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29 Cards in this Set
- Front
- Back
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anesthesia: critical length
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- 3 nodes (of Ranvier) minimum (??)
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Are small or large diameter pain sensory fibers blocked by anesthesia first? Why?
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-small
-greater affinity for anesthetic |
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reason for delayed onset of anesthesia
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-disassociation rate. Also must wait for gates to be in _(open?) position.
BH+ <-> B + H+ -anesthetics are bases. They ionize once in the nerve and become impermeable |
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Anesthetizing a "hot" tooth
(tooth in pain) |
1. give block injection far away from local inflammation
2. give PDL or intraosseous injection. Intraosseous injections are more reliable and have better duration. |
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______ is long-acting only when given as a block injection. It provides pulpal anesthesia for _______ and soft tissue for _______
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-bupivicaine (o.x%)
- 1.5-4hrs - 5-12hrs |
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________________ is useful for short duration procedures or "no vasoconstrictor" pts
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- 3% Mepivicaine plain
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Adverse rxns to anesthesia:
most common allergy |
-syncope. Usually stress related.
-can be to sodium metabisulfite (antioxidant in VC) Symptoms: Mild: rash, itch, runny nose, eyes Anaphylaxis: warm moist skin, apprehension, diffuse hives, itching angioedema. |
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Tx of mild allergic rxns to anesthetic (2)
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-Benadryl (20-50mg) every 6hrs for 2-3 days
-broncholilator |
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Tx of anaphylactic response to anesthetic agent (4)
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-call 911
-positive pressure oxygen - Epi-pen (1:1000). 0.3-0.5 cc subcutaneously. Repeat every 10-15 minutes prn. -Diphenhydramine 1mg/kg. IV or IM |
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Adverse rxn to anesthetic: contributing factors (4)
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-type of anesthetic
-dosage -route of administration -rate of administration |
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best way to avoid toxic rxns (2)
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-limit dose
-use anesthetics w/ vasoconstrictors |
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max dose of prilocaine for ANY pt
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- 600mg. 8.33 carps
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half-life:
lido septo |
-90min
-30min |
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contraindications for vasoconstrictor
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-unstable angina
-MI w/in 6 months -coronary bypass w/in 3 months -uncontrolled hypertension, CHD,diabetes, endocrine disease |
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epinephrine primarily effects _____ receptors
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- alpha-1
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(relative) contraindications for vasoconstrictors (4)
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pts taking:
1) tricyclic antidepressants 2) phenothiazine antipsychotics 3) nonselective beta blockers 4) recreational drugs |
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for severely immunocompromised pts, ________ such as _________ prior to injection can reduce the (already slight) risk of infection.
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-antiseptic rinses
-chlorohexidine |
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max dose of articaine
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- 3.2mg/lb for healthy adults (same as lidocaine)
-remember that articaine is a 4% solution! Therefore max dose is 6.66 cartridges (according to FDA). |
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To reduce nerve injury w/ Citanest or Septo (2)
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-inject 1/2 of normal (lido) dose
-inject at 1/2 speed |
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most common parasthesia
most frequent complaint |
-temporary parasthesia of lingual nerve
(after that, IA) -loss of taste |
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Management of nerve injuries
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-inform pt
-document. Mark area of abnormal sensation on photo (prick with explorer for pain, stroke w/ fine brush for touch, ice for temp). -Contact pt after 24hrs -Compare area at follow-up visits -if no improvement after 2 weeks, refer to neurologist or OS. |
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If pt experiences spread of parasthesia over time
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-suggests progressive demyelination
-refer to specialist immediately |
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dysesthesia (5)
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-altered (unpleasant) sensation
-rarer than paresthesia but more serious -result of abnormal healing -possible neuroma formation -if lasts for >6 months, probably permanent. |
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nerve injuries:
microsurgery |
- 50-70% chance of SOME improvement
-BUT, also has high chance of making it worse |
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PDL injection (3)
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-need separate injection for each root
-short duration -less volume of anesthetic -better to use plain, non-vasoconstrictor anesthetic |
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PDL injection: precautions
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- sometimes have bone/root resorption. Usually reversible. Incidence increases w/ force of injection.
-don't use w/ pediatric pts w/ mixed dentistion |
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Intraosseous anesthesia:
injection site procedure (3) success rate duration |
(Stabident System)
-2mm below gingival margin. Btw teeth. 1) submucosal infiltration to injection site till blanched 2) penetrate cortical plate w/ perforator in reduction gear slow-speed handpiece. Will feel "drop" through plate. 3) Insert needle, inject. Watch for backflow -89% -15-30min with plain anesthetic. Plain is recommended |
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mandibular foramen is below the ________, _____% of the time, and even with it _____
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-mandibular occlusal plane
-75% -22.5% |
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mylohyoid nerve block:
indicated location easiest for depth amount |
-when profound anesthesia on mand quadrant cannot be achieved
-btw mandible and sublingual fold, just distal to last tooth being worked on (approximate apex) -ant teeth and bicuspids. Difficult for molars - 2-4mm -1/3-1/2 carp |
