Local Anesthesia Board Exam – Flashcards
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Mental
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What injection numbs the lower lip?
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Foramen rotundum - maxillary division of trigeminal nerve - V5 Foramen ovale - mandibular division of trigeminal nerve - V5 Mandibular - inferior alveolar nerve Incisive - nasopalatine nerve Mental - mental nerve
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*Foramens & Nerves that enter and exit foramen rotundum, ovale, mandibular, incisive and mental
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Nerves anesthestized - bilateral nasopalatine Area anesthestized - anterior portion of hard palate from M of right first premolar to M of leftpremolar. No hemostasis except in injection sight. Technique - 27 gauge short needle inserted into palatal mucosa just lateral to incisive papilla, target area is incisive foramen beneath the incisive papilla. Landmarks - incisive papilla and central incisors Approach - 45 degree angle toward incisive papilla
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*Incisive papilla & nasopalatine injection
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*Benzocaine - ester, not absorbed systemically, penetrates 2-3mm, 6 - 20 %, Lidocaine- amide Other info on topicals - no vasoconstrictors, concentration greater than locals, benzocaine and lidocaine are not soluble in water.
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Topical Anesthesia
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Soft tissue injury - self inflicted trauma to lips and tongue from biting it while anesthetized.
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*What cause would you expect if a patient had a lesion on lower lip the next day??
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What would happen if needle inserted to hub Insert 25 gauge long needle 20 -25 mm (3/4 of needle) till you contact bone. If you don't contact bone, you need to retract slightly, reposition angle of syringe more posteriorly and reinsert.
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*Question on IA injection technique on how far to insert the needle and outcome of a certain scenario?
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reverse polarity = *sodium in and potassium out* Local anesthetic ability to decrease the depolarization phase of the action potential
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*What happens during depolarization?
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a receptor nerve ending that is not enclosed in a capsule. A typical free nerve ending consists of a bare axon that may be myelinated or unmyelinated. It is often found in fibrous capsules, ligaments, synovial spaces, may be sensitive to mechanical or biochemical stimuli.
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What is a free nerve ending?
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transmits impulses faster
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*Which of the following best describes Myelinated nerves?
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scoop method is recommended; **never use two hands to recap
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*Understand safety precautions for recapping needles?
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Toward bone
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*How is bevel of needle oriented upon insertion?
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Esters are hydrolyzed in the **plasma by the enzyme psuedocholinesterase. 1 in every 2800 people has an inability to hydrolyze esters this is called atypical plasma cholinesterase. Amides biotransformation takes place in the **liver. People with cirrhosis or hypotension / congestive heart failure cannot biotransform amides.
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*Amide vs. Ester biotransformation specifically?
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Aspirate prior to depositing anesthesia to ensure negative aspiration.
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*When do you aspirate?
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blood pressure will increase.
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Beta Blockers decrease blood pressure, but in the presence of vasopressors, what changes occur?
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Harpoon
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What part of the syringe indicates whether it is an aspirating syringe?
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Keratinized or palatal
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*What tissue is topical least effective?
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Esters
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*What local anesthetic is metabolized by enzyme psuedocholinesterase?
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Alcohol
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What antiseptic you should not use?
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Coronoid notch
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Landmark for IA injection?
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Needle barb
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What is possible cause of pain upon removal of needle?
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No organic base for pain.
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*Psychogenic pain question ??
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A. paralysis of some of the terminal branches occurs whenever an IO block is administered or when maxillary canines are infiltrated. Muscle droop is also observed when motor fibers are anesthetisized by inadvertant deposition in their vicinity. **Can occur when anesthesia deposited in deep lobe of parotid gland most likely. **This happens during IA injection insertion is too deep.Loss of motor function to muscles of facial expression.Should last no more than several hours.Minimal or no sensory loss. Face appears lopsided. No treatment - wait for it to wear off. Patient cannot voluntarily close eye.
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*Facial nerve paralysis questions?
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When you let off pressure, it aspirates.
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How does a self aspirating syringe work?
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Cardiac patient .04 mg Normal patient .2 mg
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*Maximum dose of epinephrine for cardiac patient and normal patient.
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During IA injection or buccal injection
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When do you use a long needle?
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Injecting into the pterygoid plexus from PSA injection
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*What causes a hematoma?
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Needle barb from impaling bone
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What is a possible cause of pain on removal of the needle?
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Apply direct pressure to site of bleeding not less than two minutes to stop bleeding. CHOOSE answer apply cold and compression
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*How do you manage a hematoma?
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1.7 mL; 2 cartridges 3.4 mL
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*Volume of single cartridge
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the smaller the gauge the larger the lumen
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*Needle gauge, when is lumen smallest?
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pain
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*What sensation is lost first
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makes solution isotonic
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What function does sodium chloride provide in LA solution?
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antioxidant that prevents bidegradation of LA
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*What function does sodium bi-sulfite provide in LA solution?
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increases duration of LA , hemostasis, reduces change in toxicity
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*Action of vasodepressors in LA solution?
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Sensory (afferent) root of trigeminal nerve is ophthalmic, maxillary and mandibular,all entering thru fissures in sphenoid bone. Opthalmic enters thru superior orbital fissure, maxillary enters thru foramen rotundum, mandibular enters thru foramen ovale. Motor (efferent) root of trigeminal nerve is mandibular .
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Questions on Maxillary and Mandibular nerves, if they are afferent or efferent?
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Jaw spasm or lockjaw. Caused by 1.trauma to muscles or blood vessels in the infratemporal fossa, 2.diffusion of alcohol or sterilizing solution into carpule, 3. hemorrhaging, 4. low grade infection after injection Management: heat therapy, warm saline rinses, analgesics and muscle relaxant to manage spasms
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*Trismus, what causes it and how to manage it.
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facial nerve paralysis caused by injecting too deep during IA injection into parotid gland
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What causes dry cornea?
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Infiltration is anesthesia deposited at terminal nerve endings Block is anesthesia deposited near large nerve trunks
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Difference between block and infiltration?
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PSA - muccobuccal fold above max 2nd molar, maxillary tuberosity and zygomatic process of maxilla MSA - muccobuccal fold above maxillary 2nd premolar, maxillary bone above 2nd premolar ASA - infraorbital foramen, muccobuccal fold, infrorbital notch GP - palatal foramen, bone of hard palate NP - incisive foramen, incisive papilla, central incisors IA - pterygomandibular raphe, coronoid notch, occlusal plane of mandibular teeth Buccal - muccobuccal fold, mandibular molars Mental - muccobuccal fold, mandibular premolars Incisive - muccobuccal fold, mandibular premolars
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*Anatomical landmarks for various injections?
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heat, muscle relaxant, analgesics, physiotherapy, possible antibiotics if not resolved after 3 days.
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What to do to manage a post-operative infection?
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.018 In 2 carpules...... .036 or .017 for 1.7 ml.
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How much epinephrine is in one cartridge of 2% lidocaine with 1:100,000 epinephrine?
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sudden patient movement
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*Primary cause of needle breakage?
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conduction block of sodium ions
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How do local anesthestics work?
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touched nerve sheath
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*Patient receives electric shock during delivery of anesthesia but no pain upon insertion, what is the most likely cause ?
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mandibular bone is more dense
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*Why does anesthesia work better in maxilla than in mandibular??
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1:50,000 = .036 1:100,000 = .018 1: 200,000 = .009
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Calculate various amounts of epinephrine in solutions?
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adrenal glands in the endocrine system
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*Where does epinephrine naturally occur in the body? Which system
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Lingual
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*Ongoing numbness of the anterior part of tongue is caused by which nerve being anesthetized?
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procaine
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Which anesthetic is not an amide?
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15 minutes at concentration of 20%
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How long can you safely leave on a lidocaine patch?
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Mepivicaine
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Most common anesthetic without epinephrine?
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27ga short
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Correct needle gauge for infiltration
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procaine
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** Which anesthetic is an ester? *Ester metabolism is blood
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because amides are biotransformed/ metabolized in the liver.
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*If a patient has cirrhosis of the liver, why would you use caution in administering an amide??
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less pain, less complications, suggested deposition rate is about a minute.
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What is the benefit of slow deposition rate?
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distal and buccal to last molar in buccal tissue
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Location for buccal injection?
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blanching or vasoconstriction of blood vessels in that area
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After an infraorbital injection, patient cheek turns white, what happened?
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infection causes ph to lower in area. The more acidic the area is, the less effective anesthesia will be.
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Why does anesthesia fail to work near abcessed tooth?
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lesser palatine nerve
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*Innervation of soft palate?
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infraorbital is answer if it is a choice
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*Which nerve is not a branch of the mandibular nerve?
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Anesthesia of the facial nerve, possibly during IA injection into parotid gland
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What causes droopy eyelid?
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MB root of 1st maxillary molar
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Which root is not anesthetized in the PSA?
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puncture resistant container
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Where do you dispose of needles?
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Allergy is characterized by: fever, angioedema, urticaria, dermatitis, depression of blood Forming organs, photosensitivity, anaphlylaxis Allergic reactions are not dose related Slow Onset ; 60 minutes - skin reaction - prescribe oral histamine blocker - 50mg diphenhydramine 1Q6H for 3 -4 days. Immediate Skin Reaction ; 60 minutes - examples are conjunctivitis, rhinitis, urticaria, pruritus, erythema - administer epinephrine 0.3 mg IM or subcutaneously / .15mg for child. Administer IM 50mg diphenhydramine / .25mg for child, consult a physician, prescribe antihistamine for 3 - 4 days. Respiratory Reaction - terminate tx, administer oxygen, administer epinephrine IM or SC injection or other bronchdilator via inhaler, call 911, prescribe anithistamine. P --A —B —C Position pt comfortably (unconscious - supine, conscious - pt comfortable), Airway (unconscious - assess and maintain airway, conscious - assess airway), Breathing (unconscious - assess and ventilate if necessary, conscious - assess breathing), Circulation (unconscious - assess and provide CPR if necessay, Conscious - assess circulation)
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*Know allergic reactions.......1. Immediate onset verses delayed onset and how you would manage epinephrine for an immediate and severe vs a delayed reaction
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administering anesthesia too fast
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*Pain on injection is related to ?
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ph of vasoconstrictor low administering anesthesia too fast alcohol or sterilizing solution difussed into solution
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*Burning on injection is related to?
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Mepivicaine - Carbocaine - Polocaine (ME in CAR hitting POLE) Lidocaine - Xylocaine - Lignocaine (LAUGH XCITEDLY LOUD) Prilocaine - Citanest (PERSONAL CONTACT) Articaine - Septocaine (ASS w/o the extra s) Bupivicaine - Marcaine - Sensorcaine - Vivacaine(BOWEL MOVEMENT puts SHITin VAGINA)
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*Generic and brand names of anesthesia
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5- 10 mm from free gingival margin
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Injection site for lingual infiltration of maxillary molars?
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subcutaneous
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*In dental practice an injection for local anesthesia is?
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CNS excitation
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*A patient having overdose reaction to local anesthesia will have what symptoms?
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muccobuccal fold over 2nd premolar target is APEX
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You are preparing for scaling and root planning for Lingual of #13, where is the injection site?
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GP
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#15 has a perioabcess, you have already given PSA,what other injection will you need to give to numb the lingual?
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NP
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Central incisor has a periodontal defect on the lingual root surface, what injection would you choose?
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Muccobuccal fold
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If scaling # 8, where do you inject?
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Two handed method
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*Choose the wrong recapping technique?
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Works on mucous membranes, only 2-3 mm of numbness
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*Choose the best description of Topical Anesthetics?
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Date on cartridge
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Expiration of cartridge of LA?
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few adverse effects
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*If administering 1ml per minute to patient, what are the most likely effects on the patient?
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2/3 or 3/4 of needle
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*When administering IA injection, at what point should needle contact bone
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Blood pressure increases, heart rate increases, increase respiration
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First sign of anesthesia overdose?
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Stop propulgation of nerve impulses
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*Purpose of anesthesia?
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choose ester option......answer should be benzocaine
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Which anesthesia has the highest occurrence of allergic reactions?
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Limited mouth opening
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What is a symptom of trismus?
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Heat and jaw exercises
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*How do you manage trismus?
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PSA
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Hematoma will occur when you inject into the pterygoid plexus during what injection?
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Sodium bi-sulfite
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Which of the following is the antioxidant in LA?
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1% solution = 10 X 1.8 (or 1.7) = 18mg (or 17mg) 2% solution = 20 X 1.8 (or 1.7) = 36mg (or 34 mg) 3% solution = 30 X 1.8 (or 1.7) = 54 mg (or 51 mg) 4% solution = 40 x 1.8 (or 1.7) = 72mg (or 68mg) .5% solution =5 x 1.8 (or 1.7) = 9mg ( or 8.5mg)
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*Know how to calculate amount of active ingredient in LA solution in mg. 1%; 2%, 3%, 4%. Again, with these calculations they may use the 1.8 ml of solution or the 1.7 ml. Figure both ways, then pick the best answer.
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Infiltration
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*If you want hemostasis what injection is best?
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Lesser palatine nerve
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*What is the innervation for the soft palate?
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Benzocaine is not absorbed systemically
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*Topical anesthesia question, which of the following statements is the most accurate.
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3% Mepivicaine (carbocaine, polocaine) 4% Prilocaine (Citanest)
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Which anesthetics do not contain vasoconstrictors?
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diffusion
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If you use a LARGE amount of topical anesthetic what is the likely outcome?
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GP and NP
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*If you are scaling the maxillary teeth on the right side, lingual only, which injections will you need to give to anesthetize the patient??
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153mg
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if you are giving 3 carpules of 3% lidocaine and each cartridge contains 1.7ml, how many milligrams of solution will the patient receive?
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Between 3.4 - 3.6 ml
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You are administering 2 cartridges of two DIFFERENT types of anesthesia, how much anesthesia will you be administering
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51mg
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*You are administering 3 cartridges of 1% lidocaine, each cartridge is 1.7ml., How much anesthesia are you administering?
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date on package
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What is the shelf life of a package of local anesthesia?
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epinephrine
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*Which is the original name for adrenaline?
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true
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*the higher the gauge number the smaller the lumen
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intraosseous
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*type of injections requires an X shape syringe?
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rusted cap
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*What could happen when you have a cartridge bust in the container?
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extruded stopper
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What caused the busted cartridge?
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hematoma
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*which is defined as the diffusion of blood when nicking a blood vessel during an injection?
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Core; Mantle
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*What hits first? What hits delay?
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PSA
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Which injection has the highest percent of failures?
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true
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*CNS goes toward the peripheral
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Bevel
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Which part of the needle is the point or tip?
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nerve block
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at main trunk
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field block
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larger trunk
