin)

50
Q

LA effect on cardiovascular system

A

low level = stimulant

high levels = circulatory collapse

51
Q

LA effect on CNS

A

depressant leading to unconciousness and resp arrest

52
Q

LA and methamoglobin

A

can cause Methemoglobinemia

  • reduced ability of blood cells to release O2 to tissues

cyanosis associated with lethargy and resp distress

prilocaine, articaine and benzocaine

53
Q

safe dose

A

maximum allowable dose mg/kg

54
Q

adrenaline affect on sympathetic nervous system

A

heart

  • increased rate
  • increased force
  • increased output
  • increased excitability

blood vessels

  • coronary dilation
  • skin contraction
  • muscle dilation

blood pressure

  • increased systolic pressure
  • decreased diastolic pressure
  • overall - llittle effect

lungs

  • bronchal muscle relaxation
55
Q

Facial palsy due to LA

A

hit parotid gland in IDB

affects whole side of face

will wear off with time

56
Q

stroke

A

upper spares upper

central lesion so can still use forehead on affected side unlike iatrogenic

57
Q

what not to use for IDB

A

articaine

58
Q

local complication of LA

A

trismus

facial palsy

prolonged anaesthesia (multiple passes? chemical trauma?

59
Q

trismus due to LA tx

A

hit medial pterygoid

treat with diazepam and ibuprofen

60
Q

systemic diseases to avoid LA

A
  • Cardiovascular disease (use <3 x2.2ml)
  • hyperthyroid >thyroid crisis
  • phaechromocytoma (hypertension)
  • drugs

REVISION BDS (43 decks)

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