Local anaesthesia armamentarium
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This document provides information on local anaesthesia techniques and armamentarium. It discusses various topics such as: - Types of pain fibers and how local anaesthesia works to block pain transmission - Different types of local anaesthetic syringes including reusable, disposable, and safety syringes as well as their advantages and disadvantages - Local anaesthetic needle features like gauge, length, and proper handling techniques - Local anaesthetic cartridge contents and potential problems that can occur with cartridges - Maintenance of syringes, needles, and cartridges - Selection of local anaesthetic drugs for different medical conditions - Record keeping requirements for sedation methods
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Local anaesthesia armamentarium
- 1. Local anaesthesia armamentarium 19 October 2017 I.Kassem,BDS,MSc,MFDS RCS Ed,MOMS RCPS Glasg, FDSRCS Consultant Oral & Maxillofacial surgeon
- 2. Pain It is an unpleasant sensation following the application of noxious stimuli Pain fibers Thin + unmylelinated Easily blocked by anesthesia
- 3. lets start
- 4. Topical Anaesthetic ■ Benzocaine or Lidocaine ■ Effectiveness? ■ Gill and Orr 1979: 15 second application no more effective than placebo ■ Stern and Giddon 1975: 2-3 minutes=profound soft tissue anaesthesia
- 5. Topical Anaesthetic ■ Recommendations: ■ Dry mucous membranes first ■ 2-3 minutes, but concern with tissue sloughing ■ Tip of the tongue
- 6. Topical Anaesthetic ■ Benzocaine Spray ■ RCDSO Dispatch 21, 1, Feb/Mar 2007 pp. 28-29 ■ Advice to Dentists ■ Benzocaine Sprays and Methemoglobinemia (MHb) ■ Health Canada—9 suspected cases, none fatal
- 7. Topical Anaesthetic ■ Benzocaine spray/Methemoglobinemia ■ Recommendations: ■ Avoid in patients with a history of MHb ■ Consider lidocaine as an alternative ■ Broken/inflamed tissue may promote uptake ■ Use only amount deemed necessary ■ If suspicious, send patient to hospital for methylene blue tx ■ O2 won’t help, but give it anyways
- 8. Methemoglobinemia ■ Fe2+ ion of the heme group of the hemoglobin molecule is oxidized to Fe3+ ■ Hemoglobin converted to methemoglobin, a non-oxygen binding form of hemoglobin that binds a water molecule instead of oxygen.
- 9. Topical benzocaine was absolutely awesome for my battery acid burns
- 11. Types of Syringes Reusable Breech-loading, metal, aspirating,cartridge Breech-loading, plastic, aspirating,cartridge Breech-loading, metal, self-aspirating Pressure type Jet injector Disposable “Safety” syringe
- 12. ADA Criteria Durable, able to withstand sterilization Accept wide variety of cartridges & needles Simple, easy to use, lightweight, self-contained, and inexpensive Effective and easily visualized aspiration
- 13. Advantages - reusable syringe One-handed aspiration Visible cartridge Autoclavable and rust-resistant Durable with proper maintenance
- 14. Disadvantages - reusable Weight Size Possibility of cross-infection with improper care
- 16. Advantages - plastic Lightweight Lower cost Rust free
- 17. Disadvantages - plastic Size Deteriorates with repeated autoclaving Possibility of cross-infection with improper care
- 18. Self-aspirating Syringe Advantages Easier to aspirate with small hands Volume indicator Disadvantages Feeling of insecurity Finger must be moved Weight
- 19. Advantages - pressure type Dose is measured Overcomes tissue resistance Cartridge is protected
- 20. Disadvantages - pressure type Cost May inject too rapidly Gun-like appearance
- 26. Advantages - jet injector No “sharp” needle Delivers small volumes Use in lieu of topical
- 27. Disadvantages - jet injector “Jolt” of injection Inadequate for pulpal or regional blocks May damage periodontal tissue
- 28. Advantages - disposable syringe Sterile, no chance of cross contamination Lightweight
- 29. Disadvantages - disposable Cannot use dental cartridge Cannot aspirate single-handedly Awkward to use intraorally
- 30. Advantages - safety syringes Disposable Sterile Lightweight Needle covers automatically
- 31. Disadvantages - safety syringe Increased cost Feels awkward during learning process
- 32. Syringe Maintenance Brush harpoon, clean syringe and autoclave after each use Do not throw out needle adaptor Sharpen or replace harpoon periodically
- 34. Maintenance problems Surface deposits Dull or bent harpoon Excess wear
- 35. Parts of a Needle Bevel Shank Hub Syringe adaptor Syringe-penetrating end
- 36. Gauge Measure of the diameter of the needle’s lumen Size number is inversely proportional to the diameter Usual dental needle guages are 25,27, & 30
- 37. Length Long - approximately 40mm or 1 5/8 in Short - approximately 25 mm or 1 in
- 38. Needle Handling Single pt. use, change after several injections Cap between uses, dispose of in “sharps” container Check for barbs if pain on withdrawal Never force against resistance Never insert a needle to the hub
- 39. Problems related to improper use Pain on insertion Pain on withdrawal Needle breakage Needle stick injury
- 40. Needle size vs. comfort Patients cannot differentiate between 23, 25, 27, or 30 guage needles. Hamburg, H. L. 1972
- 41. Advantage of larger needles Less deflection Less chance for breakage More reliable aspiration
- 43. Cartridge 1.8 cc volume Glass tube Rubber stopper Aluminum cap with diaphragm
- 45. Contents of Cartridge Anesthetic Vasoconstrictor Preservative for vasoconstrictor Sodium chloride Distilled water
- 46. Preservative for Vasoconstrictor Sodium Bisulfite Most common antioxidant (burning) Prolongs shelf life to aprox. 8 mos.
- 47. Handling of Cartridges Should not be: autoclaved stored in alcohol or disinfectant Should be: kept in original container kept in dark place
- 48. Handling of Cartridges No need for: Cartridge warmer Sterilization prior to injection - may wipe with alcohol if not in original container
- 49. Problems with Cartridges Bubble in cartridge Small - N2 which is normal Large(>2mm) - freezing Extruded stopper Freezing, or uptake of holding solution
- 50. Problems with Cartridges Burning on injection Normal response to pH of drug Response to preservative Diffusion of holding solution Overwarmed cartridge
- 51. Problems with cartridges Leakage during injection Eccentric penetration of diaphragm Stopper sticks Rare, may be cold (check that needle has penetrated diaphragm)
- 52. Problems with Cartridges Cap Corrosion - cold sterilizing solutions Rust - leakage in container Broken cartridge Rough handling Excessive force to engage harpoon
- 53. Additional Armamentarium Topical antiseptic ? Topical anesthetic Cotton tip applicator Guaze Hemostat
- 65. Recapping the Needle “Scoop” Technique
- 75. Needle Sticks Avoid by capping needle when not in use Notify employer Blood samples from pt. and person exposed Health care evaluation - consider Hep B vaccination or other prophylactic coverage
- 76. Local Anesthetic Cartridges and Vials
- 77. ■ It contains primarily the local anesthetic drug, and also the other ingredients, which are as follows: ■ Local anesthetic drug ■ Vasopressor/vasoconstrictor drug ■ Preservative for vasopressor ■ Sodium chloride (NaCl) or Ringer's solution ■ Distilled water ■ General preservatives.
- 78. LOCAL ANESTHETIC DRUG ■ It provides pain control during dental therapy. It interrupts propagation of impulse preventing it from reaching brain. ■ Drugs are listed by their percentage (%) concentration. The number of mg of an agent contained in the cartridge can be calculated by multiplying the percentage (%) concentration (e.g. 2% = 20 mg/ml) by 2 (the number of ml in a cartridge). Thus, a cartridge containing 2 ml of 2% local anesthetic solution contains 40 mg of local anesthetic agent.
- 79. VASOPRESSOR or VASOCONSTRICTOR DRUG ■ It is added in various concentrations, to some dental cartridges to increase safety and prolong duration of action of local anesthetic agents. It also helps in controlling bleeding. The pH of dental cartridge containing local anesthetic agent with a vasoconstrictor is lower (more acidic) than that without a vasoconstrictor (pH of 3.3-4.0 v / s 5.5-6.0). Because of this pH difference plain anesthetics have somewhat more rapid or clinical action and are more comfortable.
- 80. Clinical Relevance ■ It lies in the fact that increased burning (discomfort) is experienced on injection of an "older" cartridge with a vasopressor than with a fresher cartridge. ■ Once the cartridge container is opened, it should be used within a reasonable time. Local anesthetic solutions without vasoconstrictors have a shelf-life of about 48 months. Local anesthetic solutions containing vasoconstrictors have their shelf-life reduced to 18 and 12 months for epinephrine and phenylephrine; and norepinephrine and levonordefrine, respectively.
- 82. The efficacy of benzocaine in inflammed area would be: ■ A. Decreased ■ B. Increased ■ C. Not altered ■ D. Prolonged ■ Benzocaine is not water soluble therefore pH has no effect on its functioning. In inflammation pH decreases but benzocaine is not affected. Since it is only lipid soluble therefore it is used only as topical anethetic agent.
- 83. All of the LA cross the placenta: ■ A. Except mepivacaine ■ B. Statement is true ■ C. Statement is false ■ D. Except lignocaine ■ All LA cross the placenta and enter circulatory system of fetus.
- 84. Ester type anethetics are metabolised in the: ■ A. Liver only ■ B. Kidney ■ C. Plasma ■ D. Lungs ■ Ester type LA are metabolised in plasma by enzyme pseudochlinesterase.
- 85. A patient complains of history of hepatitis one month ago should be perferably given which LA: ■ A. Lignocaine ■ B. Bupivacanie ■ C. Procaine ■ D. Procainamide ■ Amide group of LA (A, B, D) are metabolized in liver. History of hepatitis may interfere with normal metabolism and result in LA toxicity. Therefore ester group of LA (C) should be used.
- 86. Local anethetics are excerted mainly by: ■ A. Lungs ■ B. Fecal route ■ C. Kidneys ■ D. Uterus
- 87. ■ A noninvasive method to block pain electronically by using a low current of electricity through contact pads that target a specific electronic waveform directly to the nerve bundle at the root of the tooth. ■ Benefits to the patient: – No needles. – No post-operative numbness or swelling. – Chemical-free method of anesthesia. – No risk of cross-contamination. – Reduces fear and anxiety. – Patients have control over their own comfort level. Electronic Anesthesia
- 88. ■ Always document the following measures and observations: – Review of patient’s medical history. – Preoperative and postoperative vital signs. – Patient’s tidal volume if using inhalation sedation. – Time anesthesia began and ended. – Peak concentration administered. – Amount of postoperative time (in minutes) for patient recovery. – Adverse events or patient complaints. Record Keeping for Sedation Methods
- 89. STA device
- 90. Mandibular
- 91. Maxillary