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33 Cards in this Set
- Front
- Back
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Current LAs
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Lidocaine (Xylocaine) - 2%
Mepivacaine (Carbocaine) - 3% Bupivacaine (Marcaine) - 0.5% 1:200,000epi Prilocaine (Citanest) Articaine (Septocaine) - 4% |
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Duration of Action
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Inidvidual variations (bell-shaped curve, hypo/hyper responders)
Acuracy of Admin Tissue status (pH, vascularity, thickness, infection, inflammation, vascularity) Anatomic variation (bifid mandibular canals seen on pano) Block vs. Infiltration Type of anesthetic (smaller doses decrease duration, however larger doses do not increase duration) |
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Lidocaine 2% Duration
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Infiltration = 5-10 min
Block = 10-20 min |
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Mepivocaine 3% Duration
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Infiltration = 5-10 min
Block = 20-40 min |
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Prilocaine 4% Duration
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Infiltration = 10-15 min
Block = 40-60 min |
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Max Dosage
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Drug dosages recorded in mg/kg
Base clinical dose on body weight Use the min amound of drug necessary to achieve the desired level of anesthesia |
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Max Dose
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In general, most patients will not require the max dose
3 groups that require special attention: Children, Elderly (dec body weight, dec lean body mass, dec plasma albumin), medically compromised |
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Max Dose Lidocaine 2% 1:100,000 epi
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Man = 6.6 mg/kg (3.0 mg/lb)
Mal = 4.4 mg/kg (2.0 mg/lb) |
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Lidocaine (Xylocaine)
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Recommended use: all healthy patients
Precautions: Cardiac patients, hyperthyroid OD: May not see excitation - most often see CNS depression Allergy rare |
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Lidocaine (Xylocaine)
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Amide, metabolized in liver, excreted via kidneys
Rapid onset (2-3 min) 2% effective conc. Max dose: Man = 500mg, Mal = 300 mg total, regardless of weight |
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Mepivacaine (Carbocaine)
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3%
No vasoconstrictor (epi) Amide, metabolized in liver, excreted via kidney Rapid onset (1.5-2 min) higher pH than Lidocaine, so it gets into tissues faster max dosage is same as Lidocaine Peds: Man = 3.0 mg/lb, Mal = 2.0 mg/lb |
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Mepivacaine (Carbocaine)
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Provides longer duration of anesthesia than other LAs without a vasoconstrictor
This LA causes less vasodilation alone, does not need an epi boost |
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When should you use Mepivacaine (Carbocaine)?
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When you don't need/want a vasoconstrictor
Cardiac patients Short procedures Infected tissues (low pKa) |
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Prilocaine HCl (Citanest)
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Amide, metabolized in liver, CO2 end product, excreted via kidney, but very small amount active
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Precautions of Prilocaine HCl (Citanest)
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Orthotoluidine (metabolite) may induce methemoglobinemia - cyanosis
Limit dose to 600mg |
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Which is less toxic systemically, Lidocaine, or Prilocaine?
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Priolocaine is less toxic systemically than Lidocaine
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Prilocaine HCl (Citanest)
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4% plain or 4% 1:200,000 epi
Provides lengthy anesthesia with less vasoconstrictor |
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What type of patients is Prilocaine recommended for?
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epi sensitive patients requiring prolonged pulpal anesthesia > 60min
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Articaine HCl (Septocaine)
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Amide-type, ester group
Biotransformed in plasma and liver, excreted in kidneys 4% with 1:100,000 or 1:200,000 epi 7.0 mg/kg (3.2 mg/lb) - 500mg Claims of diffusion through soft and hard tissues |
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Articaine HCl (Septocaine)
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Reports of paresthesia
Methemoglobinemia with large IV dosing Contraindicated: sensitivity to amide LA, sensitivity to sulfites Precaution: pts with liver disease and CV disease, children <4 |
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Selection of LA
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Duration of pain control required
Need for post-op pain control Hemostasis Physical status of pt Absolute contraindications |
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Absolute Contraindications
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Anesthetic Allergy - Class inclusive
Sulfa Allergy - Avoid Articaine Bisulfate Allergy - Avoid vasoconstrictors |
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Relative Contraindications
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Atypical cholinesterase inhibitor (no esters)
Methemoglobinemia (no articaine or prilocaine) Liver disease (amides) Renal disease (amides and esters) Cardiac pts (no vasoconstrictors) Untreated or uncontrolled hyperthyroid pts (no vasoconstrictors) |
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Topical Anesthetics
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Can penetrate mucosa or abraded skin
Conc. required usually much higher to be effective &uarr risk toxicity Dosage may be hard to control |
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Benzocaine
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Ester!
NOT water soluble Poorly absorbed Remains at site longer than other topicals 2-3 min surface penetration 2 min minimum to be effective |
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EMLA
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Eutectic Mixture of LA (Oragix)
Lidocaine 2.5% + Prilocaine 2.5% Anesthesia of intact skin, mucosa Apply 1 hr prior to procedure Contra: Methemoglobinemia, Amide-type sensitivity |
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Lidocaine (topical)
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5% Lidocaine base (poorly soluble in water. ulcerated, abraded, lacerated skin)
2% Lidocaine HCl - water soluble, penetrates tissue better, greater systemic absorption |
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Lidocaine base: max dose
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200mg
aerosol 10mg/metered spray ointment 50mg/ml patch |
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Lidocaine HCl: max dose
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viscous lidocaine 20mg/ml
solution 40mg/ml |
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Lidocaine 2% max dose
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20mg/ml x 1.8cc = 36mg/carpule
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Mepivacaine 3% Max Dose
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30 x 1.8 = 54 mg/carpule
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Articaine 4% max dose
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40 x 1.8 = 72 mg/carpule
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Marcaine 0.5% max dose
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5 x 1.8 = 9 mg/carpule
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