LOCAL ANAESTHETIC SCENARIOS OSCE

Question 1

Patient is booked for extraction of their 14. What LA technique would you use?

Answer 1

infiltration

Question 2

Patient is booked for extraction of their 14. What needle would you use?

Answer 2

short needle (blue, 25mm)

Question 3

You are about to perform LA on a patient, how would you set up for the procedure?

Answer 3

• no gloves empty contents onto bracket table
• hand hygiene & glove up
• check expiry date & batch number on LA cartridge
• put rubber bung on handle and assemble with wide bit at the top
• place LA catridge into syringe body and handle into syringe body
• pull back protective sheath & click
• remove cap and check LA flows out

Question 4

why might lignocaine not be used when administrating LA to a patient?

Answer 4

• cant guarentee latex free

- solutions usually contains adrenaline

Question 5

why might prilocaine be contraindicated when providing LA to a patient?

Answer 5

solutions tend to contain felypressin which should not be used on pregnant patients (induces labour)

Question 6

Patient is booked in for extraction of their 14, what anatomical feature would you use to administer LA?

Answer 6

administer distal to apex of 14 at the muccobuccal fold

Question 7

how do you ensure the LA worked?

Answer 7

test for sensation locally, lack of sensation shows it worked

Question 8

What local complications can arise from administering LA?

Answer 8

• fainting
• haematoma if blood vessel damaged
• trismis if damage to muscle
• delivery of wrong nerve

Question 9

How do you safely dispose of needles?

Answer 9

• double click cover
• don’t resheath needle
• place needle and cartidge in correct sharps bin
• dispose of sharps immediately

Question 10

patient is booked for deep carious restoration of tooth 36, what LA technique would you use?

Answer 10

• IDB/IAN

- infilitration administered distal to the 36 at the muccobuccal fold

Question 11

A patient comes into your surgery that has controlled hypertension, what LA do you decide to use?

Answer 11

Lidocaine HCL 2% with 1:80,000 Adrenaline

- no more than 2 cartridges

Question 12

A patient comes into your surgery with uncontrolled/unstable hypertension and requires LA, what solution do you decide to use?

Answer 12

Plain lidocaine, prilocaine or mepivicaine (avoid LA solutions with adrenaline)

Question 13

A pregnant patient comes into your surgery that requires LA for a procedure, what LA solution do you decide to use?

Answer 13

Lidocaine 2% HCL 1:80,000 adrenaline

Question 14

You have recently given a patient an IDB, they come back to the surgery complaining that they cannot open their mouth properly, what has happened?

Answer 14

TRISMUS

- caused damage to the medial pterygoid (injected too low)

Question 15

You are performing an IDB on a patient when suddenly they lose function of the side of their face, what has happened? How do you manage this?

Answer 15

• LA has been injected into the parotid gland and is acting on the facial nerve
• reassure the patient and provide eye covering until blink reflex returns

Question 16

A patient has lost function in one side of their face after administration of LA, you suspect it is facial palsy but how do you ensure that they are not having a stroke?

Answer 16

• If patient CAN move eyebrow, they are experiencing facial palsy
• If patient CANNOT move eyebrow they may be having a stroke

Question 17

What will happen if LA with adrenaline is injected into an artery?

Answer 17

• skin blanching
• visual disturbance
• aural disturbance

Question 18

What may happen if LA with adrenaline is injected into a vein?

Answer 18

• palpitations
• anxiousness
• pallor
• sweating

Question 19

A patient comes in and requires an IDB for treatment, they phone the surgery 4/5 hours later and complain that they still have loss of sensation, what has happened?

Answer 19

Prolonged anaesthesia can be caused by:

• direct trauma to IAN by needle
• chemical trauma if use of articaine

Question 20

what are some systemic complications of Local Anaesthetics?

Answer 20

• psychogenic
• drug interactions
• cross infections
• allergy
• collapse
• toxicity

Question 21

how do beta blockers interact with LAs?

Answer 21

• slow the metabolism of lidocaine, bupivicaine, mepivicaine
• inhibits the vasodilatory affect of adrenaline
• increase toxicity of adrenaline containing LAs

Question 22

A patient comes into your surgery and requires LA for a procedure. After taking a history you see that they are on Propranolol, how does this affect the type of LA you administer?

Answer 22

Avoid LA containing adrenaline if possible.

If not possible keep dosage to a minimum.

Question 23

A patient enters your surgery and lets you know that they suffer from Haemophillia, how does this affect their treatment?

Answer 23

• cannot perform IDB as a hematoma can occur in the retromolar and pterygoid area