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Local anesthesia Final
Terms in this set (95)
Contains benzocaine, tetracaine, and butamben
Mixture of lidocaine and prilocaine, duration is 20 min and MRD is 5 cartridges. Toxicity is 20-40% as some is absorbed systemically. Metabolized by liver
Developed in 1905 and marketed in the US in 1905 as Novocaine
Refers to the actions of the drug on the body. LA interrupts the normal conduction of nerve impulses
Refers to the manner in which the body manages the drug. ADME
Formed by the combination of neutral base molecules and hydrogen ions. Are the only substance able to bind to receptor sites in the sodium channels of the nerve to block impulses
Neutral Base molecules
Lipophilic and pass through the nerve membranes. Combine with hydrogen ions to form cations. Necessary to provide adequate concentrations of cations in sodium channels
Equilibrium concentrations of catonic acid and neutral base molecules in solution. Higher the number the longer the onset of anesthesia
What is the common range for pka?
Xylocaine, lignospan, and octocaine
Lidocaine brand names
Carbocaine, isocaine, scandonest, and polocaine
What are the brand names for mepivacaine?
Citanest and citanest forte
What are the brand names for prilocaine?
Septocaine, ultracaine, and zorcaine
What are the brand names for articaine?
Vivacaine and marcaine
What are the brand names for bupivacaine?
Where impulses are initiated
Transmits signals to and from the CNS
Provides metabolic support/ conducts impulses
Terminal Nerve Endings
When stimulated, send info to excitable tissues
Nodes of Ranvier
Minute gaps consisting of unprotected nerve membranes
Produce Myelin to insulate and protect nerve membranes
Also known as delta fibers, lightly myelinated and bear primary responsibility for sharp pain
Nonmyelinated and conduct more slowly and provide a sensation of dull aching pain. Greater distribution in the dental pulp
Gates of Na+ remain closed; nerve is receiving little to no stimulation.
- 70 mv
What is the mv for resting potential?
Ion channels open when a nerve is stimulated, NA+ ions enter at the nodes of ranvier. Electrical potential becomes less negative.
-50 to -55
What is the mv for slow depolarization?
Occurs once firing threshold is reached (action potential is produced)
+ 30 mv
What is the mv for rapid depolarization?
Removal of Ca+ and k+. calcium then rebinds to receptor sites and closes the channels
-60 to -90
What is the mv for repolarization?
Specific Receptor Theory
LA binds to receptor site in sodium channel, thus blocking the entrance of sodium ions. Amide anesthetics
Membrane Expansion Theory
Lipid base portion expands the sodium channel wall, thus blocking the entrance of sodium ions. Ester type anesthetics
Lowest intensity of stimulation at which pain is experienced
Greatest intensity of painful stimulation that an individual is able to tolerate
Detect changes in temperature
Detect changes in pressure
Detect alterations in body chemicals
Activated by injury, polymodal
May last a few seconds, but no more than 6 months
Pain that persists for more than 6 months with or without an identifiable cause
Normal healthy patient
Patient with a mild systemic disease; can still receive routine care, including use of local anesthetics
Patient with severe systemic disease, can receive LA, but procedural stress should be strictly limited
Severe systemic disease that's a constant threat to life
Moribund patient, not expected to survive without operation
Declared brain dead. Organs are being removed for donor purposes
American Society of Anesthesiologists
What does ASA abbreviate?
Which trimester is the greatest for administering LA?
Which trimester is considered safest for mother and baby?
Field Block Injection
Deposition of anesthesia near larger terminal branches near the site of injection. Indicated when procedures are refined to 1-2 teeth
Depositions near primary nerve trunks at greater distances from the areas of treatment (wider areas of treatment)
Involve deposition directly at or near small terminal nerve endings
Anesthetize the pulp and labial and buccal tissues adjacent to the tooth.
Relaxes smooth muscle tone in arterioles and induce vasodilation (Leads to increased absorption of local anesthetics)
CVS stimulation (increased heart rate and increased BP)
Local Anesthetic OD
CNS stimulation (restlessness and convulsions) and then CNS depression (Coma, respiratory arrest)
Naturally occurs in the body, vasoconstrictor therefore reduces bleeding and enhances profound anesthesia. Sympathomimetic (reversal of generalized anaphylaxis and bronchospasm).
Drug interactions for vasocontrictor
Tricyclic antidepressants, phenothiazides, and inderal
Contained within the cartridge to adjust the PH to 3.5- 6.5
Contained within the cartridge to establish an isotonic solution
Contained within the cartridge to prevent oxidation of vasopressor
Few indications for human use, used as a pesticide/ fungicide in agriculture. Resulted infrequently in chronic poisonings of farm workers. Rare allergies
Gas produced when coal and other fossil fuels containing sulfur are burned. 5 Fold thickening of mucous layer in upper respiratory tract
Several antioxidants additives including sodium and potassium sulfite, bisulfite, and metabisulfite. Allergies common in asthmatic pts, avoid exposing by using LA without epi
Group of antimicrobial agents; sulfathiazole, sulfapyridine, and sulfadiazine.
Located midway between canines or about 5 mm behind lingual border of central incisors.
Needle inserted from a lateral direction, 3-5 mm until bone is contacted; 0.2 -0.3 ml deposited. Will have resistance and blanching
Greater Palatine Foramen
Situated on lateral aspect of hard palate, generally opposite than 2nd/ 3rd molar. 3-4 mm anterior to vibrating line at the junction of the horizontal and vertical plates of bone
Pain control from the retromolar pad to the midline. Vertical crosshair --> pterygomandibular raphe. Horizontal Crosshair --> Operator's thumb
Medial Pterygoid muscle
Medial border of pterygomandibular space
Lateral border of pterygomandibular space
Lateral Pterygoid Muscle
Superior border of pterygomandibular space
Posterior border of pterygomandibular space
Tingling/ itching sensation
Inability to open mouth; most common reason with LA administration is damage to the medial pterygoid muscle by inserting the needle too far medially. Fully reversible with time.
Medial Pterygoid Muscle
Damage to what muscle is the most common cause of trismus
Increased sensitivity to noxious (toxic) stimuli
Painful sensation to nonxious stimuli
Treatment includes analgesics and warm saline rinses
Treatment regiment includes physical theray, jaw opening exercises, analgesics, and muscle relaxants
Managed by placing ice packs on day of occurance to restrict swelling. Heat may be applied after 24 hours. Drainage is unnecessary
Inability to effectively block nerve impulses. Reasons for failure include: Inflammation, vascular injury, pts with history of drug addiction, and atypical innervation patterns
Placed over the aluminum cap, acts as a seal to prevent anesthetic from leaking around the needle
Aluminum End Cap
Located on the other end of the cartridge (opposite than stopper) and fits tightly around the neck of the cartridge. Holds the diaphragm
Threaded surface at the end of the barrel where the needle is attached; "Hub"
Part of the piston inside the barrel that penetrates the stopper. (Very sharp). Allows for retraction of stopper, self aspirating syringes do not have one
Passes through the finger grip complex and is attached on one end to the finger ring and the other to the harpoon tip
Attached to the external end of the piston, used to advance/ retract pistons
Encircles the diameter of the syringe barrel; piston passes through this
Designed to hold glass cartridges of local anesthetic solutions
Thumb ring with ring grip, not ideal for smaller hands
Considered the "Standard" syringe, thumb ring and saddle grip. Difficult for smaller hands
Long needle measurement for PCT clinic
Short needle measurement for PCT clinic
How much solution should be deposited for a mental nerve block?
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