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Local Anesthesia > Injection mLs and Sites > Flashcards

Injection mLs and Sites Flashcards

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1
Q

Long Buccal Nerve Block Technique

A

Insertion = mucous membrane distal and buccal to most distal molar tooth in arch

Parallel but lateral to occlusal plane

Penetrate 2-4 mm

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2
Q

Mental Nerve Block

A

Gets buccal mucous membranes of anterior teeth and skin of lower lip/chin

Insertion = Mucobuccal fold between apices of 1st/2nd premolar

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3
Q

Gow-gates

A

True complete mandibular block - contact bone

Insertion = intertragic notch to distal of maxillary 2nd molar, place needle tip below mesiopalatal cusp of 2nd molar

Target = lateral side of condylar neck

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4
Q

Vazirani Akinosi Technique

A

Closed mouth V3 block when trismus (relieves trismus = V3 provides muscle innervation)

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5
Q

Vazirani Akinosi Technique Insertion

A

Medial border of ramus, at height of mucogingival junction adjacent to maxillary 3rd molar

No bone contact

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6
Q

Posterior Maxilla Primary Techniques

A

PSA, MSA infiltration

W/ or w/o palatal injection

Consider using 2 cartridges

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7
Q

Posterior Maxilla Secondary Techniques

A

PDL and Intraosseous Injection

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8
Q

Anterior Maxilla Primary Technique

A

ASA/infraorbital area infiltration

Consider using two cartridges

Infiltrate midline for centrals

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9
Q

Anterior Maxilla Secondary Technique

A

PDL and intraosseous injection

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10
Q

Mandible Primary Technique

A

IAN/Lingual, Buccal injections

Second cartridge not routinely useful

Reinjection after 5 mins may be useful

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11
Q

Mandible Secondary Techniques

A

Gow-gates
PDL/intraosseous
Deep local infiltration

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12
Q

Anterior Mandible Secondary Techniques

A

Anterior Infiltration
Mental/Incisive Block
PDL Injection

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13
Q

Large Areas or Remote Injections

A

Maxilla -> V2 block via greater palatine foramen

Mandible -> no special technique

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14
Q

Dosing Calculation

A

Each cartridge -> 1.7 mL

Each 1 percent of local anesthetic = 10 mg/mL

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15
Q

Concentration of Vasoconstrictors

A

Given as ratio

1:100,000 solution contains 0.01 mg/mL = 10 mcg

1 cc = 1 mL

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16
Q

3% mepivacaine w/o vasoconstrictor Max safe dose

A 
Adult = 400 mg
Pediatric = 6.6 mg/kg
ST = 30-60 mins
Pulpal = 20-40 mins
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17
Q

2% lidocaine w/ 1:100,000 epi

A 
Adult = 500 mg
Pediatric = 7 mg/kg
ST = 2-4 hrs
Pulpal = 60-90 mins
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18
Q

4% articaine w/ 1:100,000 epinephrine

A 
Adult = 500 mg
Pediatric = 7 mg/kg
ST = 2-4 hrs
Pulpal = 60-90 mins
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19
Q

0.5% bupivacaine w/ 1:200,000 epi

A 
Adult = 90 mg
Pediatric = 2 mg/kg
ST = 4-10 hrs
Pulpal = 90-180 or less
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20
Q

Epinephrine dosing

A

Healthy adult = 0.2 mg
Cardio Adults = 0.04 mg
Children rarely at risk

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21
Q

Anesthetic Selection

A

Drug of Choice = Lidocaine 2% w/ 1:100,000 epi

Epi sensitive = Limit lidocaine, Mepivacaine 3% w/o vasoconstrictor

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22
Q

Long-term soft tissue Anesthesia

A

Bupivacaine 0.5% w/ 1:200,000 epi

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23
Q

Difficulty achieving local anesthesia

A

Articaine 4% w/ 1:100,000 epi

Not used for mandibular blocks

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24
Q

Intra-osseous Anesthesia

A

Deposition of LA into cancellous bone of supporting tooth.

Includes = PDL injection, Intra-septal, intra-osseous

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25
Intra-pulpal Anesthesia
Deposition of LA + pressure into coronal portion of pulp chamber
26
PDL Injection (Interligamentary Injection)
Not really used maxillary, best for mandible for localized area instead of whole quadrant. Area = bone + soft tissue + apical and pulpal tissues
27
PDL Technique
AoI = Long axis of the tooth, bevel on root (each root), advance till resistance 0.2mL/20 sec = thickness of rubber stopper Success = resistance to deposition, blanching of soft tissue
28
PDL Indications
Need for anesthesia of 1-2 teeth Isolated teeth in both mandible quadrants Children Risky IAN block (hemophilia)
29
PDL Contraindications
Infection or sever inflammation at injection site Presence of primary teeth = hypoplasia
30
PDL Advantages
Prevent unnecessary numbness of whole quadrant Small dose = .2mL/root Alternative to partially successful LA 30 sec onset
31
PDL Disadvantages
Difficult needle placement Leakage = bad taste Excessive pressure = break glass Discomfort/tissue damage Tooth extrusion
32
Intra-septal injection Technique
Target Area = base/center of interdental papilla equidistant from adjacent teeth Angle = 45 degrees to LA of tooth and 90 degrees to soft tissue Bevel face apex of tooth Depth 1-2 mm 0.2-0.4mL/20 sec
33
Intra-septal injection Advantages
Unnecessary lip/tongue numbness Minimum volume of anesthesia Hemostasis Atraumatic 30sec onset Useful in perio involved teeth
34
Intra-osseous Injections
Deposit LA solution into interproximal bone between two teeth Nerves = terminal nerve endings Area = bone, soft tissue, root structures Pulpal anesthesia 15-30 mins
35
Intra-osseous Injections Complications
``` Palpitations Post injection Pain Fistula Instrument Break Perforation of lingul plate ```
36
Failure of Intra-osseous
Infected/inflamed tissues | Inability to perforate cortical bone > 2 sec.. change site
37
Intra-pulpal injection
Deposit LA + pressure RCT Minimal volume/immediate onset
38
Intra-pulpal injection technique
Wedge needle into pulp chamber/canal Resistance Bend needle for accessibility 30 sec onset
39
Mandibular Infiltration
Simple, hemostasis, avoid damage to nerve trunks, less intravascular injection, safe for patients w/ clotting disorders
40
Mandibular Infiltration - Articaine (1.5x more potent than lidocaine)
Has amide and thiophene ring (solubility) and contains extra ester - only amide type w/ ester 7 mg/kg Metabolized = 90-95% PEH, 5-10% liver
41
Confirmation of Anesthesia Clinically
Question Patient Soft tissue testing Commence w/ treatment
42
Testing for Pulpal Anestheisa
Electric Pulp test Cold Refrigerant = Endo-Ice
43
Local Complications of Anesthesia
``` Needle break Prolonged anesthesia or parasthesia Faical nerve paralysis Trismus Soft tissue injury Hematoma Infection ```
44
Needle Breakage
Usually IAN or PSA blocks ``` Causes: Hubbing needle 30 gauge short needle Intentional bending Unexpected movements Forceful bone contact (litigation) ```
45
Prolonged Anesthesia or Parasthesia
Main cause of dental practice litigations Cause = needle injury to nerve -> electric shock feeling Contaminated LA solution LA solution itself (Articaine)
46
Facial Nerve Paralysis
Introduction of LA into capsule of parotid gland usually during IANB or Akinosi
47
Prevention of Facial Nerve Paralysis
IAN = bone contact at medial side of ramus before injection Akinosi: Avoid over-insertion of needle
48
Trismus
Can last average of 6 weeks Causes: Trauma to muscles Contaminated solutions Hemorrhage Infection
49
Trismus Management
``` Heat therapy Warm saline Analgesics Muscle relaxants Antibiotics ```
50
Facial Nerve Paralysis Management
Remove contact lenses till return muscle movement Eye patch
51
Prolonged Anesthesia or Parasthesia Management
Refer to OMFS if not improving within 2-3 weeks
52
Needle Breakage Management
Dont panic Refer to OMFS Document incidence
53
Soft tissue injury
Most common = self inflicted trauma Warn patient/guardian Manage = analgesics, ABX, saline mouth rinse, petroleum jelly
54
Hematoma
Effusion of blood into extravascular space Prevent = minimize number of needle penetration, dont probe tissue with needle
55
Hematoma Management
Direct pressure Analgesics for pain Abx for infection Discoloration gradually rseolves No heat for 4-6 hrs Ice application immediately
56
Infection
Extremely w=rare Cause = needle/cartridge contamination Prescribe antibiotics if confirm Refer to OMFS if needed
57
Overdose Causes
``` Total dose too large Absorption Rapid Intravascular Injection Bio-transformed too slow Eliminated too slow ```
58
Biotransformation
Esters hydrolyzed in plasma and liver by pseudocholinesterase (6-7% abnormal patients) into PABA Amides by microsomal enzymes in liver
59
Prevention of Intravascular Injection (IAN most common)
Use aspirating syringe 25 gauge or larger Aspirate in 2 planes Inject slowly
60
Minimal to moderate overdose
``` Talkativeness Excitability Metallic Taste Twitching Elevated BP Nausea ```
61
Moderate to High overdose
Generalized tonic-clonic seizure activity followed by: Generalized CNS and CVS depression, depressed respiratory rate
62
Mild reaction - slow onset
``` Stop treatment! Administer O2 Monitor vital signs Consider IV anticonvulsant Get help ```
63
Severe reactuib
Stop all treatment Place in supine, feet up Establish airway, give O2 Consider anticonvulsant drugs and vasopressors
64
Epinephrine Overdose
Sharply elevated systole Increased heart rate/palpitations Cardiac tachyarrhythmia
65
Allergens in LA
Esters -> usually to PABA product Na Bisulfite/metabisulfite = found in anesthetics as preservative for vasoconstrictors Methylparaben = no longer used
66
Allergy signs
Urticaria Angioedema Laryngeal edema Cyanosis
67
Anaphylaxis Progression
Cardivascular collapse
68
Delayed Allergy Skin reaction management
Benadryl - 50 mg stat @ Q6h 3-4 days
69
Immediate Skin Reaction
Epi 0.3 mg IM or SC | Benadryl - 50 mg IM
70
Bronchial Constriction Management
02 Albuterol - B2 agonist EPI 0.3 mg IM or SC Benadryl - 50 mg IM
71
Laryngeal Edema
``` Place supine, 02 Epi 0.3 mg IM or SC Maintain Airway Benadryl - 50 mg IV or IM Hydrocortisone - 100 mg IV or IM ``` Preform cricothyroidotomy

Local Anesthesia (1 decks)

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