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205 terms

LA (May 2006)

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What hard tissues does the PSA Injection anesthetize?
Maxillary molars and associated supporting structures
What soft tissues does the PSA injection anesthetize?
overlying buccal tissues
How much anesthetic should be given on a PSA?
0.9-1.8mL
What are the possible complications of the PSA injection?
Hematoma of maxillary artery or pterygoid plexus, mandibular anesthesia
What are the landmarks for the PSA injection?
Maxillary tuberosity, 2nd max. molar
What is the point of penetration site for the PSA injection?
Mucobuccal fold, just distal to 2nd molar
What is the site of deposition for the PSA injection?
Vicinity of PSA foramina, near apex of 3rd molar, approximately 3/4" deep
Describe the technique when giving a PSA injection
45 degrees down and out, 25 short needle
What hard tissues does the MSA anesthetize?
Max premolars, associated supporting structures
What soft tissues does the MSA anesthetize?
overlying buccal tissues
How much anesthetic should be given for the MSA injection?
0.9-1.2mL
What are the possible complications when giving a MSA injection?
Hematoma (rare), pain if too near periosteum
What are the landmarks for a MSA injection?
max 2nd premolar, zygomatic
What is the point of penetration for a MSA injection?
mucobuccal fold above 2nd premolar
What is the site of deposition for a MSA injection?
above apex of 2nd premolar approx, 1/4" to 1/2" deep
Describe the technique for giving a MSA injection
parallel to long axis of 2nd premolar, 25 or 27 short needle
What hard tissues does the ASA anesthetize?
max incisors and canines, associated supporting structures
What soft tissues does the ASA anesthetize?
overlying buccal tissues
How much anesthetic should be given for an ASA injection?
0.9-1.2mL
What are the possible complications when giving an ASA injection?
Hematoma (rare), pain if too near periosteum
What are the landmarks for giving an ASA injection?
max lateral and canine
What is the point of penetration for an ASA injection?
Mucobuccal fold above lateral or just mesial to canine
What is the site of deposition for an ASA injection?
Above apex of canine, approx 1/4-1/2" deep
Describe the technique for giving an ASA injection
Advance at an angle toward target 25 or 27 S needle
What hard tissues are anesthetized for a NP injection?
anterior 1/3 of hard palate
What soft tissues are anesthetized for a NP injection?
palatal tissues from canine to canine
How much anesthetic should be given for a NP injection?
0.45mL or until papilla blanches
What are the possible complications for a NP injection?
Hematoma (rare), anesthetic leaking from point of penetration
What are the landmarks for a NP injection?
Max central incisors, incisive papilla
What is the point of penetration for a NP injection?
either side of incisive papilla
What is the site of deposition for a NP injection?
incisive foramen, beneath incisive papilla, approx 4mm deep
What is theh technique for giving a NP injection?
angle under papilla toward foramen, pressure throughout 27 S needle
What hard tissues are anesthetized from GP injection?
posterior 2/3 of hard palate
What soft tissues are anesthetized with the GP injection?
palatal tissues from mesial of 1st premolars to midline
How much anesthetic should be given in a GP injection?
0.45-0.6mL or until significant blanching occurs
What are the possible complications when giving a GP injection?
hematoma (rare) soft palate anesthesia
What are the landmarks for giving a GP injection?
junction of max alveolar process and palatine bone, posterior border of hard palate, 2nd molar, GP foramen
What is the point of penetration for a GP injection?
just anterior to greater palatine foramen
What is the site of deposition for a GP injection?
just anterior to GP foramen, approx. 4-5mm deep
Describe the technique used to give a GP injection
approach from opposite corner of mouth, pressure throughout, 27 S needle
What hard tissues are anesthetized for an IO injection?
max central through premolars, associated supporting structures
What soft tissues are anesthetized for a IO injection?
overlying facial tissues, lower eyelid, side of nose, upper lip
How much anesthesia should be given for an IO injection?
0.9-1.2mL
What are the possible complications for an IO injection?
Hematoma (rare), Pain if too near periosteum
What are the landmarks for an IO injection?
max 1st premolar, IO notch, ridge, depression, foramen
What is the point of penetration for an IO injection?
Mucobuccal fold over 1st premolar
What is the site of deposition for an IO injection?
Infraorbital foramen below IO notch, approx. 2/3" deep
Describe the technique for giving an IO injection
Parallel to long axis of 1st premolar in line with foramen, contact bone, apply pressure during and after, 25 L needle
What hard tissues are anesthetized in a IAN/L injection?
Mand. teeth to midline
What soft tissues are anesthetized for an IaN/L injection?
Facial tissue from 2nd premolar to midline, all lingual tissues, anterior 2/3 of tongue, floor of mouth
How much anesthetic should be given for an IAN/L injeciton?
1/5mL for IA, 0.1mL for lingual
What are the possible complications for an IAN/L injection?
Hematoma of IAA, Lingual Artery or Vein, Trismus, Temporary facial nerve paralysis, "Shocking pain" of lingual n. if touched
What are the landmarks when giving an Ian/L injection?
coronoid notch, pteygomandibular raphe, corner of mouth
What is the point of penetration for an Ian/L injection?
apex of pterygomandibular triangle, approx. 7-8 mm above mand occlusal plane, lateral to raphe
What is the site of deposition for the IAN/L injection?
at or above the mand. foramen, approx. 20-25mm deep (approx. 1" or 2/3 of long needle) for IA, halfway back for L
Describe the technique for giving an IAN/L injection
approach from opposite corner of mouth, syringe over premolars and parallel to mand. occlusal plane, needle hugs raphe, contact bone, 25 L needle
What hard tissues are anesthetized by the LB injection?
none, no teeth
What soft tissues are anesthetized by the long buccal injection?
buccal tissues of mand molars
How much anesthesia should be administered for a LB injection?
0.3mL
What are the possible complications for a LB injection?
Hematoma at point of penetration
What are the landmarks for a LB injection?
External oblique ridge, mand molars
What is the point of penetration for the LB injection?
at the level of the buccal cusps, distal and buccal to mand molars
What is the site of deposition for the LB injection?
anterior border of ramus, approx 3mm deep
Describe the technique used to give a LB injection?
syringe parallel and buccal to mand occlusal plane, 25 L needle
What hard tissues are anesthetized by the Incisive injection?
1st or 2nd premolar to midline, associated supporting structures
What soft tissues are anesthetized by the Incisive injection?
facial tissue and lip anterior to mental foramen
How much anesthetic should be given for an incisive injection?
0.6-0.9mL
What are the possible complications for an incisive injection?
hematoma (rare), unless foramen is entered
What are the landmarks for an incisive injection?
mental foramen, 2nd mand molar
What is the point of penetration for an incisive injection?
Mucobuccal fold just anterior to mental foramen
What is the site of deposition for an incisive injection?
just distal to mental foramen, approx 5-6mm deep
Describe the technique used to give an incisive injection?
advance at an angle toward target, apple pressure after injection for 1-2min, 27 S needle
What are the hard tissues anesthetized by a mental injection?
none
What are the soft tissues anesthetized by a mental injection?
buccal tissue of premolar to central, chin and lower lip
How much anesthesia should be given for a mental injection?
0.6mL
What are the possible complications for a mental injection?
Hematoma
What are the landmarks for a mental injection?
mental foramen, mand premolars, and mucobuccal fold
What is the point of penetration for a mental injection?
mucobuccal fold anterior to mental foramen
What is the site of deposition for a mental injection?
mental foramen, apices of premolars, 5-6mm deep
Describe the technique used to administer a mental injection
parallel to long axis of premolars, 27 S needle
Analgesia
Loss or reduction of pain
Nerve Block
Close proximity to nerve trunk; remote
Field Block
Close proximity to larger terminal nerve branches
Local Infiltration
Flooding
First Local Anesthetic
Cocaine
Ester-Linked LA
No longer used
Amide-Linked LA
Lidocaine; used in dentistry today
Free Base Form of Amide-Linked LAs
Penetrates nerve membrane and dissociates into ionized form
Ionized LA Action
Blocks nerve conduction by blocking influx of Na+ preventing an action potential
Local Anesthetic Qualities
Weak base= Low water solubility, unstable, poor diffusion
Need for HCl in LA
Improves water solubility, is stable, and has good diffusion
Minimum Anesthetic Concentration/Cm
Individual susceptibility of each nerve fiber to the effects of LA
Sequence of Disappearance of Sensations
Pain-Temperature-Touch-Proprioception-Motor Function
pKa
pH at which 50% of the drug is ionized
Lower pKa Values=
Most rapid onset LAs
Potency Determined By
Lipid Solubility
All LA Are
Vasodilators
Caine Potency Sequence
Bupivi-Etido-Pro-Lido-Mepivi-Prilo-Arti
Duration Determined By
Protein-Binding Capacity
CNS Adverse Effects
Convulsions and general CNS depression
CV Adverse Effects
Contractile force
What predominates following an epinephrine injection?
Alpha Effects
As epinephrine decreases...
Beta effects predominate and vasodilation occurs
Epinephrine Effects
Increases HR, contractility, vasoconstriction/dilation
Epinephrine Dosing for Healthy Individual
3 micrograms/kg not to exceed .2mg
Epinephrine Dosing for CV Disease Pt with No Limitations
1.5 micrograms/kg not to exceed .1mg
Epinephrine Dosing for CV Disease Pt with Limitations
.75 micrograms/kg not to exceed .04mg
Tricyclic Antidepressant Considerations
Increased BP and dysrhythmyia; No more than 36 micrograms of epinephrine
Beta-Adrenergic Antagonists Considerations
Increased BP and bradycardia; No more than 36 micrograms of epinephrine
General Anesthetic Considerations
Halothane= No Epinephrine
Cocaine Considerations
No epinephrine
Alpha-Adrenergic Receptor Blockers
Hypotension and vasodilation; Minimum quantity possible
ASA I
Healthy
ASA II
Mild systemic disease with no limitations
ASA III
Severe systemic disease with limitations
ASA IV
Incapacitating disease with a constant threat to life
ASA V
Moribund
4.5-7micrograms/mL Epinephrine
Euphoria, sweating, vomiting
7.5-10 micrograms/mL Epinephrine
Increased HR, BP, and respiration; Drowsiness and LOC
10 micrograms and up Epinephrine
Seizures, Decreased HR, BP, and respirations
Local Anesthetic Classification
Amides and Ester
Amides
Lidocaine, Mepivacaine, Prilocaine, Bupivacaine
Esters
Procaine (Novocaine), Cocaine, Benzocaine
Chemistry of LA
Weak bases; they have aromatic group (benzene ring-hydrophobic); Linkage (amide or ester); and a hydrophilic amino group
Amides metabolize in
Liver
Esters metabolize by in
Plasma enzyme; Psedocholinesterase
Adverse affects of LA
CNS depression: drowsiness, unresponsiveness, coma; CV: dysrhythmias, hypotension, respiratory arrest
Malignant hyperthermia
Hight fever, tachycardia, cardiac dysrhythmia, muscle rigidity. Caused by halothane, succinylcholine
Composition of LA
Vasoconstrictor, antioxidant, sodium hydroxide, sodium chloride
Lidocaine
Xylocaine
Mepivacaine
Carbocaine
Prilocaine
Citanest
Bupivacaine
Marcaine/Bupican
Articaine
Septocaine
LA with patient with CV disease
Can receive a maximum safe dose of .04 mg Epi
Topical Anesthesia
Benzocaine (ester); Lidocaine (amide); and Benadryl (last resort)
Drug to Drug interactions with LA
Lidocaine and Cimetidine- increases effect of lidocaine
What is the pulpal duration of 3% Mepivicaine
20-40 min.
What is the soft tissue duration of 3% Mepivicaine?
2-3 hrs
How many mg of anesthetic are in one cartridge of 3% Mepivicaine?
54.0 mg
How many mg of anesthetic are in one cartridge of 4% Prilocaine?
72.0 mg
How many mg of anesthetic are in one cartridge of 2% Lidocaine?
36.0 mg
How many mg of anesthetic are in one cartridge of 2% Mepivicaine?
36.0 mg
How many mg of anesthetic are in one cartridge of 4% Articaine?
72.0 mg
How many mg of anesthetic are in one cartridge of 4% Prilocaine?
72.0 mg
How many mg of anesthetic are in one cartridge of 0.5% Bupivicaine?
9.0 mg
What is the pulpal duration of 4% Prilocaine (infilitration Citanest)?
10-20 minutes
What is the pulpal duration of 2% Lidocaine 1:50,000?
60 min
What is the pulpal duration of 2% Mepivicaine 1:20,000?
60 min
What is the pulpal duration of 4% Articaine 1:200,000?
45-60 min
What is the pulpal duration of 4% Articaine 1:100,000?
60-75 min
What is the pulpal duration of 4% Prilocaine (nerve block)?
60 min
What is the pulpal duration of 4% Prilocaine 1:200,000 Epi (Citanest Forte)?
60-90 min
What is the pulpal duration of 0.5% Bupivicaine 1:200,000 Epi (Marcaine)?
90-180 min
What is the soft tissue duration of 4% Prilocaine (Infiltration Citanest)?
1.5-2 hrs
What is the soft tissue duration of 2% Lidocaine 1:100,000
3-4 hrs
What is the soft tissue duration of 2% Lidocaine 1:50,000?
3-4 hrs
What is the soft tissue duration of 2% Mepivicaine 1:20,000?
3-5 hrs
What is the soft tissue duration of 4% Articaine 1:100,000?
3-6 hrs
What is the soft tissue duration of 4% Articaine 1:200,000?
2-5 hrs
What is the soft tissue duration of 4% Prilocaine (nerve block)?
2-4 hrs
What is the soft tissue duration of 4% Prilocaine 1:200,000 (Citanest Forte)?
3-8 hrs
What is the soft tissue duration of 0.5% Bupivicaine 1:200,000 (Marcaine)?
4-9 hrs
How much vasoconstrictor is in one cartridge of 3% Mepivicaine?
none
How much vasoconstrictor is in one cartridge of 4% Prilocaine (infiltration Citanest)?
none
How much vasoconstrictor is in one cartridge of 2% Lidocaine 1:100,000?
0.018
How much vasoconstrictor is in one cartridge of 2% Lidocaine 1:50,000?
0.036
How much vasoconstrictor is in one cartridge of 2% Mepivicaine 1:20,000 (Levonordephrin)?
0.090
How much vasoconstrictor is in one cartridge of 4% Articaine 1:100,000?
0.018
How much vasoconstrictor is in one cartridge of 4% Articaine 1:200,000?
0.009
How much vasoconstrictor is in one cartridge of 4% Prilocaine (nerve block)?
none
How much vasoconstrictor is in one cartridge of 4% Prilocaine 1:200,000 (Citanest Forte)?
0.009
How much vasoconstrictor is in one cartridge of 0.05% Bupivicaine 1:200,000 (Marcaine)?
0.009
What is the MRD of anesthetic to be given to a pt. 150 lbs or more of 3% Mepivicaine?
2.0/lb; 300 mg
What is the MRD of anesthetic to be given to a pt. 150 lbs or more of 4% Prilocaine (Infiltration Citanest)?
2.7/lb; 400 mg
What is the MRD of anesthetic to be given to a pt. 150 lbs or more of 2% Lidocaine 1:100,000
2.0/lb; 300 mg
What is the MRD of anesthetic to be given to a pt. 150 lbs or more of 2% Lidocaine 1:50,000
2.0/lb; 300 mg
What is the MRD of anesthetic to be given to a pt. 150 lbs or more of 2% Levonordephrine 1:20,000?
2.0/lb; 300 mg
What is the MRD of anesthetic to be given to a pt. 150 lbs or more of 4% Articaine 1:100,000?
3.2/lb; 500 mg
What is the MRD of anesthetic to be given to a pt. 150 lbs or more of 4% Articaine 1:200,000?
3.2/lb; 500 mg
What is the MRD of anesthetic to be given to a pt. 150 lbs or more of 4% Prilocaine (nerve block)?
2.7/lb; 400 mg
What is the MRD of anesthetic to be given to a pt. 150 lbs or more of 4% Prilocaine 1:200,000 (Citanest Forte)?
2.7/lb; 400 mg
What is the MRD of anesthetic to be given to a pt. 150 lbs or more of 0.5% Bupivicaine 1:200,000
0.6/lb; 90 mg
What is the MRD of Vasoconstrictor in mg that can be given to a healthy adult of 2% Lidocaine 1:100,000
0.2mg
What is the MRD of Vasoconstrictor in mg that can be given to a healthy adult of 2% Lidocaine 1:50,000
0.2mg
What is the MRD of Vasoconstrictor in mg that can be given to a healthy adult of 2% Mepivicaine 1:20,000?
1 mg
What is the MRD of Vasoconstrictor in mg that can be given to a healthy adult of 4% articaine 1:100,000
0.2 mg
What is the MRD of Vasoconstrictor in mg that can be given to a healthy adult of 4% Articaine 1:200,000
0.2 mg
What is the MRD of Vasoconstrictor in mg that can be given to a healthy adult of 4% Prilocaine 1:200,000
0.2 mg
What is the MRD of Vasoconstrictor in mg that can be given to a healthy adult of 0.5% Bupivicaine 1:200,000
0.2 mg
What is the MRD of Vasoconstrictor in mg that can be given to a cardiac patient of 2% Lidocaine 1:100,000
0.04 mg
What is the MRD of Vasoconstrictor in mg that can be given to a cardiac patient of 2% Lidocaine 1:50,000
0.04 mg
What is the MRD of Vasoconstrictor in mg that can be given to a cardiac patient of 2% Mepivicaine 1:20,000
0.2 mg
What is the MRD of Vasoconstrictor in mg that can be given to a cardiac patient of 4% articaine 1:100,000
0.04 mg
What is the MRD of Vasoconstrictor in mg that can be given to a cardiac patient of 4% Articaine 1:200,000
0.04 mg
What is the MRD of Vasoconstrictor in mg that can be given to a cardiac patient of 4% Prilocaine 1:200,000
0.04mg
What is the MRD of Vasoconstrictor in mg that can be given to a cardiac patient of 0.5% Bupivicaine 1:200,000
0.04 mg
Which local anesthetic agents do not contain a vasoconstrictor?
3% Mepivicaine (Carbocaine, Polocaine), 4% Prilocaine (infiltration Citanest), and 4% Prilocaine (nerve block)
What is another name for 3% Mepivicaine?
Carbocaine, Polocaine
What is another name for 0.5% Bupivicaine?
Marcaine
What is another name for 4% Prilocaine 1:200,000?
Citanest Forte
What is the dose limiting factor?
Epinephrine
What local anesthetic agents are considered short duration?
3% Mepivicaine, 4% Prilocaine (infiltration Citanest)
Which local anesthetic agents are considered intermediate duration?
2% Lidocaine, 2% Mepivicaine, 4% Articaine, 4% Prilocaine
Which local anesthetic agents are considered long duration?
0.5% Bupivicaine (Marcaine)