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Endo I > Endodontic Anesthesia > Flashcards

Endodontic Anesthesia Flashcards

1
Q

how do you give an atraumatic anesthetic injection

A
  • dry mucosa- then topical anesthetic- let it soak in at least 60 sec
  • vigorously shake or gently squeezing the lip or cheek while injecting is a distraction technique thought to activate the faster alpha fibers to close the gate
  • slow and gently ( take 60 sec to inject)
  • talk to patient constantly
  • keep patient occupied
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2
Q

describe the pain of the palatal injection

A
  • almost painless injection
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3
Q

how do you give a palatal injection

A

use small quantity of LA on palatal tissue which is tight and painful. too much - more than 1/4 carp can slough tissue
- use a refrigerant as a pre injection anesthetic
- should see white patch

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4
Q

what amount should you not exceed in palatal injection

A

no more than 1/4 carpule

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5
Q

what anesthetic should you use with palatal injection

A

articaine

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6
Q

which tooth will cause the most issue getting numb with acutely inflamed pulpitis

A

mandibular molar

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7
Q

why is anesthesia difficult at the mandibular molar

A

the inherent inaccuracies of mandibular nerve blocks but other problems are also present

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8
Q

“lip signs” do not necessarily indicate:

A

pulpal aneshesia

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9
Q

why is mandibular infiltration alone useless

A

due to the density of the cortical plates

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10
Q

why is LA difficult with acute pulpitis

A

in non inflamed tissue, a normal get channel or pore in the nerve cell will be effectively blocked by a LA resulting in inability to create an AP = no pain

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11
Q

local anesthetic is most effective when the need for it is the _____

A

least

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12
Q

what can local anesthesia be influenced by

A

the local availability of free base, as only the non ionized portion can diffuse through the neuronal membrane

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13
Q

when are local anesthetics relatively ineffective

A

when injected into tissues with an acid pH which is due to reduced release of free base

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14
Q

which types of teeth are very resistant to LA

A

teeth with acutely inflamed tissues

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15
Q

technique and _____ are equally important to a good result

A

patient management

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16
Q

what can we do to combat LA problems

A
  • anti inflammatory drug
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17
Q

what do anti inflammatory drugs do to combat LA problems

A

reduces inflammation, revert the pores to normal and raise the patients pain threshold

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18
Q

what amount of anti inflammatory drug do you give patient

A

IBU 600 mg one hour prior

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19
Q

what is the efficacy of anti inflammatory drugs to combat LA problems

A

78%

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20
Q

when can you not tell the patient to take ibuprofen

A

when you have not already seen the patient, taken history, obtained radiographs, clinical testing or made DX

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21
Q

if you do a good IA block you should have:

A

lip signs

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22
Q

why must you wait for the infiltrationto work before doing an block

A

you wont know if the lip signs are from the block or the infiltration

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23
Q

what should you do after you’ve given the block

A
  • wait a few minutes to allow anesthesia in area of IA injection
  • then go back and feel the bone and painlessly inject the 2nd carpule where you know you need to be for the IA block
  • wait for lip signs and chekc the tooth with percussion and/or cold
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24
Q

where should you inject a mandibular IA

A

-at the level of the lingula
- just lateral to pterygomandibular raphe at the height of coronoid notch

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25
Q

which direction will the needle travel in relation to the bevel

A

opposite

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26
Q

what are extra injections we can do after the confirmed block

A
  • intra ligamental injection (PDL)
  • intra pulpal injection
  • intra osseous injection
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27
Q

most LA agents have an onset of action between ______

A

1-20 minutes

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28
Q

effective pulpal anesthesia will be routinely gone in_____

A

30-90 minutes

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29
Q

when should you use LA

A

for every case at every appointment

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30
Q

what is the most essential element of patient management

A

the confidence of the patient

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31
Q

what are the two types of local anesthetic agents

A
  • esters
  • amides
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32
Q

describe esters

A
  • novacaine, procaine
  • more side effects, higher probability of allergic reaction
  • no longer in favor or commonly available in the US
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33
Q

describe amides

A
  • duration:
  • short, less than 60 min: 3% Mepivacaine
  • medium 60-120 min: lidocaine, articaine
  • long: greater than 120 minutes: 0.5% BUpivacaine w/ 1:200,000 epi
  • vasoconstrictor
  • aspirate to avoid intra vascular injection
34
Q

most pulpal anesthesia will be lost after _____

A

45 minutes

35
Q

what allows articaine to penetrate the cortical bone plates

A

thiophene ring

36
Q

what do you use for infiltration

A

articaine

37
Q

what block should you use for mandibular teeth

A

gow-gates

38
Q

how many carpules of lidocaine do we use with mandibular molar

A

2 carpules

39
Q

what technique do you use for mandibular anteriors

A

IA or Gow Gates

40
Q

what is the extra oral landmark for GG

A

tragus

41
Q

what is the intra oral landmark for GG

A

level of mesio palatal cusp of second molar

42
Q

what supplemental injection is the first choice

A

PDL injection

43
Q

what is the intent with the PDL injection

A

to force anesthetic solution down along the PDL and through the cribriform plate to reach apical neural elements in the medullary space

44
Q

describe how to give the PDL injection

A
  • wedge needle as deeply into PDL as possible. start at DB. warn patient of pain at injection
  • use @% lidocaine w/ 1:100,000 epi
  • duration of anesthesia= 15-30 minutes only
  • inject at all 4 line angles
45
Q

you must have ____ when injecting the PDL

A

back pressure

46
Q

the PDL injection may get you into the pulp but maybe not ______

A

the canals

47
Q

describe the intra pulpal injection

A
  • last choice
  • painful and ultra short acting but immediate relief
  • use 30 guage needle wedges as far in canal as possible
  • must bind tightly in canal
  • warn patient injection must hurt- most painful of injections
  • duration: minutes only
  • do not repeat this injection
  • do distal canal of lower molar first
48
Q

should you inject into swollen tissue

A

no

49
Q

should you inject in cellulitis

A

usually necrotic pulp so no IP problem but probably very sensitive to palpation and percussion
- may need I&D, drain, antibiotics before pulpal extirpation

50
Q

how should you inject in local swelling

A
  • infiltrate apically and laterally or do infra orbital block or both
  • debride the pulpal spaces and consider incise and drain
51
Q

what are the general considerations for swelling

A
  • do a regional block away from inflamed area
  • increase dose of LA
  • change anesthetic
  • supplemental anesthetic techniques
  • pre med with anti anxiety agents: liquid valium in pineapple juice: 0.25 mg/kg or NO/oxygen sedation
52
Q

how can you perfect your LA technique

A
  • use an effective, safe and appropriate LA agent
  • practice and use the most effective N block technique
  • utilize alternative injection locations as applicable
  • wait until effective to start TX
53
Q

how can you demonstrate concern for the patient

A
  • use topical anesthetic
  • use endo-ice for palatal injections
  • employ gate theory when injecting
  • slow injection - reassure patient
  • 27 gauge needle
54
Q

what is the mode of action of LA

A
  • local anesthetics cause reversible interruption of the conduction of impulses in peripheral nerves by causing a local decrease in the rate and degree of depolarization of the nerve membrane such that the threshold potential for transmission is not reached when everything goes well
55
Q

what are the effects of LA due to

A

blockage of sodium channels, thereby imparing sodium ion flux across the membrane resulting in disruption of impulse conduction

56
Q

most local anesthetic agents are _____ that are administered as _______

A

tertiary amine bases; water soluble hydrochlorides

57
Q

after injection the teriary amine base is liberated by:

A

the relatively alkaline pH of normal tissue fluids

58
Q

in tissue fluid the local anesthetic will be present in both ______

A

an ionized and non ionized form

59
Q

the relative proportions of the ionized and non ionized form are based on

A

the pH in the area

60
Q

which form diffuses through the nerve sheath, peri neuronal tissues and the neuronal membrane to reach the axoplasm

A

the non-ionized base

61
Q

what is the mechanism of action of the non-ionized form

A

the local anesthetic enters the sodium channel and either occludes the channel or combines with a specific receptor within the channel that results in channel blockade

62
Q

what is the most commonly used LA agent

A

2% lidocaine with 1:100,000 epi (xylocaine)

63
Q

describe 2% lidocaine with 1:100,000

A
  • safe and effective drug. derivative of xylidine (1.7mL/carpule)
  • each carpule contains 34mg of anesthetic
  • max safe adult dosage = 8 carpules
  • detoxified primarily in liver
  • no solution proven to be superior for pulpal anesthesia
  • not contraindicated in patients with heart disease
  • not contraindicated in pregnant women
  • not contraindicated in nursing mothers
  • because of epinephrine content, should not be routinely used in patients on MAO inhibitors or tricyclic antidepressants
64
Q

what is the most controversial LA agent

A
  • 4% articaine with 1:200,000 epi (septocaine)
65
Q

describe 4% articaine with 1: 200,000 epi

A
  • safe and effective drug contains both amide and ester linkage
  • each carp contains 68 mg of anesthetic- twice as toxic as lidocaine
  • maximum safe adult dosage is 4 carpules
  • also contains a unique sulfur molecule
  • reputation of providing superior anesthetic effect
  • potential to cause neuropathies
    -drug interactions with MAO inhibitors, tricyclic antidepressants and phenothiazides
66
Q

what is septocaine’s potential to cause neuropathies

A

paresthesia rare but 5 times as likely with lidocaine or mepivicaine

67
Q

what is the purpose of epinpehine in LA

A

delays systemic absorption which increases the duration and increases the effectiveness of the LA, also retards bleeding

68
Q

what anesthetic should you not use in nerve blocks

A

articaine

69
Q

what is the potential danger with epinephrine in LA

A
  • with epi in a pt with elevated BP is an untoward further increase in BP - especially with intravascular injection
70
Q

if the concern is with exogenous epi ranging

A

0.018mg- 0.054 mg

71
Q

a 70kg adult will produce endogenous epi at:

A

0.007mg - 0.014mg/min at rest

72
Q

a patient at rest produces almost ______ epi/min

A

1 carp of LA

73
Q

if a patient is stressed and not numb they will produce endogenous epi at:

A

0.28mg per min/ 10 carps of La epi/min

74
Q

major health concern is maintaining profound anesthesia to maintain comfort and:

A

reduce stress thereby reducing epi

75
Q

1-2 carps of 1/100k is generally of:

A

little consequence

76
Q

what should you do if pt still isnt numb after 3-4 caps

A

consider re scheduling with sedation

77
Q

solution to hot maxillary tooth:

A
  • use a regional block
  • PSA
  • 2nd division block/palatal infiltration
  • infraorbital block
78
Q

solution to hot mandibular tooth

A
  • Gow - Gates injection- includes high rising mylohyoid nerve
79
Q

walton and abbott found ____ failure of inferior alveolar block

A

47%

80
Q

malamed’s study claims ____ success with the gow gates block

A

97.25%

81
Q
A

Endo I (13 decks)

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