Local Anes 2- Armamentarium

Front 1

what are the types of syringes?

Back 1

Metallic (=aspirating manual or self or pressure type).

Plastic (=aspirating (disposable or reusable) or Luer-lock).

Pressure type.

Jet injector syringe.

Electronic Preprogrammed Delivery.

Manual (metal) aspirating.

Harpoon (on syringe piston) forced into rubber plunger (on cartridge).--movement of thumb in syringe thumb ring to create negative pressure-> allows aspiration.

Front 2

do not throw away?

Back 2

needle adaptor

Front 3

What are the advantages of the metallic, breech-loading, aspirating syringe?

Back 3

visible cartridge, aspiration with one hand, autoclavable, rust resistant, long lasting with proper maintenance.

Front 4

Disadvantages of the metallic, breech-loading, aspirating syringe?

Back 4

heavier than plastic syringe, large-(maybe too big for small operators), possibility of infection (with improper care).

Front 5

care and handling?

Back 5

wash the syringe thoroughly and clean the harpoon after each and autoclave as appropriate.

Dismantle and lubricate.

replace harpoon as necessary.

Front 6

potential problems with dental local anesthetic syringes?

Back 6

leakage.

broken cartridge.

bent harpoon.

disengaged harpoon during aspiration.

Front 7

self aspirating syringes?

Back 7

metal projection inside syringe (also directs needle).

elasticity of rubber diaphragm creates positive pressure in cartridge.

positive pressure inside cartridge also increases by depressing thumb disk.

when released, significant negative pressure for aspiration.

allows multiple aspirations throughout deposition.

Front 8

Pressure-type syringe?

Back 8

for isolated teeth (PDL)-cost >200.

trigger permits measured dose-overcomes tissue resistance.

cartridge is completely encased in metal.

1st generation-pistol grip.

2nd generation- pen grip.

Front 9

Jet-injector syringe (needle-free)?

Back 9

forced liquid, at high pressure, through small opening can penetrate skin/mucous membranes.

Best used as sub-topical prior to injection (not a good sub).-anterior teeth, soft tissue procedures.

major disadvantages=soft tissue soreness.

Front 10

Plastic disposable Leur-Loc syringe?

Back 10

Two hands operation- cannot aspirate single-handedly.

cannot use dental cartridge.

used with vials or ampules of LA.

latex allergic pt? irrigation of RCT, perio pockets, etc.

Awkward to use intraorally.

disposable.

Front 11

Computer controlled delivery?

Back 11

Wand, comfort control syringe.

computer controlled pump-drives LA-controlled by foot or hand pedal.

control rate of injection.

can aspirate.

expensive.

Front 12

Computer controlled LA delivery: oraqix?

Back 12

Injectable topical anes.

Oraqix- mixture of lidocaine and prilocaine.

Liquid at room temp, gel at body temp.

Administered with syringe and blunt needle into perio pocket.

Front 13

Cartridge?

Back 13

aluminum cap at delivery end with rubber diaphragm.

glass cylinder.

color coding band.

stopper (plunger, bung).

1.8mL (1.7mL) vol.

Front 14

color coding band of cartridges?

Back 14

gold= articaine HCl 4% with epinephrine 1:100k.

blue=bupivacaine 0.5% with epinephrine 1:200k.

light blue=Lidocaine HCl 2%.

green=Lidocaine HCl 2% with epinephrine 1:50k.

red=Lidocaine HCl 2% with epine 1:100k.

tan=Mepivacaine HCl 3%.

brown=Mepivacaine HCl 2% with levonordefrin 1:20k.

black=Prilocaine HCl 4%.

yellow=Prilocaine HCl 4% with epine 1:200k.

Front 15

Cartridge contents?

Back 15

LA drug

Vasoconstrictor (epine, levonordefrin).

Sodium bisulfite (Antioxidant)-preservative for vasoconstrictor.

Sodium Chloride (Isotonicity).

Sterile Water (Diluent).

Front 16

Problems with cartridges?

Back 16

Bubble in cartridge: small <2mm-normal.

large >2mm-freezing.

Extruded stopper-freezing, or uptake of holding solution.

Burning on injection: normal response to pH of drug, response to preservative, diffusion of holding solution, over-warmed cartridge.

Front 17

Problems with cartridges?

Back 17

Leakage during injection- eccentric penetration of diaphragm.

Cap- corrosion-cold sterilizing solution. Rust-leakage in container.

Broken cartridge- rough handling, excessive force to engage harpoon.

Front 18

Latex allergy?

Back 18

latex containing materials in local anesthetic cartridge-diaphragm.

release into solution by penetration or contact.

no documented reaction in literature.

Front 19

Needles?

Back 19

bevel. shaft. hub. syringe penetrating end.

Selection based on 2 factors: length= long (~32mm), short (~20mm), extra-short.

Size (gauge)-larger gauge is associated with:

less deflection, greater accuracy in insertion, decreased chance of needle breakage, easier aspiration, no perceptual difference in patient comfort.

Front 20

Gauge?

Back 20

measure of the diameter of the needle's lumen.

size number is inversely proportional to the diameter.

Usual dental needle gauges are 25,27,30.

red, yellow, blue.

Front 21

Needle handling and safety?

Back 21

single pt use, change after several injections (3).

Cap between uses, dispose of in "sharps" container. -recapping devices, recapping techniques.

Dont force against resistance.

Dont insert a needle to the hub.

Front 22

problems related to needles

Back 22

needle stick injury/injury to administrator.

pain on insertion.

pain on withdrawal.

breakage

Front 23

avoiding needle fracture?

Back 23

avoid using 30-gauge or short needles for IAN blocks: sharpness, not its diameter, determines the degree of discomfort.

do not bend the needle before inserting it into the tissue (5mm).

do not bury the needle in the tissue to the extent that the hub indents the mucosa ("hubbing").

Front 24

Loading the syringe?

Back 24

after removing syringe, retract the piston.

insert cartridge while piston is fully retracted.

insert rubber stopper end first.

gently push piston forward to engage harpoon in the plunger.

do not hit the piston!

attach needle to syringe. remove plastic cap from syringe end of needle. push/screw needle into needle adapter of syringe. carefully, remove plastic cap from needle.

Front 25

how do you recap the needle?

Back 25

"scoop" technique-slide uncapped needle into needle sheath.

needle cap holder.

Front 26

unloading the syringe:

Back 26

retract piston and pull cartridge away from needle until the harpoon disengages from the plunger.

remove used cartridge.

carefully unscrew recapped needle, without removing the needle adapter.

properly dispose of used needle.

Front 27

technique tips?

Back 27

hide the syringe from view.

topical.

temperature of cartridge.

slow, well directed, careful injection.

bevel toward the bone.

aspirate.

observe.

distraction: pinching,applying pressure, jiggling.

relaxation: non-pharmacologic, sedative/hypnotic anxiolytic med.

confidence. time.

Front 28

reversal of soft tissue?

Back 28

phentolamine mesylate.

non-selective alpha-adrenergic antagonist.

used in the management of catecholamine-induced hypertensive crisis.

0.4mg phentolamine mesylate (0.235 mg/ml) in 1.8mL cartridge.

same site injection.