LOCAL ANESTHESIA STUDY SHEET:

Infiltration anesthesia = anesthetizes only a small area of the mouth (often 1-2 teeth) by injecting the
anesthesia near the apices of the teeth; the anesthesia is deposited near terminal nerve endings
Block anesthesia = anesthetizes a larger area of the mouth (2 teeth or more) and is deposited near
nerve trunks

o Infiltration is not as successful on mandibular teeth as it is on maxillary teeth, because there is

less anatomic variety of the maxilla and the palate than there is with the mandible.
o The entire maxillary arch can often be anesthetized with no complications, whereas the
mandibular arch usually has a higher risk of complications.
o Mandibular injections are not as clinically effective as the maxillary, because the maxilla is less
dense and more porous than the mandible.

When calculating maximal safe doses, must consider;

- client’s age
- client’s health status
- client’s weight

Obtain necessary patient info

Take the percentage of solution and multiply by 10
.
Take the answer and multiply by 1.8 = mg of anesthetic per cartridge
Convert pounds to kilograms if using this unit of measurement (lb ÷ 2.2 = kg)
Multiply pounds by mg/lb or kilograms by mg/kg (use Table 40-5, p. 713)
This number may be different for each anesthetic and gives the MRD in mg.
Divide the MRD (step 3) by the number of mg of anesthetic per cartridge (step 2) = maximum number
of cartridges
Multiply maximum number of cartridges (step 4) by 1.8 (mL in one cartridge) = maximum number of
milliliters

Contents of a local anesthetic cartridge:

a. Vasoconstrictor (not all have this) = reduces bleeding, prolongs duration of action
b. Antioxidant = prolongs shelf life; caution for people with allergies to sulfites
c. Sterile water = diluent
d. Sodium chloride = creates isotonic match with body
e. Sodium hydroxide = helps adjust pH to 6-7

Side effects of too much epinephrine:

- excessive cardiac stimulation resulting in angina, cardiac arrhythmias, hypertensive crisis, and stroke
- in healthy patient EPI has no cardiac effects
- maximum safe dose = 13 cartridges (healthy individuals) or 2 cartridges (cardiac patients)
 TYPE OF LOCAL ANESTHESIA: INFORMATION:

Lidocaine - potent vasodilator, short duration of action

- rapid onset – 2-3 mins
- metabolized in liver
- topical (gel = 5%, spray = 10%)
- Oraqix – no pulpal anesthesia, 14-30 min
- safe during pregnancy (B category)

Mepivacaine - injectable ony – not topical

- good for short term duration without
vasoconstrictor
- rapid onset – 90 secs-2mins
- 30 min duration

Prilocaine - less cardiac effect in patients difficult to

anesthetize
- onset – 2-4 mins
- duration – 90 mins (plain), 4-8 hrs (w epi)
- max dose is 8 cartridges
- contraindicated if taking acetaminophen (can
produce methemoglobinemia)

Articaine - Brand names = ultracaine, septocaine

- rapid onset – 1-3 mins
- higher incidence of paresthesia on mand blocks
- max dose – 7 cartridges
- pregnancy C category
- longer, more profound anesthesia

Bupivicaine - slow onset (30 mins), used for lengthy appts

- up to 7 hr duration (2-3x longer than lidocaine
or mepivacaine)
- should not be used with children due to the long
duratio

PRECAUTIONS:
o No more than 2 cartridges of EPI in clients taking tricyclic antidepressants (avoid levonordefrin)
o Epinephrine increases blood guocse levels; caution in uncontrolled diabetics
o EPI is contraindicated if storke or CHF within 6 mos of appt
o No EPI for clients with uncontrolled HBP, if HBP is controlled there are no concerns