DH329 Pain Management Final Review Guide

Desirable Properties of LA

Non-irritating, Reversible, Low systemic toxicity, Effective as injectable or topical, Short onset time, Adequate duration of action, Does Not produce allergic response, Stable in solution, Sterile.

Sensory neuron

Afferent, carries information from the periphery to the brain, cell body not involved in the process of impulse transmission.

Motor neuron

Carries information from brain to periphery, Cell body involved in impulse transmission and provides metabolic support for the cell.

Myelinating Schwann Cells

Wrap around axons of motor and sensory neurons to form the myelin sheath, faster conduction.

Unmyelinated nerves

Impulse travels slowly.

Nodes of Ranvier

Form gap between two adjoining Schwann cells and their myelin spirals.

Resting state

Impermeable to sodium which prevents massive influx of the ion.

Depolarization

Stimulus excites the nerve, Na+ moves into cell, rapid increase of Na+ moving in.

Repolarization

Electrical potential gradually becomes more negative.

Absolute refractory period

Immediately after the stimulus has initiated an action potential, a nerve is unable for a time to respond to another stimulus.

Relative refractory period

New impulse can be generated but only a stronger than normal stimulus.

Esters

Hydrolyzed in the plasma.

Prilocaine and articaine

With anemic patients can cause methemoglobinemia.

LA BBB

Local anesthetics cross the blood brain barrier.

Cardiac dose

2 cartridges, 0.04 per appointment.

Short duration

30 minutes, does not have vasoconstrictor.

Jet injector

Needleless injection using high pressure liquid that is forced through mucous membranes, not replacement for traditional block anesthesia.

Bevel

Point or tip of the needle.

Short needle

20-25mm.

Long needle

30-35mm.

Gauge

Diameter of the lumen of the needle, smaller the number the greater the diameter of lumen.

Change needle

After 3-4 tissue penetrations.

Cartridge

1.8 mL.

Stopper

Receives the harpoon of aspirating syringe.

Cartridge care and handling

No need to warm the cartridge.

Burning on injection

Normal response to pH of drug.

Overheating the cartridge

Vasoconstrictors.

Topical antiseptic

Prepare the tissues at the injection site before the needle penetration to decrease transient bacteria.

Topical anesthetic

20% benzocaine, Preferably 2 minutes.

Aspirating

Negative pressure.

Injecting

Positive pressure.

ASA III

Severe systemic disease not incapacitating.

Heart Attack

No treatment for 6 months.

Sulfite allergy

Avoid use of vasoconstrictors.

Sulfonamides

Do not administer esters to these patients.

Malignant hyperthermia

Severe reaction to prilocaine and articaine.

Field block

Near larger terminal branches (supraperiosteal or infiltration).

Supraperiosteal injection

Single tooth injection.

PSA positive aspiration

31%.

Palatal anesthesia

Topical anesthesia should be in contact for 2 minutes with pressure anesthesia during the injection.

IA Failing

Even without any operator error, due to the thickness of the mandible.

IA positive aspiration rate

10-15%, highest positive aspiration rate.

Success rate of gow gates block

95% with experience.

Positive aspiration of gow gates

2%.

Injection site for IA

Center of pterygomandibular triangle, bisect thumb ¾ ant/post distance from coronoid notch back to pterygomandibular raphe.

IA bone contacted too soon

Bring syringe more closely superior to mandibular anterior teeth.

IA bone not contacted

Bring syringe more posterior to mandibular molars.

Mental block

Recommended for anesthesia of the facial gingival tissue, anteriors and premolars.

Incisive block

Recommended for anesthesia of the teeth and periodontium and facial soft tissue anterior to mental foramen, anesthetizes teeth, soothing massage for 2 minutes.

Intraosseous anesthesia

Deposition of anesthetic solution into the cancellous bone that supports the teeth.

Intraseptal Injection

Anesthesizes Bone, soft tissue, and root structure in the area of injection.

Uses 27 gauge short needle

Pressure push needle 1-2mm into septum.

Long duration LA

Uses Bupivicaine, oral surgery, prosthodontics, and periodontics.

Bupivicaine

A local anesthetic used in dental procedures.

Needle Breakage

Sudden, unexpected movement of pt or needle, smaller needles, bending needles, poor technique, defective needles.

Management of Needle Breakage

Tell pt to not move and keep mouth open keeping hands in their mouth.

Pain on Injection Prevention

Adhere and review proper injection technique, sharp needles, topical anesthetic, sterile local anesthetic solutions, inject slowly, room temp solution.

Paresthesia Causes

Contaminated solution, trauma around nerve.

Paresthesia Problem

Self inflicted soft tissue injury, loss of taste, painful sensation.

Trismus

Trauma during injection to muscle or blood vessels, not always preventable.

Trismus Management

Heat therapy every 20 minutes.

Hematoma

Not always preventable, no heat.

Infection Causes

Contaminated needle, improper tissue preparation, injecting into infected area.

Infection Prevention

Sterile needles, carefully cap needle, properly care for dental cartridges.

Soft Tissue Injuries

Most frequently occurs in children and disabled adults.

Facial Nerve Paralysis

Unilateral paralysis immediately.

Principles of Any Drug

No drug ever exerts a single action, no clinically useful drug is entirely devoid of toxicity.

Overdose

Absolute or relative over administration, high blood level of drug.

Allergy

Not dose related.

Patient Factors of Overdose

Age, weight, genetics, mental attitude and environment.

Aspirate

Prevent intravascular injection.

Basic Emergency Management

Position, circulation, airway, breathing, definitive care.

Severe Reaction

Rapid onset, 1 minute.

Epinephrine Overdose

Fear, tenseness, restlessness, tremor, perspiration, weakness, dizziness, pallor, respiratory difficulty, palpitations, and throbbing headache.

Allergy Management

Assume true allergy.

Dermatological Allergic Reactions

Uticaria and angioedema.

Respiratory Allergic Reactions

Bronchospasm, dyspnea, cyanosis, wheezing, respiratory distress, flushing, perspiration, tachycardia, increased anxiety, laryngeal edema.

Generalized Anaphylaxis

Unlikely with local anesthesia, clinical death in few minutes.

Oraverse

Reverse anesthesia following injections.

Buffering

Makes injection more reliable and predictable analgesia.

Oraqix

Needle free, 30 second onset, lasts approx 20 minutes, mixture of lidocaine and prilocaine, 5 cartridges max, metabolized in liver.

Titration

Process of administering drug incrementally to specific level or endpoint of sedation.

Elimination and Recovery N2O

Not metabolized in the liver, allows for complete recovery with 100% pure oxygen for a minimum of 5 minutes after termination of the drug, 99% eliminated through lungs.

N2O State

Liquid when compressed into the cylinder.

O2 State

Gas, odorless, colorless, and tasteless.

N2O Cylinder

Full cylinder will have pressure of 750 PSI at 70 degrees, 95% liquid and 5% vapor.

O2 Cylinder

Pressure of 2000 PSI.

Reservoir Bag

Provide source of additional gas, provide mechanism for monitoring the patients respiration, emergency method of positive O2 pressure to pt.

Conduction Tubing

Care should be taken to prevent kinking.

O2 Safe Fail

Minimum of 30% O2 at all times.

Porter Automatic Vacuum Switch

Prevents nitrous oxide from being administered without scavenging.

Appropriate Sedation

Relaxed and comfortable, tingling sensation, feeling warm.

Oversedation

Detachment from environment, dreaming, floating, inability to move, keep mouth open.

Fasting

Before moderate sedation you must do this.