Dentist Notes

LA

Paper BUpdated 2 min read
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One Liners:

  1. High Tuberosity technique = Anesthesize Maxillary nerve
  2. For Extra Oral Maxillary nerve block target = Anterior to Lateral Pterygoid plate
  3. Mental Foramen opening is directed = Backward and Lateral
  4. Muscle most frequently affected in improper Infraorbital NB = Quadratis Labi Superiorus
  5. Dumbell swelling with PSA block = Pterygoid Plexus of veins
  6. Initial stage of Facial nerve paralysis = Tongue deviates to affected side of protusion
  7. Pt Allergic to PABA = Also allergic to Tetracaine
  8. Longest acting + Most potent + Most toxic LA = Dibucaine
  9. WYDASE = Hylauronidase
  10. pKA lignocaine = 7.9
  11. Carticane = Artricaine
  12. IANB ideal needle = 25 gauge and 1 5/8 inch
  13. Verill’s sign ( Dropping of eyelids ) = Adequate sedation by Diazipam IV achieved
  14. Tooth suspected to Ludwigs Angina = Extracted
  15. Tooth decayed post radiation = dont extract since bone can fracture
  16. Cocaine increases affected of both Epi and Nor Epi
  17. LA agent responsible for penetration into nerve = Lipid solubility
  18. Sodium Bisulfate = Slows down onset of action
  19. All LA = cross BBB and placenta
  20. Prilocaine = methmoglobinemia
  21. Phenylephrine is a synthetic sympathomimetic amine that acts almost purely as an alpha adrenergic receptor agonist = Weakest constrictor
  22. Rebound phenomenon = Epi
  23. Mepivacaine = Has mild vasodilation properties = used when no vasoconstrictor is needed
  24. Prilocaine is metabolized into ortho-toluidine = In patients with compromised respiratory function, the resulting methemoglobinemia significantly impairs the blood's oxygen-carrying capacity, compounding hypoxia.
  25. Mepivacaine = Least toxic
  26. Larger gauge number = Smaller/Thinner needle diameter
  27. Propoxycaine = Topically interferes with Sulfonaimde
  28. 5-6 ug/ml = Lignocaine ECG changes first seen
  29. Gingival retraction cord = 300-1000 ug/inch Epi
  30. Minimum distance anesthetic should cover in a cover to ensure anestheisa = 8-10 mm
  31. benzocaine is an ester topical anesthetic that exists naturally in an uncharged, non-ionized state (topical) = PH doesnt matter
  32. Procaine = Most potent Vasodilator
  33. Minimum MAC for anesthesia = 0.1-0.5
  34. Rupivacaine = Causes vasoconstriction

Safest to Toxic LA

  • Chloroprocaine (Safest / Least Toxic)
  • Procaine
  • Prilocaine
  • Lidocaine (Lignocaine)
  • Mepivacaine
  • Articaine
  • Tetracaine
  • Ropivacaine
  • Bupivacaine (Most Toxic)

Blood plasma Level of LA Toxicity

Figure: Blood plasma Level of LA Toxicity

LA Deposition

Figure: LA Deposition

Color Coding

Figure: Color Coding

Composition

Sodium Bisulfate

Slows down onset of action

Vasoconstrictor

Figure: Vasoconstrictor

Factors Affecting

Figure: Factors Affecting

General Notes

A successful stellate ganglion block produces sympathetic blockade of the head, neck, and upper extremity. Expected clinical signs include:

  • Horner's Syndrome: Enophthalmos, ptosis, miosis, anhidrosis, and conjunctival injection (the hallmark sign).
  • Nasal Stuffiness: Also known as Guttmann's sign, caused by nasal mucosal vascular dilation due to loss of sympathetic tone.
  • Warmth/Flushing: Dilation of blood vessels in the ipsilateral arm and face.