The Armamentarium Flashcards
what is the armamentarium of local anesthesia delivery system
syringe + needle + cartridge = delivery vehicle
what are the types of syringes
- non disposable syringes
- disposable syringes
- safety syringes
- computer controlled local anesthetic delivery system
what is breech loading
carpule loaded from side
what causes blood in cartridge
negative pressure
what does positive pressure cause
thumb ring forced solution through needle to patient
when is pressure syringe used
pulpal anesthesia of one isolated tooth in the mandibular arch
what is a jet injector
- liquids forced through very small openings caleld jets at very high pressure can penetrate intact skin or mucous membranes
what is primary use for jet injector
topical anesthesia before needle insertion but you still need to do nerve block and infiltration
advatnages and disadvantages to disposable syringr
-A: disposable, single use. sterile. lightweight.
-D: does not take prefilled dental cartridges. difficult aspiration- need 2 hands
how should you care for needle instrument
- wash syringe after each use
- lubricate every 5 autoclaves
- clean harpoon with brush after each use
- replace piston and harpoon
what are the parts of the needle
-bevel
- shaft
- the hub
- cartridge penetrating end
what are the factors of the shaft
-diameter/guage
- length from tip to hub
the greater angle the bevel, the greater the degree of:
deflection
the smaller the guage number, the ____ the diameter
greater
advantages of larger gauge needle
- less deflection
- greater accuracy in injection
- less change breakage
- greater aspiration
- no difference in patient comfort
what gauges are each color needle: red, yellow and blue
-red: 25
- yellow- 27- what we use
- blue: 30
where is the nondeflecting needle tip
in the center of the shaft
what is the average short needle
20 mm
what is the average long needle
32mm
where is the weakest portion of the needle
at the hub
how should the needle be handled
- never used on more than 1 patient
- change after 3 or more tissue penetration
- cover in protective sheath when not in use
- scoop technique
what are the most common bent needle procedures
- inferior alveolar nerve block
- posterior superior alveolar nerve block
- intrapulpal injection
- PDL injection and intraosseous injection
what would cause pain on insertion
dull needle
do not bend needle if to be inserted into ____mm soft tissue depth
> 5mm
how much can a cartridge hold
2ml solution but US cartridges hold 1.8ml
what is the cartridge made of
glass
what is the stopper (plunger)
receives the harpoon of the aspirating syringe
what does gold around cylinder mean
articaine
what does red around the cylinder mean
lidocaine with epi
what is the diaphragm of the cartridge
- semipermeable membrane
- where the needle penetrates into the cartridge
what does the mylar plastic label wrap around glass cylinder do
protect doctor and patient in event of glass crack or shattering
what are the cartridge contents
- may have vasopressor
- NaCl
- distilled water
- methylparaben
what is the vasopressor
sodium bisulfite
- sodium bisulfite oxidize
what are the problems with the cartridge
- bubble in the cartridge- usually nitrogen gas
- extruded stopper
- corroded cap- if immersed in disinfecting solution
- rust on cap
- leakage during injection
- broken cartridge
- burning on injection
what can cause burning on injection
pH, alcohol, heat, expiration date
what are the topical anesthetics
-betadine
- chlorhexidine
what are the most common psychogenic reactions
- vasodepressor syncope
- hyperventilation
what are other common induced reactions
- tonic clonic convulsions
- bronchospasms
- angina pectoris
what do you avoid with bleeding problems
avoid techniques with increased chance of aspiration
what would heart failure cause
- CHF (ASA III or ASA IV) may cause decreased liver perfusion -> increased t 1/2 amide local anesthesia
what does AIDS, hepatitis, A, A and jaundice cause
increased t 1/2 amide
what can be the causes of seizures
- stress/anxiety
- hypoglycemia
- hyperventilation
when is local anesthesia contraindicated in pregnancy
during 1st trimester
what does cimetidine cause
- increase t 1/2 of circulating local anesthesia
- H2 receptor blocker compete with lidocaine for hepatic oxidative enzyme
- cimetidine + ASA III CHF = relative contraindication for amide local anesthesia
what do tricyclic antidepressants do (TCAs)
- enhance cardiovascular action to exogenously administered vasopressors
- 5-10x increase with levonordefrin and nore-epi
- 2x increase with epinephrine
what does cocaine stimulate
nore-epi release and inihbit reuptake
- tachycardia/ hypertension -> increase myocardio O2 requirement -> cardiac ischemia -> MI
- 72 houes needed for cocaine clearance
what are relative contraindications with local anesthesia
-malignant hyperthermia
- methemoglobinemia
