Final Flashcards Preview

SP18: Local Anesthesia > Final > Flashcards

Flashcards in Final Deck (66):
1

T/F: A second cartridge for an IAN/lingual and buccal injections is useful.

False

Reinjection after 5 minutes is useful

2

What are some secondary techniques to numbing the anterior mandible?

1. Anterior infiltration
2. Mental block
3. PDL injection

3

T/F: Each cartridge contains 1.7 ml of solution.

True

4

T/F: Each 1% of LA is 10mg/ml.

True

1.7 ml solution of 2% lidocaine = 34 mg/cartridge

5

T/F: A 1:100,000 solution contains 0.01 mg/ml.

True

1.7 ml of 1:100,000 epi solution = .017mg of epinephrine

6

What is the adult and pediatric maximum dose of mepivacaine?

Adult - 400 mg
Child - 6.6 mg/kg

7

What is the adult and child max dose of 2% lidocaine (1:100,000)?

Adult - 500mg
Child - 7mg/kg

8

T/F: The maximum doses of articaine and lidocaine are the same.

True

9

What is different about most articaine local anesthetics vs lidocaine?

Lidocaine is a 2% solution while articaine is a 4% solution

10

T/F: Mepivacaine has a short acting time.

True

11

Which local anesthesia has the longer acting time?

0.5% Bupivacaine (1:200,000)

12

What is the adult and child maximum dose of bupivacaine?

Adult - 90mg
Child - 2mg/kg

13

How many cartridges of 2% lidocaine would it be safe to give an adult?

14 cartridges

2% solution = 20mg/ml
20mg/ml x 1.7ml/cartridge = 34 mg/cartridge

500 mg/34mg = 14 cartridges

14

What is the suggested maximum dose of epinephrine for a healthy adult? One with severe hypertension/cardiac disease?

0.2 mg - healthy

0.04mg - unhealthy

15

What is the safe dose of epinephrine for a healthy 70 kg adult patient with 1:100,000 epinephrine solution?

11 cartridges

Maximum = 0.2mg = 20 ml in 1:100,000 solution

20ml/1.7ml cartridge = 11 cartridges

16

How many ml of a 1:100,000 epinephrine can an unhealthy adult have?

4ml = 2 cartridges

17

T/F: Articaine is safe to use for a mandibular block.

False

Possible for mandibular infiltration

18

What are three methods of intra-Osseous anesthesia?

1. Periodontal ligament injection
2. Intra-septal injection
3. Intra-Osseous injection

19

Interligamentary injection is another term for _________.

PDL injection

20

What area is anesthetized during a PDL injection?

Bone, soft tissue, apical and pulpal tissues

21

T/F: A PDL injection should be given with the long axis of the tooth, with the bevel on the root.

True

22

What are two signs that you are in the right spot for a PDL injection?

1. Resistance to deposition
2. Ischemia (blanching) of tissue

23

How much LA is deposited for a PDL injection?

0.2 ml (one stopper length) in 20 seconds

24

What are two contraindications for a PDL injections?

1. Infection/inflammation at site
2. Presence of primary teeth

25

T/F: The PDL injection is used when you only have a partially successful IAN.

True

26

What can happen from excessive pressure on the cartridge?

Break the glass

27

Where is the target area for an intra-septal injection?

Center of interdental papilla equidistant from adjacent teeth

28

What angle to you hold the needle at for an intra-septal injection?

45 degrees to long axis of tooth

90 degrees to the tissue

29

How much anesthetic is given for an intra-septal injection?

0.2-0.4 ml

30

T/F: Intra-Osseous injections are given into the inter proximal bone between two teeth.

True

31

How long does it take for pulpal anesthesia to take place with intra-Osseous injections?

15-30 minutes

32

T/F: Intra-Osseous injections involve drilling a whole into the bone.

True

33

T/F: Palpitations are a more likely side effect of intra-Osseous injections.

True

34

What teeth are indicated for an intra-pulpal injection?

Teeth ready for RCT

35

T/F: Intra-pulpal injection technique uses pressure as part of the anesthesia technique.

True

36

Articaine contains a _________ instead of a benzene ring like other amide LAs?

Thiophene ring

37

T/F: Articaine contains an extra ester linkage.

True

38

What is a downside about using a 4% solution instead of a 2% solution?

Higher chance of parasthesia

39

T/F: Soft tissue testing is a good indicator of pulpal anesthesia.

False

Electric pulp test or Endo-Ice (cold refrigerant)

40

Electronic pulp testing readings less than _______ resulted in pain during restorative procedures.

80

Reading must be 80 or above to indicate pulpal anesthesia

41

T/F: Lip numbness is indicative of pulpal anesthesia.

False

42

What is articaine useful for in anesthesia?

Mandibular infiltration

43

T/F: There does seem to be more complications (parasthesia) with articaine.

True

44

T/F: The Gow-Gates and Vazirani-Akinosi is superior to IA block.

False

45

T/F: Two cartridges in an IA block are preferred due to better pulpal anesthesia.

False

Better soft tissue, no effect on pulp

46

What is the effect of buffering anesthetic solutions?

Faster onset and less pain on injection - but probably not

47

T/F: Injecting more slowly results in better anesthetic results.

True

48

T/F: If a patient has profound lip numbness, but no pulpal anesthesia, you should repeat the block.

False

Move on to supplemental techniques

49

Which injections are most vulnerable to needle breaking?

IA block and PSA

50

How do you prevent needle breakage?

Don’t use short or 30 gauge needles, do not bend needle

51

What should you do if there is a needle breakage?

Refer to OMFS

52

What are the top 3 causes of parasthesia?

1. Direct nerve injury
2. Contaminated LA
3. LA itself (articaine)

53

How do you manage a patient with parasthesia?

Record the incident and watch for 2-3 weeks, if no improvement refer to OMFS

54

How do you avoid facial nerve paralysis when giving IA block?

Ensure bone contact on medial side of ramus

55

Multiple injections to the muscles can cause _________.

Trismus

56

If the patient has trismus for over 48 hours what should be suspected?

Infection

57

T/F: Infection from local anesthesia is extremely rare.

True

58

T/F: Local anesthetics exert a single action and are non-toxic.

False

No drug has these qualities

59

What is biotransformation?

Esters hydrolyzed by pseudocholinesterase into PABA in plasma/liver

Amides bio-transformed by liver enzymes

60

Which injection gives the highest percentage of positive aspirates?

IA block (12%)

61

What are some signs of a LA overdose?

Talkativeness, slurred speech, metallic taste, twitching

62

What is the first sign of moderate to high LA overdose?

Tonic-clonic seizure activity

63

What is always the first step when an LA overdose is recognized?

Stop treatment

64

T/F: O2 should be administered if a patient is suspected to have an LA overdose.

True

65

T/F: Benadryl can be prescribed for a patient who has a skin reaction to LA.

True

66

T/F: Epinephrine can be administered for a bronchial constriction or laryngeal edema reaction.

False