AGD | Academy of General Dentistry

Local anesthetic calculations: avoiding trouble with pediatric patients

Self-Instruction Exercise No. 362

Member Information

Required for AGD members

Required for non-members

Are you an AGD member?
Yes No

If Yes, please enter your AGD Number:

Full Name (First & Last):

Address:

Address 2:

City:

State/Province:

ZIP/Postal Code:

Country:

E-mail:

Promotional Code

Payment Information

Enroll me for Self-Instruction so that I can submit this exercise. My credit card information is entered below. I understand that my card will be charged $30 if I am an AGD member and $50 if I am a non-member.

I am currently enrolled in the Self-Instruction program. (If you are unsure of your enrollment status, please call 888.243.3368, ext. 4336.)

Card Type

Visa MasterCard American Express

Card Number

Expiration Date

Exercise No. 362
Subject Code: 132
Anesthesia and Pain Control

The 15 questions for this exercise are based on the article, Local anesthetic calculations: avoiding trouble with pediatric patients, on pages 48-52. This exercise was developed by Riki Gottlieb, DMD, FAGD, in association with the General Dentistry Self-Instruction committee.

Reading the article and successfully completing this exercise will enable you to:

describe the signs and symptoms of local anesthesia systemic toxicity (LAST);
understand the mechanism of action of local anesthetic toxicity (LAO); and
learn how to calculate the maximum recommended dose (MRD) to prevent local anesthesia toxicity.

Answers for this exercise must be received by December 31, 2015.

LAST can be described using all of the following terms except one. Which is the exception?

A. rare consequence of LAO
B. avoidable consequence of LAO
C. allergic reaction to LAO
D. occurs more frequently in children
According to the article, the most common cause of morbidity and mortality due to LAST is _______________________.

A. respiratory depression
B. cardiovascular stimulation
C. central nervous system (CNS) excitation
D. nerve damage
Symptoms of early toxicity consist of all of the following CNS symptoms except one. Which is the exception?

A. metallic taste
B. tinnitus
C. dry mouth
D. dizziness
Concomitant opioid sedative administration will _______ respiratory depression and ________ the seizure threshold of local anesthetics.

A. reduce; increase
B. enhance; increase
C. reduce; decrease
D. enhance; decrease
All of the following are relatively larger in children than adults except one. Which is the exception?

A. tongue
B. tonsil
C. airway
D. adenoid
A local anesthetic without a vasoconstrictor offers ______ minutes of pulpal anesthesia.

A. 20-40
B. 60-80
C. 100-120
D. 140-160
Use of ______ makes it easier to reach or exceed the MRD.

A. 2% lidocaine, 1:100,000 epinephrine
B. 3% mepivacaine, no epinephrine
C. 4% articaine,1:100,000 epinephrine
D. 5% bupivacaine, no epinephrine
A 4% formulation of a drug means that there are _____ mg/ml, and in a 1.8 ml dental cartridge there are _____ mg/cartridge.

A. 30; 36
B. 30; 42
C. 40; 54
D. 40; 72
The MRD of 3% mepivacaine is 2.6 mg/lb. What is the maximum number of cartridges one can give a 45 lb child?

A. 1
B. 2
C. 3
D. 4
Clark’s rule is another weight-based method for calculating the MRD. According to Clark’s rule, the dose of local anesthetic should be reduced by the ratio of the child’s weight to an adult weight of 200 lb.

A. Both statements are true.
B. The first statement is true; the second is false.
C. The first statement is false; the second is true.
D. Both statements are false.
Using Clark’s rule, what would be a 60 lb child’s MRD for the use of 2% lidocaine with 1:100,000 epi?

A. 3.5 cartridges
B. 4.5 cartridges
C. 5.5 cartridges
D. 6.5 cartridges
The effects of various local anesthetics used in conjunction with each other are unrelated. The effects of all local anesthetics, including toxicity, are mediated at the sodium channel in a dose-dependent fashion.

A. Both statements are true.
B. The first statement is true; the second is false.
C. The first statement is false; the second is true.
D. Both statements are false.
All of the following are correct about the Rule of 25 except one. Which is the exception?

A. It can be applied to all US dental local anesthetic formulations for healthy patients.
B. The Rule of 25 states that 1 cartridge of any formulation marketed in the US may be used per 25 lb.
C. Using the Rule of 25 may be more appropriate in children ≤8 years than weight-based calculations.
D. The Rule of 25 indicates the use of 3 cartridges of local anesthetic for a 50 lb child.
To prevent local anesthetic overdose, all of the following should be followed except one. Which is the exception?

A. Determine the maximum amount of local anesthetic at the beginning of the appointment.
B. Keep all used local anesthetic cartridges until the end of the appointment.
C. Inject the local anesthetic quickly, at a rate of approximately 10-15 seconds per cartridge.
D. Use aspiration technique to determine intravascular injection.
All of the following actions are to be performed immediately in the event of local anesthetic overdose, except one. Which is the exception?

A. stop dental procedure
B. administer nitrous oxide
C. position patient on left lateral side
D. begin basic life support and call 911

Evaluation
Please respond to the statements below, using the following scale: 1 Poor; 2 Below average; 3 Average; 4 Above average; 5 Excellent
Practicality of the content	1	2	3	4	5
Benefit to your clinical practice	1	2	3	4	5
Quality of illustrations	1	2	3	4	5
Clarity of objectives	1	2	3	4	5
Clarity of exercise questions	1	2	3	4	5
Relevance of exercise questions	1	2	3	4	5

Did this exercise achieve its objectives?				Yes	No
Did this article present new information?				Yes	No
How much time did it take you to complete this exercise?			mins

560 W. Lake St., 6th Floor, Chicago IL 60661-6600 [P] 888.243.3368 [F] 312.440.0559

Evaluation