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Paediatric And Special Care Dentistry > Administration Of Local Anaesthetic In Children > Flashcards

Administration Of Local Anaesthetic In Children Flashcards

1
Q

What are the uses of local anaesthesia?

A

Operative pain control
Diagnostic tool
Control of haemorrhage

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2
Q

What forms of intraoral surface anaesthesia can you get?

A

Spray
Gel
Solution

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3
Q

What kind of gel surface anaesthesia can you get for the mouth?

A

20% benzocaine gel

5% lidocaine analgesic gel

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4
Q

What kind of spray surface anaesthesia can you get?

A

10% lidocaine spray

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5
Q

Give an example of a skin surface anaesthesia can you get?

A

EMLA lidocaine 2.5%, Prilocaine 2.5%

Ametop Tetracaine

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6
Q

What types of conventional LA can you get?

A

Lidocaine hydrochloride 2% with adrenaline 1:80,000 (lignospan, xylocaine)- gold standard in UK, solution of choice
Plain lidocaine- short acting agent, no vasoconstrictor present
Prilocaine 3% with felypressin (Citanest with Octapressin)- no adrenaline, extra-hepatic metabolism
Mepivacaine HCl 3% (Scandonest 3% plain)- no adrenaline
Articaine 4% with 1:100,000 or 1:200,000 adrenaline (Articaine Septanest)- fast onset, profound anaesthesia, less LA used, claim better infiltrations in the mandible, less preservatives
Bupivavaine 0.25% with adrenaline 1:200,000 (Marcian) or without adrenaline- slow onset (30 mins), 3-7 hour duration

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7
Q

What are the different techniques of LA?

A

Infiltration anaesthesia- extravascular placement of LA in region to be anaesthetised
Regional block anaesthesia- deposition of LA into the tissues around individual nerves or nerve plexuses- IDB, long buccal, mental, incisive, maxillary
Intraligamentary anaesthesia
Intrapulpal

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8
Q

What is the aim of an infiltration?

A

Deposit LA near to apex, supra periostea
0.5-1ml sufficient for pupal anaesthesia
Buccal approach, closer to apices

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9
Q

What part of the maxilla can inhibit the spread of the infiltration?

A

Zygomatic buttress

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10
Q

In the primary dentition, what LA injections can be used in the mandible?

A

Buccal infiltration is usually adequate for primary molars
Buccal infiltrations are usually unreliable for permanent molars so >6 years old a regional block is usually used for primary molars

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11
Q

What is the technique for an inferior alveolar block in a child?

A

Same technique as for an adult
Direct approach from primary molars on opposite side, syringe parallel to occlusal plane
Insertion approx 5mm above occlusal plane
If contact bone immediately don’t withdraw completely, indirect technique
For young child, a short needle may be used
Usually easier in child as the mandibular foramen is below the occlusal plane

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12
Q

What is the technique for a lingual block in a child?

A

Withdraw half-way following IDB, aspirate and deposit remaining solution

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13
Q

What is the technique for a long buccal in a child?

A

Equates to an infiltration in a child

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14
Q

What is the technique for a mental block in a child?

A

Needle advanced in buccal sulcus between 1st and 2nd molar apices
Excellent soft tissue anaesthesia
Problem with incisors due to cross over supply

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15
Q

What is the technique for a maxillary block in a child?

A

Regional blocks are rarely used in child
Greater palatine and nasopalatine blocks are avoided by infiltrating LA through already anaesthetised papillae
Pressure with mirror as distraction if palatal block required

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16
Q

What is the technique for intraligamentary anaesthesia in a child?

A

Intraosseous injection with LA entering with PDL

Recommended dose is 0.2ml/root

17
Q

What are examples of needle free LA devices?

A

Jet injectors

Index systems

18
Q

What are some advantages of needle free LA devices?

A

Mucosa anaesthetised to depth of 1cm without use of needle
Deliver jet under high pressure
Conventional LA solution used

19
Q

What are some disadvantages of needle free LA devices?

A

Expensive
Technique not applicable to all areas
Soft tissue damage if careless technique
Specialised syringes can be frightening
Loud noice and bad taste following delivery

20
Q

What is an example of a computerised injection system?

A 
The wand-
Fine needle- pen like 
Easier for operator
Anaesthetic delivered under controlled pressure 
Decreased post-op numbness 
Lower pain ratings 
Less disruptive behaviour
21
Q

What are the advantages of intraligamentary anaesthesia?

A

Less uncomfortable than IDB or palatal
Rapid onset and less effect on soft tissue, decreased self-mutilaton
Used in patients where IDB is contraindicated
Can come in pen grip or pistol grip syringes

22
Q

What are some disadvantages of intraligamentary injections?

A

If immature root or short, risk of avulsion

Risk of damage to permanent successor

23
Q

What are some tips and tricks for LA in children?

A

Avoid LA at the first visit if possible
Has to be a clinical decision- age of child and cooperation, urgency and type of treatment, parental input, maxillary infiltration as 1st experience if possible
Good preparation of child
Good technique

24
Q

How should the administration of LA be carried out in a child?

A

Organise equipment and material
-Sharp fine needle (30 gauge)
-Aspirating syringe- disposable
-Allow LA to reach room temperature
-Keep out of sight
Establish good operator/patient position
-Patient 30 degrees to vertical
-Sit/stand in front at 8 o’clock position
-Assistant present to restrain hands if necessary
Inform child
-Explanation depends on age
-Tooth going to sleep, patient awake
-Explain/show topical gel- sparkly feeling
-Patient on board

25
Q

What things are mandatory to document in your case notes?

A 
Local analgesic solution and vasoconstrictor, in date 
Drug concentrations 
Amount given in cartridges/ml 
Site of injection(s)
Abnormal reactions (if any)
Post op instructions given 
How the child coped with LA
26
Q

What are some important things to note about Articaine LA?

A

Slow infiltration over 1 minute
Contraindicated for regional blocks
Special care wit lower infiltrations avoid around mental nerve
Good for anaesthetising hypoplastic first permanent molar teeth
Lower restorations where coagulopathy
Only use if advised by supervisor

27
Q

What are some generalised complications with LA?

A 
Psychogenic 
Allergy 
Drug interactions 
Infection 
Toxicity
28
Q

What is the max dose of lidocaine?

A

Lidocaine is 4.4mg/kg

2.2ml cartridge of 2% lidocaine’s has 44mg of active agent

29
Q

What is the limit of lidocaine for a child?

A

3-5 year old (20kg) given lidocaine 2%- max limit = 2 cartridges

30
Q

How do you prevent toxicity?

A

Aspiration- to ensure you don’t inject the LA into a blood vessel
Slow injection
Dose limitation

31
Q

How do you treat toxicity?

A

Stop procedure

Basic life support

32
Q

What are some early localised complications of LA?

A

Pain
Intravascular
Failure of LA- anatomy, pathology, operator
Facial nerve paralysis
Interference with special sense- vision and hearing after intra-arterial injection
Haematoma formation- trismus

33
Q

What are some late localised complications of LA?

A

Self-inflicted trauma
Oral ulceration
Long lasting anaesthesia- direct nerve damage
Trismus- IDB, bleed within muscle
Infection- introduction of bacteria at injection site
Developmental defects- intraligamentary injection in primary dentition

34
Q

What are some general factors that contraindicate LA?

A

Young age
Disability preventing cooperation
Treatment required- duration, difficult access

35
Q

What are some medical history factors that may contraindicate LA?

A

Allergy
Liver disease- reduce dose
Poor blood supply- irradiation therapy must avoid vasoconstrictors

36
Q

What specific factors may cause LA to be contraindicated?

A

Bleeding disorders
Incomplete root formation
Trismus
Epilepsy

Paediatric And Special Care Dentistry (5 decks)

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