Pharmacology Behaviour_LA

Question 1

What are the different methods used pharmacologically for behaviour management?

Answer 1

• Conscious sedation
• Deep sedation
• GA

Question 2

What are some factors to consider before deciding to use pharmacological agents to manage behaviour?

Answer 2

• Patient age, behaviour, co-operation
• MHx
• SHx (distance travelled to clinic and language)
• Informed consent
• Benefits + risks
• Treatment to be performed
• Practitioner’s experience

Question 3

What pharmacological agents are available for behavioural management?

Answer 3

• LA
• Nitrous
• Oral sedation
• IV sedation
• GA

Question 4

Can sedation substitute for LA for pain management?

Answer 4

No

Question 5

What is the most important management objective?

Answer 5

• Removal of pain, if can not manage pain then can not do treatment
• Remember if child can not handle local likely can’t handle drill

Question 6

What should be considred in treatment planning LA?

Answer 6

• No medical contraindications
• Maximum allowable dose
• Previous pt history with LA
• Pros and cons of most affected vs least affected first
• Pros and cons of block vs infiltration first appointment
• Need for pharmacological behaviour

Question 7

T or F? Infiltrations are less traumatising than blocks for children?

Answer 7

F

Children normally can’t tell the difference between the two, generally fine with both or freak out with both

Question 8

What is the maximum dose of LA recommended for kids?

Answer 8

4.4mg/kg

Question 9

How much should a 5-6 year old weigh on average?

How many carpules can you use on them?

Answer 9

20kg

4.4mg * 20 = 88 mg maximum dose

One cartridge contains 44mg of LA

Hence 88/44=2 carpules maximum

If 0.1g of topical applied, this adds another 5mg of dosage, thus 88-5=83; 83/44= 1.8 carpules

Question 10

If you have given one carpule of lignocaine, and your tutor has given the second and neither has worked, what can you do?

Answer 10

Top up with articaine, using different agents can avoid overdose of a single agent

Question 11

What are some complications involved with using LA?

Answer 11

• Lip and cheek biting

- Overdose (via intravascular injection or excessive dose)

Question 12

What are some signs of overdose?

Answer 12

CNS depression
Seizures
Disorientation
Loss of consciousness

Decreased CO, CV collapse

Question 13

What is the maximum dosage of articane?

Answer 13

7mg/kg

Question 14

How many carpules can be adminstered in a 5-6 year old?

Answer 14

5-6 year old=20kg

Max dose = 7 * 20 = 140mg

Max carpules= 1.5 (for some reason)

Question 15

What is a contra-indication of articaine for use in children?

Answer 15

Can not use in children under 4 years

Question 16

Should you use articane as a substitution for an IANB?

Answer 16

-No, always use IANB with the articaine infiltration, don’t want to risk kid going crazy

Question 17

What extra steps can be used to make a palatal infiltration more comfortable?

Answer 17

-Do intrapapillary injections on mesial and distal of tooth–>numbs up the tissues slightly in preparation for palatal injection

Question 18

How should the needle be passed to you?

Answer 18

Behind the head

Question 19

What behavioural management techniques can be used with LA?

Answer 19

Distraction
Non-verbal communication
Warning child of “funny feeling”, may tickle a lot