Local anesthesia three Flashcards by Michael McMahan

 Individual response to drug is a Bell shaped curve phenomenon
 Accuracy in deposition of local anesthesia
 Tissue status (vascularity, pH)
 Anatomical variation
 Types of injection administered (block or infiltration)

Factors affecting both depth and duration of anesthesia

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t/f: Larger than recommended doses do NOT increase duration !!!

true

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Determining Maximum Recommended Dosages:

 Different mg/kg MRDs dependent on inclusion of vasoconstrictor
 Manufacturer’s recommendation

Old Days

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Determining Maximum Recommended Dosages:

No distinction / adjustment made for inclusion of vasoconstrictor
 Council on Dental therapeutics of the American Dental Association
 United States Pharmacopeal Convention

Currently

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Maximum calculated drug dose should_____ in medically

compromised, debilitated, or elderly persons

decrease

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t/f: when exceeding MRD, there is a greater likelihood of OD arising

true, but it doesn’t guarantee an OD.

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t/f: OD may arise at the dosage below the calculated MRD (hyper-responders)

true

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How to determine doses, if two drugs are used?

 The total dose of both local anesthetics not exceed the lower of the two
maximum doses for the individual agent.

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Drug Information: 
 Potency: the standard
 Metabolism: liver
 Onset of action: rapid (2-3 mins)
 Anesthetic t ½  : 1.6 hours

Lidocaine

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What is the MRD of Lidocaine?

 Maximum Recommended Dose (MRD)
 4.4mg/kg (Council on Dental Therapeutics of the ADA and USP convention)
 Absolute maximum 300mg
 8 Cartridges will be the maximum # used on a patient

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What are other limiting factors of Lidocaine?

**BOARDS****

 Healthy patient, maximum epinephrine is 0.2mg or 200mcg
 Cardio patient , maximum epinephrine is 0.04mg or 40mcg
 Conclusion:

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What is the sequence of limiting the maximum dose of lidocaine?

First: maximum amount of epinephrine can be given

* Second: lowest possible dosage of lidocaine needed

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First Amide to be marketed and replaced procaine (Novocain) as
the drug of choice

lidocaine

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t/f: Allergy to amide (lidocaine) is virtually nonexist

true

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What is the most common type of cartridge of lidocaine?

2% w 1:100,000

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Drug Info:

 Potency: similar to lidocaine
 Metabolism: Liver
 Onset of action: Rapid (1.5 to 2 mins)
 Anesthetic t ½ : 1.9 hours

Mepivacaine

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What is the Maximum Recommended Dose ( MRD) of Mepivacaine?

 4.4mg/kg
 Absolute maximum 300mg
 5.5 cartridges will be maximum # used on a patient

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t/f: Mepivacaine has mild vasodialating properties

true

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_______ has a Longer duration vs other agent w/o vasoconstrictor

Mepivacaine

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3% _______ plain provides
 20-40 mins pulpal anesthesia
 2-3 hours soft tissue anesthesia

Mepivacaine

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When is Mepivacaine indicated?

 When vasoconstrictor is NOT indicated

 Most often used in pediatric / geriatric patient

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Drug Info:

 Potency: similar to Lidocaine
 Metabolism:
 Hydrolyzed to orthotoluidine and N-propylalanine
 Orthotoluidine induce methemoglobin • May cause observable cyanosis
 Onset of Action: slightly slower (2-4 mins)
 Anesthetic t ½ : 1.6 hours

Prilocaine

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What is the MRD of Prilocaine?

Study These Flashcards

 6.0mg/kg
 Absolute Maximum 400mg
 5.5 cartridges will be the maximum # used on a patient

________ is relatively contraindicated when:

 Idiopathic / congenital methemoglobinemia
 Hemoglobinopathies (Sickle cell anemia)
 Anemia
 Cardiac / Respiratory failure evidenced by hypoxia
 Patient taking Acetaminophen or Phenacetin
• Produce elevations in methemoglobin level

Study These Flashcards

prilocaine

What are the two types of Prilocaine?

 4% w/o vasoconstrictor |  4% w vasoconstrictor

Drug Info: ```  Potency: 4X lidocaine  Metabolism: Liver  Onset of Action: Longer 6-10 mins  occasionally similar to lidocaine  Anesthetic t ½ : 2.7 hours (Long Duration) ```

Bupivacaine

What is the MRD of Bupivacaine?

 1.3mg/kg  Absolute maximum 90 mg  10 cartridges is the maximum # used on a patient

_________ has been available in U.S. since 1983

Bupivacaine

What is a primary indication that Bupivacaine should be utilized?

 Lengthy dental procedure >90 mins pulpal anesthesia is needed  Management of postoperative pain • Reduce post-op opioid analgesics

What demographic is Bupivacaine not recommended on?

Younger pt and Physically / mentally disabled person

the following combination is the run down to effective manage ______.  Preoperative  pretreatment of 1 or 2 doses of NSAID  Perioperative  Local anesthesia  Long-duration local anesthesia given upon D/C  Postoperative  Continue oral NSAID q X hours for Y days

Pain

Drug Info: ```  Potency: 1.5X lidocaine  Metabolism:  Only amide type L.A. with ester group • Plasma esterase hydrolysis • Liver metabolism  Onset of Action:1-2 mins infiltration  Anesthetic t ½ : 0.5 hours  Maximum Recommended Dose:  7mg/kg ```

Articaine

The following are claims for _______ use.  Increased success rates ( don’t miss often)  Diffuse soft / hard tissue reliably  Infiltration of mandible resulted pulpal and lingual anesthesia  Controlled study failed to corroborate these claim !!!

Articaine

the following are contraindications for _______ use:  Patient allergic to amide type anesthesia (few to none)  Sulfite sensitivity  Caution with hepatic disease  Patient with significant impairments in cardiovascular function  Children < 4 y/o is not recommended due to insufficient data

Articaine

______ and _____ resulted in more non-surgical paresthesias than all of the local anesthetics, despite being used for fewer injections.

Articaine and prilocaine

``` After 55 years of clinical use, 2% _______ with 1:100,000 epinephrine is still the closest to the ideal intermediate-duration local anesthetic in dentistry. ```

lidocaine

``` t/f: Topical anesthesia is effective only on surface tissue (2-3mm) ```

true

Are spray devices able to deliver measured | doses?

Drug Info:  Ester local anesthesia  Poor absorption into cardiovascular system  Not suitable for injection  Ester local anesthesia are more allergenic than amide  Most commonly used topical anesthesia

Benzocaine

EMLA stands for what?

Eutectic Mixture of Local Anesthesia

What is the composition of EMLA?

 Lidocaine 2.5% + Prilocaine 2.5%

What does the following?  Provides surface anesthesia of intact skin  Usage  Circumcision, Leg ulcer debridement and GYN procedures

EMLA

The following are directions for ____?

EMLA

EMLA is contraindicated when:

 Methemoglobinemia  Infant <12 months old had other methemoglobin-inducing drugs  Amide sensitive

What are the two forms of lidocaine topical?

 Lidocaine base • Poorly soluble in H2O  Lidocaine hydrochloride • Water soluble • Better tissue penetration but systemic absorption is also greater

What is the MRD of Lidocaine topical?

 Maximum recommend dose is 200mg

Drug information:  Long-duration ester local anesthetic  Injection or topical application  Usage should limit to small area  Rapidly absorbed through mucous membrane  Extreme caution urged b/c great potential for systemic toxicity

Tetracaine Hydrochloride

Which two local anesthetics have long duration for post opt pain control?

Bupivacaine or Prilocaine

What is the recommended local anesthetic for post opt pain control for Children / mentally disabled?

Mepivacaine

What is important for picking a LA that also needs to maintain hemostasis?

Use epi with 1:100,000 or 1:50,000

_______ contraindicatipon: true, documented reproducible allergy

Absolute

_______ contraindication: find a better substitute (ex: amide for atypical pseudocholinesterase patient)

relative

For pulpal anesthesia ______ lasts 1 (h)

2% Lidocaine + Epi 1:100,000

For Soft tissue anesthesia _______ lasts 3-5 hours

2% Lidocaine + Epi 1:100,000

3% Mepivacaine lasts | 5-10 (mins) for ______ and 1.5-2 (h) for ___ ____.

pulpal: 5-10 (mins) Soft Tissue: 1.5-2 (h)

0. 5% Bupivacaine +Epi 1: 200,000 >1 h for _____ and 4-12 hr for ____ ____

Pulpal: >1 h Soft tissue: 4-12 hr

Articaine 4% + epi 1:100,000 ______ :0.5(h) ______ _____ : 3-5 (h)

Pulpal: 05 H Soft Tissue: 3-5 hours

Local anesthesia three Flashcards

(57 cards)