NERB Local Anesthesia – Flashcards
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Reason for pain upon removal of needle
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needle barb
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smaller number ________ lumen
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larger
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Sodium chloride
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isotonic
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Sodium bisulfite
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antioxidant; prevents biodegredation
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Sodium hydrochloride
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buffer for pH
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Vasodepressors
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Increase duration
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Injection to numb lower lip
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IANB
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Where is epi found naturally in body?
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Adrenal gland/ Endocrine system
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Suggested LA deposit rate
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1 ml/min
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Where mandibular nerve passes through skull
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foramen ovale
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where maxillary nerve passes through skull
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foramen rotundum
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where nasopalatine nerve passes
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incisive foramen
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Max division of Trigeminal Nerve - Motor, Sensory, Mixed?
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Sensory
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Beta blockers effect on BP
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lowers BP
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LA is what type of injection
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subcutaneous
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Reason for sudden pain and instant anesthesia upon injection
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hit a nerve
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Needle for infiltration
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27 short
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Where is buccal injection?
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distal/buccal to last molar
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Nerve associated with soft palate
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Lesser palatine
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Injection choice for homeostasis
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infiltration
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Sign of LA overdose/toxicity
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CNS excitement
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Where infiltrate #13 lingual
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apex of tooth
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Reason for cheek turning white after injection
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Blanching; vasoconstriction of BV
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Reason for pain when delivering LA
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injecting too fast
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Reason for burning when delivering LA
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vasoconstrictor
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Lido aka
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Xylo
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Mepiv aka
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Carbo
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Prilo aka
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Citanest
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Bupiv aka
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Marcaine
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What is given for immediate allergic reaction? What is given for delayed allergic reaction?
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Epi; Benadryl
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Most common LA without epi
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Mepivacaine 3%
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Contraindication for uncontrolled hyperthyroidism?
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NO VC
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PABA sensitivy associated with...
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Esters
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How far should needle be inserted for IANB?
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20-25mm or 2/3-3/4 length of needle
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Depolarization: Sodium ____ , Potassium ______
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Sodium In/Influx, Potassium Out/Efflux
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When aspirate?
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Before deposit of solution
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Topical is least effective on ...
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keratinized
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Topical works on ...
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mucous membranes
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IANB landmark
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coronoid notch
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Max epi cardiac pt.
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0.04mg
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max epi healthy pt.
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0.2mg
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Limited opening
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Trismus
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Treatment for trismus
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heat and exercises
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Preferred method for recapping needle
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Scoop
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Bad method for recapping needle
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2 handed
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Psychogenic pain
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no organic base
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Reason for facial nerve paralysis
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needle enters parotid gland
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Dry Cornea associated with which nerve
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facial nerve
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Most common reason for needle breakage
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sudden patient movement
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Treatment for hematoma
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cold and compress for 12 hours
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LA blocks ______ channel
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Sodium
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Onset is associated with
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pKa
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Increased pKa = ______ onset
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slower
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Treatment options for persistent chest pain
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Morphine, O2, Nitro, Aspirin
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Most common reason for syncope
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anxiety and fear
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bradycardia
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decreased pulse
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Resting State: Sodium (Na) ______ , Potassium (K) _____
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Na Out, K in
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Action Potential Na _____, K ______
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Na In, K Out
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Contraindication for Epi!
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Nonselective Beta Blocker
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VC _____ duration of action
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increases
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C-fibers conduct pain impulses quickly or slowly?
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SLOWLY
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IA needle insertion:
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"V" medial border of coronoid notch
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Buccal needle insertion:
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distal to last molar
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Mental needle insertion:
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btwn 2 PMs mucobuccal fold
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IA anesthetizes:
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anterior 2/3 tongue, lingual and buccal to 2nd PM
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Buccal anesthetizes:
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all buccal mandibular
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Mental anesthetizes:
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anterior to mental foramen (lower lip, chin)
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Needle for IA:
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25 (do not deposit until bone is touched!)
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Needle for Mental:
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25 short
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3 Nerves associated with IA
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IA branch of V3, Mental, Lingual
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IO Insertion:
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straight up over 1st PM (advance until bone is touched)
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PSA Insertion:
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45degree 2nd molar (up, back, in)
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MSA Insertion:
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straight up 2nd PM (height of MB fold)
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GP Insertion:
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mucosa 1st molar
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NP Insertion:
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mucosa lateral to incisive papilla
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IO anesthesizes:
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central - mb root of 1st molar
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PSA anesthesizes:
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molars
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hematoma associated with which injection
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PSA
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MSA anesthesizes:
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PMs, MB root of 1st molar
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GP anesthetizes:
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palatal tissue distal to canine
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NP anesthetizes:
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anterior hard palate
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Infected tissue has ____ pH
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low
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Prilocaine associated with increased risk of...
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Methemoglobinemia
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Mepivacaine/Carbocaine _______ onset
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Shortest because closest pKa to body pH
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Bupivacaine/Marcaine ________ onset
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longest onset and duration; *smallest MAX dose 90mg
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MAX dose 4% Articaine
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500mg
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MAX dose 0.5% Bupiv
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90mg
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MAX dose 2% Lido
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300mg
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MAX dose 3% Mepiv
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300mg
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MAX dose 4% Prilo
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400mg
