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xD2 Pedo > Pedo Local Anesthesia > Flashcards

Pedo Local Anesthesia Flashcards

1
Q

What directs the type of anesthetic you will use?

A 
Patientt medical history
Patient mental/development status 
Anticipated duration of procedure 
Need for heme control 
Other agents planned (Nitrous oxide, General Anesthesia, sedation) 
Practitioner knowledge
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2
Q

What are the benefits of vasoconstrictors?

A

Limits systemic distribution of local Increases duration of local

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3
Q

What type of local anesthetic is usually used for pedo cases?

A

Shorter acting
2% Lido
4% Septo

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4
Q

Why give a shorter acting local for pedo?

A

Decrease post-op trauma

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5
Q

How should children be considered physiologically?

A

Not little adults. Anatomy and physiology is different with different size, shape, and location of foramina and landmarks, pharmacology is different, psychology is different (decreased ability to cooperate or verbalize)

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6
Q

What is characteristic of children cardiovascular compared to adults(cardiac output and oxygen consumption)?

A

Higher cardiac output
Higher oxygen consumption
Higher output with higher baseline heart rate

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7
Q

Normal pedo HR are higher or lower than adults?

A

Higher Heart rate

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8
Q

Normal pedo BP is higher or lower than adults?

A

Lower

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9
Q

Is the volume of distribution of drugs increased or decreased in adults?

A

Increased volume of distribution

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10
Q

With respect to the increased vol of distribution, what does that mean for the pedo plasma level if a standard dose is given?

A

Lower plasma level than adults

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11
Q

Is the minute volume increased or decreased in children and what does this mean for cardiac output?

A

Minute volume increased with corresponding increased cardiac output

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12
Q

With respect to the increased vol of distribution, what does that mean for the pedo respiratory rate if a standard dose is given?

A

Respiratory rate increases

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13
Q

What are the 5 main differences between adult and pediatric airway?

A
  1. Proportionally larger head and tongue
  2. More anterior and cephalad larynx
  3. Long floppy epiglottis
  4. Short trachea and neck
  5. Narrowest point is cricoid cartilage
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14
Q

What is the anatomy of the pedo zygomatic process?

A

Closer to the maxillary alveolar bone

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15
Q

Over which teeth is the zygomatic process prominent in pedo?

A

Over apices of Max 1st perm molar and primary 2nd molars

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16
Q

Is pedo maxillary bone more porous or less porous?

A

More porous, can infiltrate easier

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17
Q

Is a shorter depth of needle required for maxillary local anesthesia?

A

Shorter depth

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18
Q

Where is the mandibular foramen(Lingula for the IAN) located in pedo?

A

More inferiorly and posteriorly, approximate level of occlusal plane

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19
Q

Pedo mental foramen faces anteriorly or posteriorly?

A

Anteriorly

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20
Q

What is the insertion depth for local in the mandible?

A

Shorter depth of needle

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21
Q

How does mandible grow?

A

Down and forward

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22
Q

How long should topical be left over the injection site to be effective?

A

90-120 seconds

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23
Q

Can patients tell difference between size 25,27,30 needles and which one has the most separations associated?

A

Can’t tell difference. 30 has most separations. Therefore pick the larger guage, except extra short only comes in 30 guage

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24
Q

What is the length of the extra short needle?

A

12mm

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25
Q

What is the length of the short needle?

A

21mm

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26
Q

What is the length of the long needle?

A

30mm

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27
Q

What needle length is suitable for children under 6 yrs old?

A

Short

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28
Q

What needle type is ideal for maxillary anterior infiltrations?

A

Extra Short

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29
Q

Where can needle be bent for papillary and PDL injections?

A

At hub and only once

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30
Q

What areas are anesthetized with the IAN block?

A

Mandibular teeth to midline
Body of mandible
Anterior 2/3 of tongue
Lingual soft tissue and periosteum

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31
Q

What are some indications for IAN?

A

Multiple teeth to be restored in one quadrant

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32
Q

What is the Gate Theory?

A

Stimulate nerve impulses (e.g. cheek shaking) lessens pain on insertion

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33
Q

Which is usually more painful, tissue distention or needle insertion?

A

Tissue distention

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34
Q

Should you make sure IAN block is successful before doing the Long Buccal and why?

A

Yes, Long Buccal can mask unsuccessful IAN

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35
Q

Over what landmark should the barrel of the syringe be placed when giving a pedo IAN?

A

Over opposite side primary molars

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36
Q

What is the IAN success rate in pedo?

A

High (90-95%)

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37
Q

What gives possible accessory innervations to mandibular anteriors and molars?

A

Mylohyoid nerve (branched off IAN before mandibular canal)

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38
Q

What is the mylohyoid injection landmark?

A

Below mylohyoid groove aiming at apex of 2nd molar lingual aspect

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39
Q

What nerve is blocked if following areas are anesthetized: anterior mandible, 2nd primary molar to the ipsilateral central incisor, buccal soft tissues , and pulp in pedo?

A

Mental nerve block

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40
Q

Should the needle bevel be towards or away from bone in mental nerve block?

A

Towards the bone

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41
Q

Which direction does the mental foramen face in pedo?

A

Anteriorly

42
Q

Can mandibular infiltrations be done in pedo?

A

Yes, because the bone is less dense

43
Q

What is the drawback of mandibular infiltration versus IAN?

A

Infiltrating may have shorter duration

44
Q

When is a PDL injection contraindicated?

A

When there is inflammation/infection at injection site

45
Q

Is the PDL injection a primary or supplemental injection?

A

Supplemental

46
Q

What are the advantages of the PDL injection?

A

Mminimize post op bleeding
Good for patient with bleeding disorder
Specific teeth anesthetized with minimal residual anesthesia resulting in less post op discomfort and trauma

47
Q

What are the post-op instructions for for a patient who received anesthesia?

A

No chewing until anesthesia has worn off, soft diet then work up as anesthesia wears off, can be numb >1 hr post op

48
Q

What are some common post op anesthesia soft tissue traumas?

A

Biting lip, tongue, cheek

49
Q

What is the procedure if post op anesthesia soft tissue injury occurs?

A

See pt within 24 hrs. advise warm saline rinse

50
Q

What is used more commonly on maxilla: local infiltration or PSA, MSA, ASA?

A

Local infiltration

51
Q

What is an indication for maxillary local infiltration?

A

Minimal restoration needs

52
Q

If extracting maxillary teeth, where should you always administer anesthesia?

A

Palatal

53
Q

What other procedure indicates palatal infiltration?

A

Seating stainless steel crowns

54
Q

What is the depth of insertion for anterior injections?

A

1.5-2.0 mm

55
Q

What is the technique if multiple teeth require anterior injection?

A

Maintain same injection site but move needle

56
Q

What should be done with patient’s head while giving anterior infiltrations to avoid trauma to patient or self?

A

Support head

57
Q

What is an alternative to palatal injection?

A

Interdental papilla infiltration at base of papilla triangle. Allow 3-5 min to work

58
Q

What is a better technique for patient management: nasopalatine block or interdental papilla infiltration?

A

Interdental papilla infiltration

59
Q

What is a landmark to use when giving the greater palatine injection?

A

10 mm posterior to distal surface 2nd primary molar at depression in palate

60
Q

What are some methods to block pt vision of needle?

A

Light in the eyes
Nitrous hood obstruct vision
Pass instruments out of patient line of sight

61
Q

What are the 3 parts of local anesthetic?

A

Lipophilic aromatic ring (non-ionized for lipid solubility)
Amide chain
Terminal Amine (determines charge, water solubility)

62
Q

What part of the anesthetic blocks the Na channel?

A

Ionized

63
Q

If surrounding tissue pH is lower (infection), what will be the character of the local given?

A

More ionized, therefore unable to diffuse

64
Q

By blocking Na channels what does local due to the nerve?

A

Slows rate of depolarization so threshold not reached (increases threshold?)

65
Q

All Amide locals have what where in their name?

A 
An “I” in the portion before –caine 
Articaine
Prilocaine
Mepivicaine
Lidocaine
Bupivicaine
Etidocaine
66
Q

What is the amide metabolism site ?

A

Liver

67
Q

What are 2 places where prilocaine is metabolized?

A

Primarily liver, but also lung

68
Q

Where are esther locals metabolized?

A

Plasma by psuedocholinesterase

69
Q

What is the definition of pKa?

A

The pH at which 50% of drug is charged vs uncharged?

70
Q

The pKa determines what?

A

Onset of action

71
Q

The farther the pKa is away from physiologic ph (7.4) the longer or shorter it will take for onset?

A

Longer onset

72
Q

What does absorption of anesthetic mainly depend on and what can slow its absorption?

A

Vascular supply

Vasoconstrictor

73
Q

This determines the DURATION of the anesthetic?

A

Protein binding

74
Q

Why does Bupivicaine last longer thatn Lidocaine?

A

Bupivicaine has higher protein binding

75
Q

What determines the anesthetic’s toxicity and potency?

A

Lipid solubility

76
Q

What is key for the 2-3 mm of topical anesthetic tissue penetration?

A

Tissue must be dry

77
Q

Which is more toxic: local or topical?

A

Topicl

78
Q

What is the maximum dose of articaine?

A

7mg/kg

79
Q

What is the percentage of Articaine in the local anesthetic?

A

4%

80
Q

How many mg of 4% Articaine are in a 1.7 ml vial?

A

40mg x1.8mL = 72mg Articaine/1.8 mL carpule

81
Q

What is a peculiarity of Articaine that allows it to be metabolized in liver and plasma?

A

Amide (liver metabolism) w/ ester side chain (plasma metabolism). Gives short half life

82
Q

How much 1:100k epi is in a 1.8ml carpule?

A

0.01 mg/mL x 1.8mL = 0.018 mg/1.8mL carpule

83
Q

How much 1:100K Epi is in a 1.7 mL carpule?

A

0.01mg/mL x 1.7mL = 0.017 mg/1.7 mL carpule

84
Q

If Epi is 1:50K, is there more or less Epi in the carpule than a 1:100K

A

More, double the 1:100kconcentration

85
Q

If Epi is 1:200K, is there more or less Epi in the carpule than 1:100K?

A

Less, half the 1:100k concentration

86
Q

How convert Lbs to Kg?

A

Divide lbs by 2.2

87
Q

What are the sSteps to determine max dose/max # carpules for child based on weight?

A

Know mg/g for local (Articaine 7mg/kg; Lido 4.4mg/kg)
Determine wt in Kg
Calculate max dose for that Kg weight
Calculate total number of carpules to get the dose

88
Q

1 kg = how many pounds?

A

.454 lbs

89
Q

Every 11 lbs = how many kg?

A

5kg

90
Q

What is the maximum dose of 2% Lidocaine?

A

4.4 mg/kg

91
Q

What is the maximum dose of 4% Septocaine?

A

7 mg/Kg

92
Q

What is a shortcut for the pediatric clinic that helps avoid overdosing on local?

A

1 carpule 2% lido for every 20 lbs

93
Q

What are 2 causes of Local anesthetic overdose?

A

Intravascular injection causing rapid uptake Excessive dose delivered

94
Q

CNS depression (disoriented, seizures, loss of consciousness, respiratory arrest) is a sign of what?

A

Local overdose, can happen during injection or w/in 5-10 min

95
Q

What are the cardiovascular effects of a local anesthesia overdose?

A

Initial HR and BP increase, followed by vasodilation and HR and BP decrease

96
Q

Slurred speech, shivering, muscle twitching, dizziness/lightheadedness, drowsiness, warm, flushed feeling are signs of what and can be monitored how?

A

Local anesthesia overdose. Communicate with patient during and immediately post injection

97
Q

What is the acute treatment for Local Anesthesia overdose?

A

Postpone planned treatment
Admin supplemental oxygen
Monitor BP and HR
Trendelenburg position (Feet elevated above head and heart)

98
Q

The potential for toxic reactions increases when local is used in conjunction with what?

A

Sedative medications

99
Q

If pt has a sulfite allergy, consider using what?

A

Plain 3% Mepivicaine

100
Q

What is the cause of sulfites in local anesthesia?

A

Epi has a bisulfate preservative

101
Q

Is it likely patient has a true allergy?

A

No, more likely an adverse reaction

xD2 Pedo (5 decks)

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