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Anesthesia

Local Anesthesia CH. 21 Questions PG. 361-368

QuestionAnswer
What shall I do when a patient claims to be allergic to a local anesthetic? Believe the patient. Do not use any form of local anesthetic. Determine what happened before taking any other steps.
How do I select the proper local anesthetic for a given patient and procedure? The duration of pain control to complete the procedure and for post treatment pain control. The physical status ( i.e. ASA classification), hypersensitivity, methemoglobinemia, or sulfur allergy.
What is the ultimate deciding factor in local anesthetic solution? Duration of desired pain control
Are there any contraindications to the use of vasopressors in dental patients? Patients with blood pressure 200/115. Uncontrolled hyperthyroidism. Severe cardiovascular disease. Undergoing general anesthesia with halogenated agents. Receiving nonspecific beta blockers, tricyclic antidepressants.
Often medical consultants recommend against inclusion of a vasopressor in a local anesthetic for a cardiovascular risk patient. Why? What can I do to achieve effective pain control? HBP, Severe cardiovascular disease can be treated if they are ASA II or III then local anesthetics can be used but epinephrine should be avoided.
When should epinephrine be avoided? It increases myocardial sensitivity even more, predisposing the patient to a greater frequency of dysrhythmias or more significant dysrhythmias as in ventricular tachycardia or ventricular fibrillation.
Why is a vasopressor such as epinephrine used? Decrease the rate at which the local anesthetic is absorbed into the cardiovascular system as well as minimizing the bleeding and prolonging the duration of clinical action.
Why is the use of vasopressors in local anesthetics recommended for cardiac risk patients? Vasopressors keep the duration of pain tolerance down thus reducing the stress of the patients resulting in no release of catecholamine's.
What is the cardiac dose for epinephrine? 0.04 mg
If I elect not to use a vasopressor for a patient, which local anesthetics are clinically useful? Mepivacaine 3% (40 minutes of pulpal anes.) and Prilocaine 4% (60 minutes of pulpal anes.)
What is the recommended gauge of needle? 25 gauge needle.
Why are cartridge warmers not recommended? Solution becomes too warm, thus resulting in increased discomfort on injection and possible destruction of heat-sensitive vasopressor.
Why do some patients complain of a burning sensation when a local anesthetic is injected? pH during initial injection, overly warm solution, presence of alcohol or cold sterilizing solution, solution with a vasopressor or near its expiration date.
What is the recommended sequence for preparation? Place the cartridge in the syringe, embed the aspirating harpoon, place needle on the syringe.
Why should you always expel a small volume of anesthetic from the syringe before inserting the needle into the patients mouth? Ensure patency (the condition of being open, expanded or unobstructed) of the needle
What should always be done before local anesthetic administration in a patient? Review medical history, and physical examination (i.e. vitals, visual inspection, etc. )
What is the most common position of choice for a patient receiving local anesthetic? Patient's chest and head are parallel to the floor with the feet slightly elevated.
What is the most common error when administering the IA injection? insertion of the needle too low on the medial side of the ramus below the mandibular foramen.
What is the second most common error when administering the IA injection? insertion of the needle too far anteriorly (laterally) on the medial side of the ramus thus contacting bone too soon after penetration.
Created by: daisenmurray