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Outcomes
Define local anesthesia
Identify chemical configuration and characteristics of
local anesthetics
Identify the desirable properties of a local anesthetic
Describe methods to induce anesthesia
Understand the anatomy of a nerve and nerve cell
membrane
Understand the process of anesthetic diffusion and
electrophysiology of nerve conduction
Describe saltatory conduction and understand its
importance in nerve conduction
Understand the mechanism of local anesthetics
Lecture Outcomes
Understand dissociation of LAs and tissue pH
Understand how low tissue pH (infection) alters
dissociation of LAs
Understand rate of onset and dissociation constants
Describe the factors that affect LA action
Understand the sites of metabolism of LAs
Understand the role and action of vasoconstrictors in LAs
Understand the systemic effects and drug interactions of
vasoconstrictors
Define methemoglobinemia
Understand the maximum dosages of LAs for children and
adults
Lecture Outcomes
Calculate amount of LA and
vasoconstrictor found in a dental
anesthetic cartridge
Understand anesthetic delivery
equipment
Describe medications used in post op
pain management
ANESTHESIA
An----------without
Esthesia---ability to experience sensation
Handbook of Local Anesthesia 6 th edition
By Stanley F. Malamed
Reading assignments:
Part 1 (chapters 1-4)
Chapter 16
Chapter 21 Questions
(local anesthetics & vasoconstrictors)
WHAT IS LOCAL
ANESTHESIA?
Loss of sensation in circumscribed
areas of the body without loss of
consciousness caused by depression of
excitation in nerve endings
- This is a physiologic process -
Low temperature
Anoxia
deprivation or relative decrease in O2
Chemical irritants
Can cause nerve damage effecting transmission of nerve impulse
Example: Sargenti method of endodontics made pts lips go numb after RCT
Benadryl has weak analgesic properties
ANATOMY OF A NERVE
The neuron is the basic structural unit
of the nervous system
Two types of neurons - functionally
Sensory afferent
Motor efferent
ANATOMY OF A NERVE
The axon typically has a superficial
layer called myelin (Schwann cells)
Cell body of a motor neuron is
involved in transmission (nodes of
Ranvier, speed of transmission)
Cell body of a sensory
Neuron is only available
For nutritional support
Myelin:
Lipioproteinaceous substance (specialized
Schwann cells)
Increases the speed of transmission
Acts as a barrier to LA
SALTATORY PROPOGATION
The message
leaps from one
Node of Ranvier to
the next
https://www.youtu
be.com/watch?v=A0
Z78rFPFCA
Cell/nerve membrane
Blocks diffusion of water soluble
molecules
Semi-permeable to certain molecules
via channels or pores
Transduce information from the
extracellular surroundings (matrix)
intracellularly via proteins
embedded in the membrane
Proteins
What are the two main types of
membrane proteins?
1. Transport proteins (channels,
carriers or pumps)
2. Receptor proteins
Transport proteins
Continuous channels
passive flow of ions (Na, K, Ca)
Gated channels
Gate must be open to allow passage
Saltatory conduction
saltare= to leap
So
During an injection which nerves lose sensation first?
A. Small unmyelinated nerves or
B. Large myelinated nerves
Why?
Smaller diameter means less stuff to go through
Myelin
Myelin insulates the axon both electrically and pharmacologically
Na+ channels found mainly at nodes of Ranvier
An electrical impulse can jump over 1-2 nodes of Ranvier
2-3 successive nodes need to be blocked to halt propagation
The more myelinthe further apart the nodes, hence the harder to block
Anesthetic Diffusion
LA becomes increasingly
diluted by tissue fluids and
removed by capillaries and
lymphatics
Core fibers are exposed to a decreased concentration
of LAmore difficult to achieve profound anesthesia
distal distribution
Mantle fibers (surface) are exposed to higher
concentration LA easier to achieve profound
anesthesiaproximal distribution
Profound anesthesia can be more difficult for premolars
than molars.
Electrophysiology of Nerve
Conduction
Stimulus applied
ions
Which cation is predominately found
intracellularly?
K+remains in axoplasm d/t electrostatic
attraction
Transmission of Neuronal
Information
Membrane channelsfound in all
neurons
Nongated
Modality gated (sensory neuron, CN V)
Ligand gated
Voltage gated (voltage-dependent Na+
channels)
Na+ channel
NA+
Nerve at rest
Na+ is about half the size of K+ and
Cl What (primarily) keeps Na+ in the
extracellular space?
H2O
When Na+ becomes hydrated it cannot pass
through its channel, whereas K+ and Cl- can
Hydrated
Na+
Hydrated
Na+
Stimulus applied
Saltatory conduction
Whats Important
Primary effect of local anesthetics is
to decrease the rate of depolarization
Basicallythey block the depolarization
phase
Sodium channel