WREB Local Anesthesia Study Guide – Flashcards
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What exits the foramen rotundum?
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Maxillary Branch of Trigeminal Nerve
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What exits the foramen ovale?
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Mandibular Branch of Trigeminal Nerve
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What exits the mandibular foramen?
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Inferior Alveolar Nerve
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Purpose of Myelin Sheath?
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Protective Covering for the nerves
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What causes psychogenic pain?
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Mental or emotional problems that affect the experience of pain, there is no organic (medical) base for the pain.
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Injection and landmarks for maxillary molars.
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PSA Height of mucobuccal fold above second molar
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Injection and landmarks for maxillary premolars
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MSA Height of mucobuccal fold above second premolar
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Injection and landmarks for maxillary incisors (facial)
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ASA Height of mucobuccal fold above canine
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Injection and landmarks for mandibular molars
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IA Medial to internal oblique ridge, lateral to pterygomandibular raphe, at or above height of coronoid notch
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Injection and landmarks for buccal tissue of mandibular molars
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LB Mucous membrane distal and lateral to most posterior molar
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Injection and landmarks for mandibular premolars/incisors, including pulpal
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Incisive Mucobuccal fold at or just anterior to mental foramen
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Injection and landmarks for mandibular premolars/incisors, tissue
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Mental Mucobuccal fold at or just anterior to mental foramen
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Injection and landmarks for palate near molars
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GP Anterior depression of GP foramen, lingual to second molar
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Injection and landmarks for palate near anteriors
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NP Just lateral to incisive papilla
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Landmarks for AMSA
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Halfway between premolars and palatine suture.
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Dose of IA
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1.5-1.8ml
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Dose of LB
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.2-.3ml (stopper)
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Dose of Mental/Incisive
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.6ml
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Dose of infiltrations
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.6ml
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Dose of NP
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.4ml
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Dose of GP
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.4-.6ml
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Dose of AMSA
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.9-1.8ml but, with a 4% anesthetic it's .7-.9ml
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Dose of PSA
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.9-1.8ml
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Dose of MSA
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.9-1.2ml
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Dose of ASA
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.9-1.2ml
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Nerve that innervates the soft palate?
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Lesser palatine
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Molar root not anesthetized by PSA
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Mesiobuccal root of first molar
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Types of topical
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Ester-Benzocaine, tetracaine Amide-Lidocaine Ketone-Dyclonine
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What happens during depolarization?
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Slow Na ion influx until firing threshold is reached.
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What happens during rapid depolarization?
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Once firing threshold has been reached (-50 to -55 mv) there is a rapid influx of Na ions.
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What happens during repolariztion?
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Na begins to move with concentration gradient out of cell, there is an absolute refactory period, Na continues to move out of cell with help of sodium pump, there is a relative refactory period until resting state is reached.
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What does LA do to deporlariztion?
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Inhibits Na influx by displacing Ca ion.
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Esters (and Articaine) are metabolized by... Excreted by....
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Pseudocholinesterase in blood plasma Kidneys
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Amides are metabolized by... Excreted by....
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Liver (prilocaine in the lungs as well) Kidneys (mostly unchanged)
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Avoid esters (and articaine) if...
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Pt's have atypical pseudocholinesterase Sulfur allergy Myasthinia Gravis
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If there's methemoglobinemia...
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Avoid prilocaine and benzocaine.
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If they're taking beta blockers...
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Limit or avoid vaso's
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If they're taking phenothiazides....
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Do not use 1:50,000 epi
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If they're taking tricyclic antidepressants
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No levo.
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Volume in one carpule of LA
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1.8ml
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What is the function of Sodium Chloride in LA solutions?
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Isotonicity
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What is the function of Sodium Bisulfite in LA solutions?
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Antioxidant prevents biodegredation of LA (delays deterioration of epi)
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Why use vaso?
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Increases depth and duration of LA.
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How much epi in 1:200k
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.005mg/ml or .009mg/carp
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How much epi in 1:100k
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.01mg/ml or .018mg/carp
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How much epi in 1:50k
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.02mg/ml or .036mg/carp
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How much levo in 1:20k
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.05mg/ml or .09mg/carp
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MRD Lidcaine
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2mg/lb or 300mg/appt
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MRD Mepivicaine
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2mg/lb or 300mg/appt
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MRD Prilocaine
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2.7mg/lb or 400 mg/appt
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MRD Articaine
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3.2mg/lb or 500mg/appt
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MRD Bupivicaine
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.6mg/lb or 90mg/appt
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Maximum carpules Bupivicaine
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10 (B10)
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Maximum carpules Articaine
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6 (A6, or Asics-the shoes)
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Maximum carpules Prilocaine
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5 (depri5, P5)
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Maximum carpules Mepivicaine
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2%=8 3%=5.5
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Maximum carpules Lidocaine
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8 (L8, late)
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Most common LA without vaso?
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Mepivicaine 3%
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How much LA in one carp of 2% Lido?
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36mg (Rules of 18, 1.8x2%=36)
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How much LA in one carp of 3% Mepivicaine?
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54mg (Rules of 18, 1.8x3%=54)
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How much LA in one carp of 4% Articaine?
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72mg (Rules of 18, 18x4%=72mg)
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How much LA in one carp of .5% Bupivicaine?
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9mg (Rules of 18, 18x.5%=9)
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If a pt. is allergic to red wine, what LA to give them?
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Anything plain (no vaso) (you wouldn't want to put wine in vases! :).
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On which oral tissue is topical anesthetic least effective?
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Keratinized
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Why does infiltration work better on the maxilla as opposed to the mandible?
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Mandible has denser bone.
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How would you best achieve homeostasis?
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Use 1:50k epi
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A patient complains of a lesion on the lower lip a day after LA administration, what is the most likely cause?
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Self mutilation
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First sign of local anesthesia toxicity
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CNS Exitement (sometimes)
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Smaller Needle gauge equals _____________ (larger/smaller) lumen
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Larger
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Difference between block and filtration
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Block- anesthetic is deposited close to main nerve trunk- cover a larger area. Filtration- deposited near large terminal nerve endings.
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Maxillary division of trigeminal nerve is...
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Sensory only
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What exits the incisive foramen?
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Nasopalatine nerve.
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Brand name of 4% Articaine.
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Septocaine
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Brand name of 2% Lidocaine
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Xylocaine.
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Brand name of .5% Bupivicaine
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Marcaine.
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Brand name of 3% Mepivicaine plain.
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Carbocaine
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Brand name of 2% Mepivicaine.
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Polocaine
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Brand name of Prilocaine.
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Citanest
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Nitrous oxide exits the body through the...
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Lungs
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What is responsible for the duration of action of LA?
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Protein binding
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Tachyphylaxis
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The rapid decrease in the response to a drug after repeated doses over a short period of time
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Nerve impulses are spread by...
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Saltatory Conduction.
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What are the most likely cause(s) of an overdose from a local anesthetic:
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Solution was administered too rapidly or Solution was inadvertently injected intravascularly
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What is the max amount of epi that can be given to a cardiac pt
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.04mg or 2 carps 1:100k
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The metabolic by-product responsible for allergic reactions to the ester classification of anesthetics is...
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Para-aminobenzoic acid (PABA)
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How much of the nerve must be bathed in LA to achieve anesthesia?
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8-10mm
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Asthma patients are sensitive to what additive?
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Sulfites (so no epi)
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What does a yellow brown tint in the carpule indicate?
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Oxidation
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What is the site of action for a LA?
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Nerve Membrane
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What initiates nerve conduction?
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Dendrities
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What distributes incoming signals to CNS?
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Axon
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Why would there be mild burning sensation during administration of anesthesia?
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ph of solution, too warm, contamination.
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What sensation is lost first?
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Pain
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Injection site for lingual infiltration of maxillary molars
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5-10mm from the free gingival margin
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How far do you insert the needle on an IANB?
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20-25 mm or 3/4 the length of the needle.
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Which is true of topical anesthetics?
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No systemic issues.
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Management of hematoma
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Cold compression and pressure to bleeding site
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Managment of trismus
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Heat and jaw exercises.
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Allergic reaction management; immediate onset vs delayed
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Epi if immediate, benadryl if delayed.
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What do beta blockers do?
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Decrease BP
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Nerve fiber that is lightly mylinated and causes sharp pain.
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A
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Nerve fiber without myelin that causes dull achy pain.
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C
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LA overdose leads to...
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1. CNS excitation 2. CNS depression 3. Coma, convulsions, respiratory arrest
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What does the alpha adrenergic receptor do?
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Smooth muscle contraction in arterioles and veins
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What does the beta adrenergic receptor do?
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Cardiac stimulation, then smooth muscle relaxation.
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Which anesthetics are pregnancy category B?
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Lido and Prilo (the rest are category C)
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Half life of Bupivicaine
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2.7-3.5 (2hr 42min-3hr 30min)
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Half life of Mepivicaine
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1.9 (1hr 54 min, or 114 min)
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Half life of Lidocaine
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1.6 (96 min)
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Half life of Prilocaine
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1.6 (96 min)
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Half life of Articaine
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.75 (45 min)
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Types of Lidocaine
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2% plain = 5-10 pulpal, 60-120 ST 2% 1:100,000 = 60 pulpal, 180-300 ST 2% 1:50,000 = 60 pulpal, 180-300 ST
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Types of Articaine
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4% 1:100,000 = 60-75 pulpal, 180-360 ST 4% 1:200,000 = 45-60 pulpal, 120-300 ST
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Types of Prilocaine
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4% plain = 10-15 pulpal, 90-120 ST 4% 1:200,000 = 60-90 pulpal, 180-480 ST
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Types of Mepivicaine
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3% plain = 20-40 pulpal, 120-180 ST 2% 1:20,000 levo = 60 pulpal, 180-300 ST
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Types of Bupivicaine
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.5% 1:200,000 = up to 12 hours pulpal and ST
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Which anesthetics have a weak vasodilation?
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Mepivicaine & Prilocaine - this is why they can come in plain forms and still have a decent duration of action.
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Which anesthetic affects the CVS first instead of the CNS?
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Bupivicaine-all other LA's affect the CNS first.
