Anesthesia Review Sheet

Anesthesia

Types of Injections

* Maxillary Injections (27 short)

PSA – Max molars except MB root of 1^st permanent molar, facial soft tissues of molars, ½ - ¾ cart. Used. Contraindications: when risk of hemorrhage is too great (hemophiliac)

MSA – Max premolars/ MB root of 1^st permanent molar, facial sift tissues of premolars and MB root of #3. 1/3 – ½ cart used. Contraindications: Infection or inflammation in area.

ASA – max centrals, laterals, canines, facial soft tissue of max central, lateral, and canine. 1/3^rd cart used. Contraindications : when hemostasis is needed, and when only one or two teeth need to be anesthetized.

GP – No teeth anesthetized, lingual soft tissues of max molar to canine. <1/4 cart used. Contraindications: inflammation or infection in area.

NP – No teeth anesthetized, lingual soft tissues of max from incisor to canine. < ¼ cart used. Contraindications: inflammation or infection in area.

* Mandibular Injections

IA/Lingual – mand molars, premolars, canines, inscisors, facial soft tissues if 2^nd premolar to central inscisor. ¾ - 1 cart used. Contraindications: infection in area or acute inflammation, patients who may bite their lip or tongue. Lingual injection will anesthetize no teeth and lingual soft tissue of mand central to 3^rd molar and anterior 2/3 of tongue/floor of mouth. <1/4 cart used.

Buccal – No teeth anesthetized, facial soft tissue of mand molars to 1^st premolar, 1/8 cart used. Contraindications: infections or inflammation in area.

Mental – No teeth anesthetized, buccal soft tissues of lower lip, chin, and buccal soft tissues from 1^st premolar forward. 1/3^rd of a cart used. Contraindications: inflammation or infection in area.

Incisive – all teeth anterior to mental foramen, buccal soft tissues of lower lip, chin, buccal soft tissues from 1^st premolar forward. 1/3 – ½ cart used. Contraindications: inflammation or infection in area.

Types of Anesthetic

* Short-Medium Acting Amide Drugs

• Lidocaine 2%
• Mepivacaine 2-3%
• Prilocaine 4%
• Articaine 4%

*Long Acting Amide Drugs

• Bupivacaine .5%
• Etidocaine

Vasoconstrictors

Reason for use:

1. Safety – potential for toxic reaction (overdose) to anesthetic is reduced by slowing the rate at which it enters circulation
2. Longevity – duraction of anesthetic effect is increased
3. Effectiveness – depth and profoundess of anesthetic is increased
4. Hemostasis – only if drug is locally injected directly into area

Potential Risk with Use of Vasoconstrictors

1. Hypersensitivity to the drugs
2. Medical Problems
1. Allergy to amides is rare, if confirmed , avoid it. Ester allergy is fairly common, avoid it too. Bisulfite allergy avoid anesthetic with vasoconstrictor (bisulfite used as preservative in vasoconstrictors)
2. Hyperthyroidism – if uncontrolled avoid vasoconstrictor, okay to use normal anesthesia if controlled
3. Impaired liver or kidney function – only severe impairment is clinically relevant
4. Malignant Hyperthermia – Amides are considered safe
5. Methemoglobinemia – avoid Prilocaine and articaine
6. Heart failure, heart attack, recent heart surgery, hypertension – concern vasoconstrictor(limit use or totally eliminate use depending on the case)
7. Hemophilia – avoid injecting highly vascular areas
8. Pregnancy – safe to administer, avoid 1^st trimester, use Lidocaine or Prilocaine

Drug interaction

· Cimetidine & vasoconstrictors

· Non selective beta blockers & vasoconstrictors

· Tricyclic antidepressants & vasoconstrictors

· Cocaine & vasoconstrictors

Kind of Vasoconstrictors & Dilution

1. Epinephrine is the one most widely used in dentistry
2. Used in low concentrations usually

• 1:100,000 (.018 mg/ cart) – MRD (healthy) = .2mg/appt or 10 carts/ appt MRD (medically compromised) - .04mg/appt or 2 carts/appt.
• 1:200,000 (.09mg/ cart) MRD (healthy) =.2mg/appt MRD (medically compromised) - .04mg/appt or 4 carts/appt

Type of needle and gauge

• Gauge – 25, 27, 30 (smallest to largest)
• Needle – short (maxillary), or long (mandibular
• Colors 25(red), 27 (yellow), 30(blue)