Specific Agents Flashcards
T/F if you use a longer acting LA during a procedure there is less of a need to provide pain medication post -op?
TRUE
5 major parameters when selecting an LA?
- length of time needed to control pain
- Requirement for pain control following the procedure
- possibility of self-mutilation in the postoperative period
- requirement for hemostasis (vasoconstrictors)
- presence of any contraindications
duration of action is divided into two categories
- pulpal (hard tissue)
2. soft tissue )total)
Duration of LA depends on what 5 things
- individual variation
- technique’
- tissue status (vascularity and pH)
- anatomical variation
- type of injection (infiltration/block)
highly vascular?
LA washes away and doesn’t stay around as long
low ph?
acidic environment and not as much of a base form to go into nerve
which type of LA injection lasts longer?
Block > local infiltrate
dosages for LA are given in what?
mg/kg or mg/lb
maximum dose definition?
LA blood level jsut BELOW the threshold for an overdose rxn
hyporesponders?
15% of the lower portion of the bell shaped curve in which pulpal anesthesia lasts less than normal
Hyperresponders?
15% of the upper portion of the bell shaped curve in which pulpal anesthesia lasts longer than normal
Articaine aka and what type
Amides aka septacaine - 2nd most popular after lidocaine (xylocaine)
lidocaine aka
(xylocaine)
intermediate acting?
articaine (septacaine) + lidocaine (xylocaine)
Mepivocaine used with vascocontrisctor?
usually not
esters metabolized where?
PLASMA
Procaine - type and details
Ester – provides essentially no pulpal anesthesia and 15-30 minutes of soft tissue anesthesia
GREATEST VASOCONSTRICTOR - BUT NO LONGER AVAILABLE
high incidence of allergy
prpoxycaine
ester– not available alone because hight toxicity
Benzocaine - type and details
ESTER – topical local anasthetic for temporary relief of pain associated with toothache, minor sore throat pain and canker sore
ravocaine type and details
Combination of procaine and propoxycaine – not availabel anymore and was useful when amides were contraindicated
lidocaine type and details for dental and medical
AMIDE type
Dental – injectable local anesthetic + topical LA
Medical - LA and acute tx of ventricular arrhythmias from myocardial infarction
little/ no allergies to amide LA
max dosage of lidocaine
7mg/kg OR 3.2 mg/lb
max=500 mg
duration of lidocaine w/ and w/out epi
with pulpal = 60-120 minutes
soft tisssue =3-5 hours
withOUT
pulpal = 5-10 minutes
soft tissue = 60-120 minutes
Which one has more epi? 1:50,000 or 1:100,000? implications on duration of LA? use of one vs the other?
1:50,000 has more epi
Same duration of LA on the soft tissues (3-5 hours) and pulpal tissue (60-120 mins) BUT MORE EPI will be used in situations where need to control bleeding more (more invasive surgeries)
max dosage of epi to cardiac? to hea;thy?
- 04 max to cardiac pt.
0. 2 to healthy pt
max dosage of mepivicaine
6.6mg/kg or 3mg/lb (max 400 mg)
duration of mepivicaine
Pulpal 20-40 minutes
Soft tissue: 2-3 hours
causes slight vasodilation
clinical signs of methemoglobinemia
greyish blue cyanosis of the lips, mucus membranes, and nail beds
may have respiratory and circulatory arrest
prilocain max dosage =
8.0 mg/kg or 3mg/lb (max 400 mg)
max - 600 g
what levels of methemoglobinemia will cause symptoms?
20%
treatment for methhemoglobinemia
1-2 mg/lg of 1% methylene blue solution intravenously over a 5 minute period
Prilocaine is RELATIVELY contraindicated by pt’s with?
- Idoipathic or congenital methemoglobinemia
- Sickle cell
- Anemia
- Cardiac or respiratory failure by hypoxia
- Patients receiving acetaminophen or phenacetin
duration of action of prilocaine 4%
Pulpal 10 min infiltrate
60 minutes = block
Soft tissue 1-5-2 hours infiltrate
2-4hr/ block
prilocaine duration of 4% with epi?
pulpal = 60-90 minutes
soft tissue = 3-8 hours
articaine max dosage
3.2 mg/lb or 7.0mg mg/kg
potential complication with articaine?
methehomoglobin
metabolism of articaine
liver and plasma (more liver)
duration of articaine 4% with and without epi
4% without pulpal = 45-60 minutes
soft tissue =2-5 hours
with pulpal =60-75 minutes
soft tissue = 3-6 hours
which local anesthetic agents are noted to have a higher incidence of lingual paresthesia?
4% articaine
4% prilocaine
due to higher concentration
long acting?
bupivaciane and marcaine
indications to use Bupivacaine
lengthy dental procedures
management of post op pain
duration of bupivacaine
Pulpal = 90-180 minutes
Soft tissue =4-9 hours
max dosage of bupicacaine
90 mg
concentrations of drugs in topicals?
have to be at higher concentrations
two topical anasthetics used
Benzocaine = ester
lidocaine = amide
EMLA
Eutectic mixture of LA
cream composed of lidocaine 2.5% and prilocaine 2.5 %
used as a topical anesthetic to be placed on INTACT skin. – like starting an IV catheriers, etc.
which dose do you use for calculating max dosage with pt. using two LA’s?
Max dosage of the LA with the LOWER max dose
example using Articaine and mepivicaine
articaine = 7.0 mg/kg and mepivicaine = 6.6 mg/kg
so will use max dosage of 6.6 for the pt.
because it is MORE TOXIC /CONCENTRATED
