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APM- LA and sedation > Local Anaesthetics in dentistry > Flashcards

Local Anaesthetics in dentistry Flashcards

1
Q

What does analgesia ?

A

The reduction or elimination of pain in a conscious patient

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2
Q

What do local anaesthetics do?

A

They eliminate sensations, especially pain, in one part of the body by the topical application or regional injection of a drug

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3
Q

Are local anaesthetics reversible?

A

YES they are reversible lockings of nerve conduction

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4
Q

What do local anaesthetics block?

A

They block entry of sodium ions into cells

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5
Q

What are the 3 types of local anaesthetics?

A
  1. Ester based – largely superseded (Procaine)
  2. Amino-amides
  3. Articaine
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6
Q

Give some examples of amino amide local anaesthetics

A

(lidocaine, Mepivocaine, Prilocaine, Bupivocaine

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7
Q

What is the most common local anaesthetic we administer and what is the dosage we give?

A

Lidocaine 2% plain or with epinephrine 1:80,000

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8
Q

Describe the effect of Mepivacaine 3% plain 2% with epinephrine

A

It is plain and very short acting

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9
Q

How are local anaesthetics metabolised excreted?

A
  1. Amino amides are metabolised by the liver

2. Excreted via the kidneys

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10
Q

What advise do manufacturers say about the use of lidocaine?

A

manufacturers advise caution in patients with liver disease

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11
Q

Who should we avoid giving Felypressin?

A

Avoid in pregnancy

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12
Q

Who should we taken caution in giving Adrenalin / Epinephrine?

A

Care in ischaemic heart disease, hypertensives, unstable angina

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13
Q

What do Vasoconstrictors increase in local anaesthetics?

A

Vasoconstrictors increase duration and depth of anaesthesia and reduce local blood flow

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14
Q

How can the operator reduce the chances of getting a needle stick injury?

A

Do not re-sheath or re-use

Use safety-plus system

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15
Q

What are some reasons local anaesthetic might fail?

A
  1. Insufficient solution injected
  2. Inaccurate placement
  3. Intravascular injection
  4. Biological variation
  5. Anatomical variation
  6. Some teeth more difficult than others (lower laterals)
  7. Infection or inflammation
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16
Q

How can patients have an allergy local cal anaesthetics?

A

Usually due to preservative

Was more common to ester-type (benzocaine, cocaine procaine)

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17
Q

What are some symptoms of local anaesthetic allergy?

A
  1. Swelling
  2. Nausea malaise
  3. May lose consciousness
  4. Facial and laryngeal oedema
18
Q

What are Psychogenic reactions a patient could have to LA?

A

Feeling faint
Fainting
Palpitations
Panic attack

19
Q

What is a Vasovagal attack?

A

Fainting

20
Q

What should you do if your patient faints?

A
  1. Lie them flat - head down
  2. Loosen tight clothing
  3. Call for help
  4. Give them a Glucose drink
  5. Check – airway, breathing, circulation
  6. Oxygen if necessary
  7. If not recovered in 2-3 minutes – assume not simple faint
21
Q

What can adrenaline interact?

A

Interacts with antidepressants MAOIs (possibly tricyclics)

22
Q

Who should we take care with when administrating adrenaline?

A

Care in hypertension and heart problems (especially if unstable)

23
Q

What some adverse events that can occur when administering LA?

A
  1. Broken needle (Rare)
  2. Pain during or after
  3. Haematoma
  4. Trismus
  5. IV injection
  6. Blanching
  7. Facial paralysis
  8. Prolonged impaired sensation
  9. Soft tissue trauma
  10. Visual disturbances
24
Q

How can we make LA less painful?

A
  1. Use topical properly
  2. Room temperature cartridges
  3. Careful needle placement
  4. SLOW injection
  5. Do NOT retract tissues with a mirror.
25
Q

How can we Maximise LA effectiveness?

A
  1. Good Communication skills
  2. Surface anaesthetics
  3. Good technique
  4. Solution at room temperature
  5. Patient comfort
  6. Stretch tissues
  7. Careful puncture
  8. Slow injection
  9. Explain sensation
26
Q

What symptoms can patients have is they get LA toxicity?

A 
Light headedness,
sedation 
paraesthesia
twitching
Convulsions
loss of consciousness, respiratory depression
cardiovascular collapse
27
Q

How much LA is usually found in 1 cartridge?

A

2.2ml

28
Q

What is the maximum dose of lidocaine 2% we can give a health adult?

A
  1. 4mg/kg max 300mg

7x2. 2ml cartridges

29
Q

What is the maximum dose of 3% Prilocaine we can give a health adult?

A

6mg/kg max 400mg

6cartridges

30
Q

What is the maximum dose of 4% Prilocaine we can give a health adult?

A

6mg/kg max 400mg (4.5cartridges)

31
Q

What is the maximum dose of 4% Articaine

we can give a health adult?

A

7mg/kg max 440mg (5cartridges)

32
Q

What is the maximum dose of 2% Mepivacaine

we can give a health adult?

A

4.4mg/kg max 300mg (6.8 cartridges)

33
Q

What is the maximum dose of 3% Mepivacaine

we can give a health adult?

A

4.4mg/kg max 300mg (4.5 cartridges)

34
Q

What is the maximum dose of lidocaine 2% we can give a child?

A

2 2.2ml cartridges

35
Q

What is the maximum dose of 3% Prilocaine we can give a child?

A

1.8 cartridges

36
Q

What is the maximum dose of 4% Prilocaine we can give a child?

A

1.4 cartridge

37
Q

What is the maximum dose of 4% Articaine we can give a child?

A

1.5 cartridges

38
Q

What is the maximum dose of 2% Mepivacaine we can give a child?

A

2 cartridges

39
Q

What is the maximum dose of 3% Mepivacaine we can give a child?

A

1.4 cartridges

40
Q

What should we beware of with the elderly?

A

Over the age of 65 liver function in the elderly reduces by 60%
Therefore reduce safe dosages by 50%

APM- LA and sedation (2 decks)

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