Local anesthesia administration

Question 1

T/F

All local anesthetics are weak acids

Answer 1

False

All local anesthetics are weak bases

Question 2

Amides are metabolized where? What is their allergenicity?

Answer 2

In the liver by P450

Hypoallergenic

Question 3

Example of an amide anesthetic

Answer 3

Lidocaine

Question 4

Esters are metabolized where? What is their allergenicity?

Answer 4

in the bloodstream by pseudocholinesterase

Hyperallergenic

Question 5

Example of an ester anesthetic

Answer 5

Benzocaine

Question 6

What are the two forms of local anesthetic and where are they typically found?

Answer 6

Acidic- in carpule, and once intracellular

Basic- in tissue, and while crossing lipid bilayer

Question 7

How does an infection affect the effectiveness of LA?

Answer 7

Equilibrium shifts toward acidic form

This will delay onset and decrease amt of anesthetic in the tissue

Question 8

T/F

All local anesthetics are vasodilators

Answer 8

True

Question 9

What addition to the LA helps to delay the absorption of the LA into the bloodstream, prolonging the effective time?

Answer 9

Epinephrine

Question 10

Which type of LA should not be used in PEDO?

Answer 10

Prilocaine

Methemoglobinemia

Question 11

What is the max dose and duration with epi for lidocaine?

Answer 11

4.4 mg/kg

120-240min

Question 12

What is the max dose and duration with epi for articaine?

Answer 12

7.0mg/kg

140-270min

Question 13

What are the typical signs of overdose in a pedo patient?

Answer 13

Excitation followed by depression (biphasic rxn)
Vasodilation with depression of myocardium
–> drop in blood pressure
Bradycardia/cardiac arrest may result
Dizzyness, anxiety, confusion, muscle twitching and seizures, unconsciousness and possible respiratory arrest may occur

Question 14

What is the maximum total dosage in mg for lidocaine for the heaviest patient according to the AAPD?

Answer 14

300mg

Question 15

What is the maximum total dosage in mg for articaine for the heaviest patient according to the AAPD?

Answer 15

500mg

Question 16

What is the depth of effectiveness for topical anesthetic?

Answer 16

2-3mm

Question 17

What is the procedure for topical anesthetic application?

Answer 17

Dry tissue
Use a thin coating
Direct contact for 1-2min
Keep away from tongue

Question 18

What are the appropriate gauges for needles used in dental LA administration?

Answer 18

23-30 gauge

Blood can be aspirated through all of these

Question 19

What is the minimum age a child must be to receive articaine?

Answer 19

4y.o.

Question 20

What is the difference in position of the mandibular foramen in children as compared to adults?

Answer 20

Slightly lower and more posterior in a child

Question 21

Pulpal involvement of which primary molars will require an IAN block?

Answer 21

2nd primary molars

Question 22

What is the best way to achieve palatal anesthesia in a pediatric patient?

Answer 22

Start buccal, wait 2-3 min
Consider interpapillary, waith 2-3min
Apply sucularly or incisively if necessary

Question 23

What are the main postoperative complications of IAN blocks?

Answer 23

Drooling
Speech
Child upset
Soft tissue trauma
Hematoma

Question 24

What percentage of children experience postoperative tissue trauma following mandibular block anesthesia?

Answer 24

13%

Question 25

Is a rubber dam required?

Answer 25

According to AAE it is considered standard of care for any and all endodontic procedures