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74 Cards in this Set
- Front
- Back
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esters
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ex: procaine, benzocaine, tetricaine; metab by psudocholinesterase in plasma/liver -> risk of allergy; resulting metabs are inactive
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amides
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ex: lidocaine; metab in liver; needs hydroxylation and dealkylation; early metabs are active -> higher toxicity risk; delayed allergic rxn
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LA working on Na channels
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work on alpha subunit; non-covalently binds to AAs on S6 segment -> interferes w/ S4 fxn
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S4 segment
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lots of lys and arg residues -> positively charged; M gate
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bupivicaine
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very lipid soluble -> very long acting -> don't use on kids; example of phasic block
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felypressin
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vasoC that acts like ADH; targets the venous side (others target arterial side)
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epi/NE on alpha adrenergics
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epi acts on alpha 2 in periphery; NE acts on alpha 1 along symp NS
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R activation: epi
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activates alpha 1,2 and beta 1,2; B2 causes bronchodilation and periph vasodilation -> no change in BP from local vasoC (alpha2)
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R activation: NE
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does not activate B2 -> increase BP
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R activation: levonordefrin
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moderate binding to a1 and B2 Rs -> moderate effect on BP
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non-toxic IV range for epi
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0.06-0.24 ug/kg-min
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4% articaine w/ 1:100 epi
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no active metabs; very fast acting; side effect: methemoglobinemia (also associated w/ prilocaine)
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2% lido plain
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soft tissue infiltration only (e.g. for cysts)
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3% mepi plain and 4% prilo plain
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no vasoCs but have high efficacies; short duration of action; 3% mepi has high risk of OD in children
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0.5% bupivicaine w/ 1:200 epi
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very long duration of action; NOT for supraperiosteal injections for pulp of maxillary
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2% lido w/ 1:50 epi
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only for surgical hemostasis (more vasoC -> decreased bleeding)
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general dosage detemrination
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0.5 cart per 10 lbs up to 7 cartidges
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precise dosage determination
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Xcart = (Dmax•Wtkg)/(Canes•1.8mL/cart)
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dosage determination values for lidocaine
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C= 20 mg/ml (from 2%); D(max)=7mg/kg; D(tot)=500 mg
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bacterial endocarditis
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antibiotic prophy before PDL injections or intraosseous injections
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HTN, hyperthyroidism, atherosclerotic heart disease
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minimise vasoC use
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hemophiliacs
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minimise nerve blocks to avoid artery dmg
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pregnancy
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avoid mepi, bupi, arti
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liver damge
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use articaine for jaundiced pts bc its metabolism is not affected
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tricyclic antidepressants/SSRIs
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blocks reuptake of catecholamines; limit epi dose to 1/3; avoid levonordefrin
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nonselective beta blockers
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blocks periph vasodilation -> BP increaes; give 1/2 cart L+E -> monitor BP
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COMT inhibitors/adrenergic neuron blockers
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potential increased effect of vasoC -> use LA cautiously and monitor HR/BP
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adverse effects: hematoma
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most common w/ PSA block; only arteries cause hematomas
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adverse effects: paresthesia
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most common w/ IAN block -> avoid using 4% slns in IAN block to avoid permanent dmg
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V1 symp/para
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para: ciliary ganglion -> pupil constriction; symp: superior cervical plexus
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V2 infraorbital n.
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gives off MSA (when present) and ASA
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V2 MSA (when present)
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premolars + MB root of 3/14
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V2 ASA
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3 anterior teeth
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V2 PSA
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maxillary molars except MB root of 3/14
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V2 pterygopalatine trunks
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PPG -> gives off PSN (which gives off nasopalatine), greater and lesser palatine
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V2 nasopalatine
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from nasopalatine; thru incisive foramen; supplies gingiva or anterior palate; can supply ant teeth
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V2 greater palatine
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supplies hard palate up to canines + part of soft palate
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V2 lesser palatine
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supplies soft palate
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V2 para fibers
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from CN VII via greater superficial petrosal -> goes to lacrimal and other glands
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V2 symp fibers
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from ICA via deep petrosal n. -> vascular resistance
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ideal injection rate
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1 cartridge (2 mL) per minute or slower
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V2 exits cranium via…
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foramen rotundum
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V3 exits cranium via
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foramen ovale
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V3 anterior root
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gives off motor ns. then gives off buccal n.
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V3 buccal n.
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sensory n. of anterior root; supplies buccal mucosa and buccal gingiva of posteriors
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V3 posterior root
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gives off lingual n. and IAN, which gives off mylohyoid, mental and incisive ns.
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V3 lingual n.
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para and taste fibers from chorda tympany (CN VII); supplies lingual mucosa, anterior 2/3 of tongue and mucosa of floor of mouth
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V3 IAN relationship to lingual n.
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IAN runs posterior and lateral to lingual n.
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V3 IAN
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enters mandibular canal to supply all mandibular teeth
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V3 mylohyoid
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motor going to ant digastric belly and mylohyoid; sensory going to skin over chin
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V3 mental n.
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exits mental foramen; supplies lip, labial gingiva of incisors
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V3 incisive n.
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supplies mandibular anterior teeth
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V3 otic ganglion
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para from lesser superficial petrosal (CN IX) -> supplies parotid gland
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V3 submandibular ganglion
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para from chorda tympani (CN VII) via lingual; para and symp supply sublingual/submandibular glands
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taste regions
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ant 2/3: CN VII via chorda tympani; post 1/3: CN IX; epiglottis: CN X
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most common reason for LA failure
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IAN injection w/ needle too low or too medial
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supplementary injections
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short duration (single tooth): PDL, IO; long duration (multiple teeth): gow-gates, akinosi
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hot tooth -> swith LA to…
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5% lido or 4% articaine
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IO (stabident) injeciton site
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distal to tooth of interest, 2 mm below gingival margins; avoid midline and mental foramen
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AMSA injection
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b/w premolars and b/w midline and gingiva; anesthetizes palatal mucosa (not premolars)
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P-ASA injection
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inject into nasopalatine canal at anterior palate; anesthetizes anterior teeth w/o affecting lip
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ASA injection: site? Volume?
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apex of canine; 1-1.5 mL
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MSA injection: site? Volume?
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adjacent to 2nd premolar; 1-1.5 mL
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PSA block: site? depth? Volume?
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ht of vestibule, distal to zygomatic process (up, in, backwards); 1.5 cm (.5 of long needle); 1-1.8 mL
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PSA hematomas
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to lateral -> pterygoid venous plexus; to anterior -> PSA artery
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infraorbital block: blocks? Site? depth? Volume?
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midline to premolars; infraorbital foramen adj to 2nd premolar; 1.5 cm; 1 mL
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nasopalatine block: site? depth? Volume?
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laterally at edge of incisive papilla; 3-5 mm; 0.2-0.3 mL
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greater palatine block: site? depth? Volume?
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anterior to gr. palatine foramen (3-4 mm anteiror to palate/alveolar process jxn); 5mm; .25-.5 mL
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maxillary nerve block: 2 approaches? depth? Volume?
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high tuberosity approach, pterygopalatine canal via gr palatine foramen approach; 2.5-3 cm (entire needle); 1-2 cartidges
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mental/incisive block: blocks? Technique?
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midline to premolars; target mental foramen, which is below apex of 2nd premolar; insert 1 cm lateral of tooth surface and distal to foramen; advance needle 1cm inferiorly and medially
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buccal block: technique? depth? Volume?
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insert lateral and distal to last molar @ occusal plane level; 2-3 mm; 0.5 mL
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IAN: blocks? technique? depth? Volume?
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everything except post buccal gingiva and cheek; thumb on cornoid notch, bisect thumb, lateral to raphe, needle coming from opposite premolar; 2-2.5 cm (hits bone); 1-1.5 mL, w/draw needle 1/2 way, inject rest
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gow gates: blocks? Technique? depth? Volume?
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IAN area+buccal nerve+maybe auriculotemporal; insert distal to max 2nd molar @ level of ML cusp, come from opposite corner of mouth, aim for intertragic notch; 2.5 cm (hits condyle neck); full cartridge
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closed mouth: blocks? Technique? Depth? Volume?
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similar to area of GG block; into maxillary vestibule parallel to occusal plane at level of mucogingival jxn; insert to the hub; full cartridge
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