Local Anesthesia properties WREB review Dental Hygiene – Flashcards
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Short acting LA
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3% Mepivicaine (plain); 2% Lido (plain); 4% Prilocaine (plain) as infiltrate
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Intermediate
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2% Lido 1:100,000 or 1:50,000; 2% Mepiviaine 1:20,000 levono; 4% Articaine 1:100,000; 4% Prilocaine
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Long
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4% Lido 1:200,000; .5% Bupivacaine 1:200,000
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lidocaine (brand names)
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xylocaine, octocaine, lignospan
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Mepivicaine (brand names)
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carbocaine, polocaine, scandonest
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prilocaine (brand names)
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citanest plaine, citanest forte (with epi)
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bupivacaine (brand names)
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marcaine
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Articaine (brand names)
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septocaine, zorcaine
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MRD: lidocaine
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500 mg or 3.2 mg/lb (7 mg/kg)
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MRD: mepivicaine
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400 mg or 3.0 mg/lb (6.6mg/kg)
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MRD: prilocaine
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600 mg or 4.0 mg/lb (8.8 mg/kg)
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MRD: Bupivacaine
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80 mg
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MRD: Articaine
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No absolute; 3.2 mg/lb (7.0 mg/kg)
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Contraindication lidocaine
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none
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Contraindication mepivicaine
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careful with children; NO levonordefrin with TCAs
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Contraindication prilocaine
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methemoglobinemia; possible paresthesia
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Contraindication bupivicaine
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not for kids (long duration)
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Contraindication articaine
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methemoglobinemia, possible paresthesia
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Contraindication any amide
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allergy, liver dysfunction, narcotics, tranquilizers (CNS depressants)
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Contraindication epi
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allergy sulfites, steroid-dependent asthmatics, uncontrolled everything, heart disease, taking non-selective beta blockers
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Advantages lidocaine
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safe; ok pregnancy; "gold standard"
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Advantages mepivicaine
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fast and short; least vasodilating
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Advantages prilocaine
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ok pregnancy; long anesthesia, but not as profound
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Advantages bupivacaine
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long duration, lower amt epi
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Advantages articaine
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short half life (less OD risk); use for difficult to numb patients
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Duration 4% Articaine
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75 / 180-300
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Duration .5% Bupivacaine
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90-180 / 240-540
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Duration 2% Lido plain
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5-10 / 60-120
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Duration 2% Lido w/ epi
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60 / 180-300
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Duration 3% Mepivicaine plain
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20-40 / 120-180
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Duration 2% Mepivicaine w/ levono
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60 / 180-300
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Duration 4% Prilocaine plain
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infiltrate 10-15 / 90-120; block 40-60 / 120-240
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Duration 4% Prilocaine w/ vaso
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60-90 / 180-480
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What happens during depolarization?
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Cell becomes more permeable to Na+; at threshold, rapid depolarization creates action potential, which is propagated up nerve.
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Correct sequence of nerve conduction & LA effects
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Depolarization (slow/rapid) LA works on this step; Propagation (impulse travels); repolarization (absolute/refractory)
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What relevance do beta blockers have on LA choice and epi?
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significant risk for acute hypertensive episodes if they receive vasopressors
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MAOIS and LA
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don't use vasopressors
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What is the function of sodium chloride in LA?
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make solution isotonic
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What is the function of sodium bisulfite in LA?
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preservative/antioxidant
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How much epi in 1:100,000?
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.018 mg
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How much epi in 1:200,ooo?
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.009 mg
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What is the concern with asthmatics and allergy to sodium bisulfites?
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higher incidence of allergy to bisulfites and can cause airway to close
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What is the concern of articaine use with asthmatics?
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contains sulfites (allergy can cause bronchoconstriction)
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When a nerve is anesthetized, which sensation is lost first?
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Autonomic or pain, depending on what review material you study...
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what is the cause of layrngeal edema?
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airway obstruction (either partial or complete); pt loses consciousness due to lack of oxygen
